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Patient Information: I have basal cell carcinoma what can I do?



There are several effective treatment options available for squamous cell carcinoma. To decide which one will be the most appropriate highly depends on the individual case and should be discussed with your physician.

Mohs Surgery / Surgery


Surgery is the most effective treatment. The tumor will be excised and the wound will be closed with a few stitches (amount depending on size of affected area). Surgery always requires a local anaesthetic. Usually the wound will heal within two weeks. Mohs surgery is a special type of surgery where the surgeon is specially trained. During the surgery a microscopic method is used to make sure all of the affected skin areas are excised.

Advantages of the treatment

  • It has the highest cure rate of all surgical treatments.
  • The removed tissue can be examined microscopically to determine if the tumor has been totally excised.

Disadvantages of the treatment

  • There are local anesthetics required.
  • It is a rather complicated proceedure.

Cryosurgery


Here liquid nitrogen is applied to the affected surface with a cotton tip applicator or spray device. Liquid nitrogen is extremely cold (-195,8 C = -320,44 F) and will cause death of all cells of this area. Unfortunately there is no control as to how deep the tissue has been destroyed. Therefore reoccurences are not uncommon.

Advantages of the treatment

  • Depending on the type of basal cell carcinoma it usually is an effective treatment.
  • It is a quick procedure.
  • It only requires one or two visits to the doctor.
  • In general it is a rather cheap treatment. (?)

Disadvantages of the treatment

  • The treatment causes discomfort and/or pain.
  • Due to freezing the skin may presumably react with blisters, reddening, swelling or a change of color in skin patches.
  • An infection may occur due to delayed wound-healing.
  • There is a risk of scarring.

Curettage


Curettage describes the scraping away of a superficial skin disorder. Usually a scalpel or another sharp device, called a curette, is used for scraping. Unfortunately there is no control if all of the affected tissue has been removed. Therefore reoccurances are not uncommon.

Advantages of the treatment

  • Depending on the type of basal cell carcinoma it usually is an effective treatment.

Disadvantages of the treatment

  • The treatment usually requires a local anesthetic.
  • Occasionally, a change of color or an infection of the skin may occur.
  • There is a possibility of scarring.

Radiotherapy


This therapy uses X-rays to destroy damaged cells. Usually the affected area needs to be treated several times to reach a dose that is effective, depending on the size and stage of the basal cell carcinoma. Therefore the therapy might last several weeks.

Advantages of the treatment

  • This treatment has a good cure rate.
  • It is good for elderly patients who are not physically able to undergo surgery.

Disadvantages of the treatment

  • There is a risk of scarring.
  • There are several treatment sessions required.

Topical 5-fluorouracil


Topical 5-fluorouracil, also called 5-FU, is a cream that is applied to the skin. It contains a drug that will cause cell death by binding to cellular DNA.

Advantages of the treatment

  • Depending on the type of basal cell carcinoma it is a highly effective treatment.
  • It has good cosmetic results.

Disadvantages of the treatment

  • In general the treatment is rather painful and disfiguring due to inflammation and reddenig of the area. If a large area is treated it may be quite disfiguring.
  • The cream has to be applied over quite a long period (appoximately 2 to 4 weeks).
  • The success of treatment depends on patient cooperation.

Photodynamic therapy


Photodynamic therapy is based on a chemical reaction of a drug induced by light that will kill abnormal cells. The drug will be absorbed by the skin cells and will cause sensitivity of the skin towards light of a certain color/wavelength. If light is induced to the treated area, a chemical reaction is initiated that will lead to the death of the diseased cells. The drug most often used is called aminolevulinic acid (ALA). It is applied to the skin as a solution with an applicator or as a cream.

Photodynamic therapy seems to be a promising therapy for superficial basal cell carcinomas.

Advantages of the treatment

  • The treatment is highly effective and does not require a surgery.
  • It has excellent cosmetic results.
  • Usually the treated areas heal fast (within two weeks).
  • Only one or two treatments are necessary.

Disadvantages of the treatment

  • The treatment will cause a typical photodynamic reaction such as stinging, burning, itching, reddening and/or swelling.
  • Pain during irradiation may require anesthesia.

Other Treatments


Interferon alfa
Interferon alpha is not yet an approved treatment for basal cell carcinoma, although at the moment there are ongoing trials with interferon alpha for treating basal cell carcinoma. Usually it is injected directly into the affected area and should support the immune defense system. Unfortunately this therapy is connected with several disturbing side effects e.g. flu-like symptoms such as fever, drowsiness and nausea. Sometimes it may also cause a reduction of white, sometimes even red blood cells.



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