Malignant tumors of the skin: basal cell carcinoma (BCC), or Basalioma

By Cristiano Antonino On Feb 27, 2023

Also called basal cell carcinoma (BCC), basalioma is a malignant skin cancer. Its causes can be diverse, from excessive UV exposure to frequent use of tanning beds, and its typical manifestation is a skin sign of varying shape and size

Among malignant neoplasms, basalioma is the most common

It is estimated to be the most common of all other malignancies and accounts for 75% of skin cancers.

In 95% of cases it affects people over 40 years old (of these, 80% are over 60 years old), and its incidence under 20 years old is very rare.

The areas of the body most affected are those most frequently exposed to the sun.

Basalioma, what it is

Basalioma is a malignant skin cancer that can arise in the presence of certain triggers.

Formed by three layers (epidermis, dermis and subcutaneous tissue), the skin is the largest organ in the human body.

Tumors affecting it affect the epidermis,and may originate either from melanocytes (we speak in this case of melanoma), or from superficial keratinocytes (spinocellular carcinoma) or from basal cells (basaliona), the deepest layer of the epidermis.

Counted among nonmelanomatous skin cancers, basalioma originates from uncontrolled proliferation of the basal cells of the epidermis (which are in direct contact with the first cells of the dermis).

It is a carcinoma, and therefore a malignant neoplasm, which originates from the over-multiplication of a neoplastic cell belonging to the basal layer of the epidermis.

The diagnosis is clinical (observation of the skin lesion) and biopsy (confirmation of the histotype of the lesion).

Basalioma: the symptoms and types

The primary symptom of basalioma is the appearance of a skin sign, anywhere on the body.

However, the most affected areas are those most exposed to the sun: the face, scalp, neck, shoulders, back, back of the hands, and ears.

These lesions appear as small nodules with a pearly appearance or as pink patches, slowly increase in size, and sometimes can be pigmented and be mistaken for melanomas.

There are several subtypes of basal cell carcinoma:

the most common is nodular basalioma, which presents as a pink, red, or brown dome-shaped nodule that is hard in texture and often translucent (so much so that capillaries can be seen). It usually appears on the head or neck;
superficial basalioma (also called pagetoid or bowenoid) consists of an irregularly shaped erythematous patch with an often crusted surface. It usually appears on the trunk;
infiltrative basalioma, which is very aggressive, presents as a very erythematous and usually ulcerated patch, plaque or nodule. It can infiltrate deep into the dermis, reaching the muscle layer, and is capable of giving rise to metastasis;
the micronodular basalioma, which is very rare, consists of small nests of round or elongated basaloid cells;
morpheaform basalioma (also called scleroderma or scarring) presents as a yellowish or pearl-colored patch or plaque, with a smooth slightly raised or atrophic surface, irregularly blurred margins, and a hard texture. It usually occurs on the head and trunk;
basosquamous (or metatypical) basalioma has some features typical of spinocellular carcinoma, is very aggressive, and has a higher metastatic potential than other basal cell carcinomas;
cystic basalioma is distinguished by blue, purplish or gray nodules, often multiple;
fibroepithelial basalioma (or Pinkus fibroepithelioma) is a soft pink or red exophytic nodule with a soft texture and often shiny surface. It typically appears in the lumbosacral region in Caucasian women between 30 and 50 years of age;
pigmented basalioma is most common in Asian populations and-at first glance-may be mistaken for melanoma;
rodent ulcer basalioma (also known as Jakob’s ulcer) has a similar appearance to nodular basalioma, but with a central necrosis. Very aggressive, if not removed it can cause ulcers so prominent that they reach the bone. It generally affects the nose;
polypoid basalioma consists of exophytic polypoid nodules, appearing on the head and neck;
pore-like basalioma may resemble a star or skin pore, and appears in areas of the face rich in sebaceous glands (forehead, nose, nasolabial grooves);
aberrant basalioma appears in abnormal sites such as armpits, nipples, scrotum, vulva, and perineum.

Basalioma: the causes

Basalioma originates from a genetic mutation in most cases caused by excessive exposure to UV rays or tanning lamps.

Then there are other risk factors, which are linked to a higher chance of the neoplasm occurring:

light skin phototype, as light skin contains less melanin (the pigment that protects the skin from UV radiation);
weak immune system, due to taking immunosuppressive drugs, advancing age, or due to diseases that lead to immunosuppression;
genetic predisposition to the development of skin cancer;
exposure to ultraviolet radiation from phototherapy (therapy typically prescribed for the treatment of acne, psoriasis, or other skin diseases);
exposure to arsenic.

Basalioma: the diagnosis

Should you notice a change in the skin, especially if a wound or small ulcer appears that does not tend to heal, going to a doctor is essential.

Only a professional will be able to proceed with an objective test so as to diagnose the cause of the “spot” and prescribe the most appropriate course of treatment.

Diagnosis is made following an objective test and biopsy.

The dermatologist will go to carefully observe the lesion through the dermatoscope, an optical instrument that allows the observation of subcutaneous patterns not best visible to the naked eye, aiding its recognition.

Next, he will inquire about the patient’s health status, the symptoms he is experiencing, and his lifestyle habits.

To determine the nature of the abnormal lesion, however, biopsy is the only way.

By taking a fragment of tissue from the suspected skin area and observing it under a microscope, the presence of cancer cells can be detected.

Basalioma: therapy

Several therapeutic techniques are available to dermatologists to treat basalioma.

The choice depends on the size, site, and type of the lesion, as well as the patient’s clinical condition and comorbidity.

The goal of the surgery is to remove the carcinoma, through the most appropriate technique:

skin curettage (skin scraping), combined with electrocautery (to stop any bleeding), is indicated for small lesions appearing on the limbs;
surgical excision is the “classic” solution, which involves removal of the lesion through an incision (however, it can originate an unsightly scar, especially in more exposed areas such as the face);
cryotherapy involves the application of liquid nitrogen to the lesion: this, freezes the tumor cells neutralizing them;
photodynamic therapy (or PDT) uses photosensitizing substances that must be activated by a light source to perform their function;
Mohs surgery involves removing the lesion layer by layer, observing each one under a microscope: the surgery ends when the first layer is completely free of cancer cells;
laser therapy, indicated on the fingers and genitals, involves exposing the lesion to a light beam that vaporizes the tumor, causing very little blood loss and without damaging the surrounding tissue;
radiation therapy kills neoplastic cells by hitting them with high-energy x-rays.

As an alternative to surgical therapy, basalioma can be treated with specific drugs: topical chemotherapeutics are creams formulated to kill cancer cells, while topical immunotherapeutics, by activating the immune system response, destroy the carcinoma.

If diagnosed and treated in time, basalioma very high cure rate.

However, it is necessary to monitor the skin closely and consistently for recurrence or other cancers.

Basalioma, how to prevent it

To prevent the occurrence of basalioma, it is important not to expose yourself to the sun uncontrollably.

In particular, it is necessary to avoid exposure during the hottest hours, always use protective creams especially if the skin is very fair, avoid tanning lamps, check the skin even in the most hidden areas, and visit the doctor at the onset of any small suspicious lesion.