Basal cell carcinoma surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D., Maneesha Nandimandalam, M.B.B.S.[2]
Overview
Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and cryosurgery.
Basal Cell Carcinoma Surgery
- Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and cryosurgery.[1]
Electrodesiccation and Curettage
- It is the most widely used method for removing primary basal cell cancinoma's[2]
- It is a 2 step process which involves removal of the tumor by vigorously scraping it away from the adjacent normal skin first, followed by electrodesiccation later.
- This procedure goes well for nodular or superficial basal cell carcinoms, because these tumors tend to be friable and are not embedded in fibrous stroma.
- The entire process should be repeated for 1-2 more times.
- The surgeon should be extremely cautious while performing scraping in several directions, because many recurrences after curettage are believed to be due to insufficient aggressiveness on the part of the surgeon.
Surgical Excision
Surgical excision is performed to remove and examine the specimen under a microscope. The larger mount of skin that is removed, the higher the cure rate. Normally, 3-4 mm margins of normal skin are removed. Although surgical excision is more time-consuming and costly compared to curettage, it produces cure rates as high as 95%[3].
Mohs Micrographic Surgery
- It is a procedure involving removal of visible lesion on the skin in several steps[4].
- First we should remove a very thin layer and later we remove the next layer and view under the microscope.
- We should keep on repeating the same procedure until no cancerous tissue is remaining.
Mohs micrographic surgery is indicated for the following:
- Tumors with poorly defined clinical borders
- Tumors with diameters > 1 cm located anywhere on the face
- Tumors with diameters > 2 cm located in areas other than the face
- Tumors with infiltrative or morpheaform/sclerotic histopathologic patterns
- Tumors arising in regions where a good cosmetic outcome is important
Cryosurgery
Cryosurgery may be considered for small, clinically well-defined primary tumors. This procedure is especially useful for patients who are debilitated with medical conditions. Liquid nitrogen is applied to the tumor, the treatment stops when the temperature reaches -60°C[5].
References
- ↑ Wong CS, Strange RC, Lear JT (October 2003). "Basal cell carcinoma". BMJ. 327 (7418): 794–8. doi:10.1136/bmj.327.7418.794. PMC 214105. PMID 14525881.
- ↑ Silverman MK, Kopf AW, Grin CM, Bart RS, Levenstein MJ (1991). "Recurrence rates of treated basal cell carcinomas. Part 2: Curettage-electrodesiccation". J Dermatol Surg Oncol. 17 (9): 720–6. PMID 1820764.
- ↑ Grabski WJ, Salasche SJ (1998). "Positive surgical excision margins of a basal cell carcinoma". Dermatol Surg. 24 (8): 921–4. PMID 9723063.
- ↑ Smeets NW, Kuijpers DI, Nelemans P, Ostertag JU, Verhaegh ME, Krekels GA; et al. (2004). "Mohs' micrographic surgery for treatment of basal cell carcinoma of the face--results of a retrospective study and review of the literature". Br J Dermatol. 151 (1): 141–7. doi:10.1111/j.1365-2133.2004.06047.x. PMID 15270883.
- ↑ Kaur S, Thami GP, Kanwar AJ (2003). "Basal cell carcinoma--treatment with cryosurgery". Indian J Dermatol Venereol Leprol. 69 (2): 188–90. PMID 17642878.