Basalioma • Treat as soon as possible

The basalioma (basal cell carcinoma or basal cell carcinoma) is the most common type of skin cancer and only rarely causes daughter tumors. Even so, it should be dealt with as soon as possible.

A basalioma in the eye. Areas exposed to the sun such as the face are particularly at risk.
© BSIP / Contributor via Getty Images

Like malignant tumors, the basalioma (basal cell cancer or basal cell carcinoma) can grow into deeper tissue layers and destroy them. However, basalioma, a form of white skin cancer, does not usually form daughter tumors (metastases). Because of this peculiarity, the basalioma is often referred to as a semi-malignant (sometimes malignant) tumor, although this does not correspond to medical reality: it is malignant cancer cells.

Black skin cancer or birthmark? These pictures help with recognition!

Black skin cancer or birthmark? These pictures help with recognition!

Basaliomas have recently appeared more frequently in younger people

Depending on where someone lives, whether in northern or southern Europe or in Australia, the average number of new cases a year is between one hundred or 250 people per 100,000 inhabitants. The basalioma occurs equally frequently in men and women. So far, the average age for a new illness has been around 60 years.

Although light skin cancer is mainly caused by long-term UV radiation, the number of cases is increasing among younger patients with light skin cancer. People with fair skin and sensitive to the sun are especially at increased risk of basaliomas. Nowadays experts estimate that one in three people will develop a basalioma in their lifetime.

Symptoms of basalioma

The basalioma usually occurs on the skin that is directly exposed to the sun. Around 95 percent of all basal cell carcinomas develop in the head and neck area. Are mainly affected

  • Nose,
  • Forehead,
  • Cheeks,
  • inner corner of the eye and
  • Eyelids as well
  • Auricles and
  • Scalp.

The trunk or limbs are only affected in around five percent of cases.

How to recognize a basalioma

Pale skin cancer can also be recognized by a layperson, since the symptoms of basalioma can be seen with the naked eye: Most of the time, the person concerned first notices a pinhead-sized, skin-colored or brownish pigmented, coarse nodule with a partially pearly sheen. This can slowly develop into a skin-colored, translucent knot over months or years. At the edge there can be enlarged veins, in the middle it can gradually sink in slightly. A typical symptom of basalioma is recurrent bleeding from the affected skin area.

For new nodules: go to the dermatologist!

Basaliomas can also be flat, mostly on the torso, but also on the face, so that only a hardening of the skin area may be noticed. Some basaliomas are covered with bloody crusts. A dermatologist should be consulted if a new lump or hardening of the skin is noticed, especially if it does not resolve on its own, grows slowly or even bleeds.

Causes of basalioma: light skin particularly at risk

A major cause of a basalioma is the ultraviolet radiation, which affects the skin in the course of life. This is more energetic than visible light and therefore cannot be perceived by the human eye.

A distinction is made between UV-A and UV-B radiation. Both types of UV radiation naturally reach the earth's surface together with the visible light of the sun. Both UV-A and UV-B radiation can change the genetic material of skin cells. The consequence can be that damaged cells become tumor cells, that is, they do not migrate to the surface of the skin and die, but survive and continue to divide.

Basalioma grows in depth

This disturbed equilibrium between the formation and exfoliation of cells leads to the proliferation of tissue with the formation of a tumor. This is noticeable to the outside as a nodule, but it also grows deeper: the cells of the basalioma then penetrate from the basal cell layer of the epidermis into the fibrous connective tissue of the dermis, which is why this form of white skin cancer is referred to as basal cell carcinoma or basal cell cancer. This deep growth cannot be easily recognized from the outside and is the real problem with a basalioma.

People with fair skin are particularly at risk

People who spend a lot of time outdoors in their work or in their free time are particularly at risk of developing basalioma. This applies to farmers, gardeners and construction workers, among others. Other risk factors are extensive sunbathing and frequent outdoor exercise without adequate sun protection. Skiers, mountaineers, climbers and water sports enthusiasts are particularly affected. The reason for this is the higher UV radiation in the mountains and by the sea. Basically, fair-skinned people are at higher risk of basal cell cancer than people with dark skin.

Pigments protect the basal cell layer

This is due to the fact that the body's own pigment in the higher layers of the epidermis prevents part of the UV radiation from penetrating the basal cell layer and damaging the genetic material there. The less pigment a person's skin contains, the lower the natural protection against UV radiation. Therefore, fair-skinned, light-sensitive people with a tendency to sunburn quickly have a higher risk. Often these people have blonde or reddish hair and / or blue eyes.

Basalioma does not appear until decades after skin damage

In addition, basaliomas occur more frequently in some families. In these patients, hereditary predisposition probably also plays a causal role. The time interval between skin damage by UV radiation and the appearance of a basalioma that is visible to the naked eye is estimated to be in the order of ten to 35 years.

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This is how the doctor recognizes a basal cell carcinoma

In order to get an impression of the skin type of the person affected and not to overlook any other skin changes, the dermatologist may ask the patient to undress completely in order to diagnose the basal cell carcinoma or basal cell carcinoma. Because of the typical appearance of most basal cell cancers (basalioma), the suspected diagnosis can often be made by looking at it with the naked eye. The reflected light microscope, a highly magnifying glass with a built-in lamp, which is held against the surface of the skin, provides additional help. An examination with high-resolution ultrasound can under certain circumstances help to estimate the extent of the skin change in depth. However, the presence of a basal cell carcinoma can only be proven if the skin lesion or at least part of it is examined under the microscope. This is the only way the dermatologist can be absolutely sure that it is not another skin tumor that would require another procedure.

Histological examination

To obtain a tissue sample (biopsy), the entire skin lesion can be removed with a scalpel. The treatment would then already be completed at the same time. If treatment other than removing the basal cell is planned, only a small sample of tissue is cut out of the tumor with the scalpel. This procedure can also be carried out in the practice and is practically painless thanks to the local anesthetic.

If the attending physician has carried out the procedure with the aim of completely removing the basal cell carcinoma, the tissue examination will also randomly check whether the cut edges of the specimen are free of tumor tissue.

Even if the entire basal cell carcinoma visible to the naked eye has been cut out, groups of tumor cells may still have remained in the skin. These can continue to divide and grow back into an externally visible basalioma node. The risk of incomplete removal is particularly high with basalioma because this tumor typically grows inward.

Treatment: basalioma is removed

Basalioma is not only the most common form of skin cancer, but is also one of the most common malignant tumors in Central Europe. In Germany alone, according to the German Cancer Society, at least 130,000 people develop this form of white skin cancer every year. Although it does not metastasize, it should be removed as soon as possible, otherwise it will grow in depth and damage organs.

The standard therapy consists of cutting out the tumor with a scalpel. The procedure is performed under local anesthesia. In order to avoid heavy bleeding during the procedure and subsequent bleeding, drugs that inhibit blood clotting should be discontinued after consulting the prescribing doctor at least seven days before the planned procedure.

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Basalioma removal with a safe distance

To be sure that the basalioma was completely removed during the operation, the doctor works with a safety margin. This means that a narrow margin of externally inconspicuous skin around the tumor is also removed. Then the wound is sutured. A skin graft may be necessary for larger basal cell carcinomas. The removed tissue is then examined to check that the tumor has been completely removed. If this is not the case, a follow-up operation may be necessary.

Only a small scar remains from the white skin cancer

Ideally, after the wound has healed, only a fine, possibly barely visible scar remains. Complications such as wound healing disorders, infections or bleeding are rare. In individual patients, however, it cannot be completely ruled out that a subjectively disturbing scar may develop. In this case, those affected may be able to think about a small surgery to correct the scar.

Depending on the type and size of the basalioma, alternative forms of treatment can be considered. If it is a superficial basal cell carcinoma on the trunk that has not yet penetrated deep into the skin, it can be scraped out, for example. This procedure is known as curettage.

Destruction of the basalioma by heat or cold

Another option for treating superficial basal cell cancer, especially on the trunk, is to destroy the tumor using cold, by freezing it with liquid nitrogen (cryosurgery) or using heat using a laser treatment. Changes in pigmentation or scars can be left behind. The cosmetic result may therefore be less favorable than after the surgical therapy.

Cream away the basal cell cancer

Local immunotherapy with imiquimod and local chemotherapy with 5-fluorouracil are also possible. Both active ingredients are applied as a cream and are particularly suitable for patients with several basaliomas in the trunk area. The respective ointment is applied daily (imiquimod five times a week) for four to six weeks.

No health insurance: photodynamic therapy

A more recent therapy option, the costs of which are only covered by statutory health insurances in individual cases, is photodynamic therapy (PDT). The areas affected by the basal cell cancer are first coated with an ointment, which makes the tumor cells particularly sensitive to light.

After an exposure time of three hours, the basaliomas are irradiated with cold red light for eight to ten minutes. About three sessions are required. Treatment can be painful, so pain medication is often given. Scars or pigmentation disorders as a result of this form of basalioma therapy are rare.

Higher risk of recurrence without surgery

The risk of recurrences, i.e. new basaliomas, is greater with all non-surgical procedures than with complete removal with a scalpel. This is due, among other things, to the fact that the destruction of the tissue makes it impossible to check whether the tumor has been completely removed – the main disadvantage of non-surgical procedures.

Irradiation as an effective alternative

If the basal cell carcinoma is large, in a location that is unfavorable for surgical removal (for example on the eyelid) or if the cancer cells have already migrated deep into other tissue areas, radiation therapy is an effective treatment alternative. X-rays are used to capture the genetic material of the cancer cells damage. In up to 96 percent of cases, basalioma does not return after successful radiation therapy, at least within a period of five years.

Drugs for basal cell carcinoma

A new treatment option for advanced basal cell carcinoma, for which surgical removal or radiation therapy is not an option, is drug treatment. It is based on so-called hedgehog inhibitors, which block certain signaling pathways into the cell interior that are important for tumor growth. The disadvantage is the wide range of possible side effects, which include muscle cramps, hair loss, taste disturbances, weight loss, fatigue and nausea.

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If you have been diagnosed with a basal cell carcinoma, you have several promising therapeutic options. You should discuss in detail with the attending physician which is the most suitable in each individual case.

Prevent basal cell cancer with consistent UV protection

Parents have a great responsibility for their children here, especially since children's skin is particularly sensitive to UV radiation. Sunburn clearly indicates that the person concerned has been exposed to too much UV radiation.

In general, extensive sunbathing is not recommended. In summer you shouldn't expose yourself to the blazing sun, especially at lunchtime when the sun is at its highest, in order to prevent basal cell cancer. It is cheaper to stay in the shade. It should be noted that the UV radiation can also be very intense there, especially in southern holiday destinations. In general, on a beach holiday and at home, instead of swimming trunks or bikini, it is advisable to wear light clothing with long sleeves and pant legs that keep UV radiation off the skin. The face can be protected with a sun hat. In addition, a sunscreen with a high sun protection factor should be applied to the face and all other body regions not covered by clothing. It should be noted that most sunscreens filter the UV-B, but not the cancer-causing UV-A radiation.

If you stay in the blazing sun for too long, repeated application of a conventional sunscreen may protect against sunburn, but not against changes in the genetic material in cells of the epidermis, which may lead to the formation of basaliomas and other skin tumors such as black skin cancer (malignant melanoma ) being able to lead.

For the risk of developing a basalioma, it is less the number of sunburns than the so-called cumulative light damage to the skin that is decisive. Cumulative light damage is the memory light damage that accumulates over the course of decades. Therefore, numerous visits to the solarium, for example, can increase the risk of later developing basal cell carcinoma far more significantly than a single sunburn. Even if UV exposure without sunburn is possible in the solarium or when using conventional light protection agents, it should always be borne in mind that light damage that is initially unnoticed is caused.