Basal Cell Carcinoma of eyelids & face

General Overview:

General Overview:

Basal Cell Cancer (BCC): Basal Cell carcinoma is the most common Skin Cancer affecting the eye lid & the face. Basal Cell Cancer rarely spreads (undergoes metastasis) & kills. It is a form of cancer which grows gradually. But, as Basal Cancer can lead to significant disfigurement & tissue destruction by invasion of skin & surrounding tissues, it is considered to be malignant. Because of the local tissue destruction, this cancer is also called a rodent ulcer.

80% of all the cases of BCC are found to be in the region of head & neck.

Out of the two types of skin cancer, Melanoma & Non-melanoma; Basal Cell Carcinoma falls into the Non-melanoma type of Cancer.

Causes & Risk factors:

v BCC is more prevalent in the Caucasian races, with white skin & light colored eyes. Since the ultra-violet rays of the sun are carcinogenic, Melanin (skin pigment) protects the skin from sun related damage & BCC formation.

The most common age group affected belongs to the people over the age of 40, although it is also found to affect people in the younger age groups.

Most likely risk factors for acquiring BCC of skin are:

  • Light-colored or freckled skin
  • Blond or red hair
  • Blue, green, or grey eyes
  • Presence of many moles over the skin
  • Overexposure to sunlight and forms of radiation such as X-rays
  • Exposure to sun-tanning parlours / artificial tanning parlours
  • Many severe sunburns early in life
  • Close relatives who have or had skin cancer
  • Long-term daily sun exposure (such as the sun exposure people who work outdoors receive)

Clinical features:

BCC of skin is usually asymptomatic or painless & a slow growing cancer.

Patients may present with an elevated skin or growth over skin which is:

  • White or light pink
  • Pearly or waxy
  • Brown or flesh-coloured

The skin may be slightly raised or even flat in some cases.

Affected persons can have:

  • A skin sore which is bleeding easily
  • Non-healing sore
  • Sore having oozing or crusting spots
  • Scar-like sore without the area being injured
  • Presence of irregular blood vessels around the affected area
  • A sore with sunken (depressed) area in the center (rodent ulcer)

Basal Cell Carcinoma of Eyelid:

Non-melanoma cancers of skin are predominantly seen in the eyelid region. The first symptoms are those of an eye mass / growth, due to the eyelid tumor. These type of skin cancers rarely spread to the adjacent lymph nodes and distant sites (metastasis), but with eyelid skin cancers there is a significant risk for tissue damage to nearby vital structures of the eye  and may even lead to blindness; the skin around the eyelid is thin and comprises of little subcutaneous tissue. The anatomical connections to the bone underlying the region help in spreading the tumor locally into the cavities behind the eyes & the nose.

The main areas to get affected around the eye are –

-eyebrow

-upper & lower eyelid

-lid margins

-inner & outer junction of eyelid (canthi)

 

Examination & laboratory tests:

The skin area around the eyelid mass is examined in terms of size, colour, shape & consistency or texture.

The affected suspicious area if found,  should be removed surgically (excision biopsy) and sent to laboratory for examination histologically under microscope. This procedure is known as “Skin Biopsy”. This is a confirmatory test for diagnosing Basal cell cancer or other types of skin cancers.

 

Prevention:

Use of sunglasses or eyeglasses while going in the sunlight.

Skin sunscreen applications to be used for eyelids in order to prevent overexposure to sunlight & UV radiation.

Ultraviolet light is most intense & harmful between 10 a.m. and 4 p.m., hence avoiding exposure to sunlight will turn beneficial in preventing occurrence of basal skin cancer. Use skin protection such as wearing hats, long skirts or long pants, long-sleeved shirts etc.

Always use sunscreen lotions.

  • Apply high-quality sunscreens with sun protection factor (SPF) ratings of at least 15, even when you are only going outdoors for a small amount of time.
  • Apply a lot of sunscreen on all the areas exposed, including ears and feet.
  • Try using sunscreens that block both UVA and UVB light.
  • Sunscreen should be applied at least 30 minutes before going outside, and should be reapplied frequently, especially after swimming.
  • Use a waterproof formula.
  • Use sunscreen even in Winter. Protect yourself even on cloudy rainy days.

Other important facts to help you avoid too much sun exposure:

  • Avoid surfaces that reflect more of light, such as sand, water, white-painted areas & concrete.
  • Start of Summer season is said to be more harmful.
  • Avoid sun lamps, tanning beds, and tanning salons.
  • Skin burns faster at higher altitudes.

Treatment:

Depending upon the size, shape, teture or consistency & color of the affected area, the surgery / treatment should be carried out

It may comprise of:

  • Excision Biopsy: Cutting out the skin cancer (until a healthy tissue edge is reached) and stitching the skin together. Skin Flaps & grafts are utilized to close the area of the skin defect, post the skin cancer removal.
  • Curettage and electrodesiccation or cautery: Scraping away cancer cells and using electricity to kill the cancerous cells which remain.
  • Cryosurgery: Killing of cancer cells by freezing them.
  • Topical agents: Skin ointments and lotions containing imiquimod or 5-fluorouracil for superficial (not very deep) basal cell cancer.
  • Mohs surgery: Discarding a layer of skin and examining it immediately under a microscope, then removing many layers of skin until there are no signs of the cancer; generally used for skin cancers on the nose, ears, and other areas of the face.
  • Photodynamic therapy: Light therapy in combination with topical agents.

When surgery is not useful to treat basal cell skin cancer (in very advanced or refractory cases), Radiation therapy may prove to be beneficial.

Skin Cancer Treatment | Basal Cell Carcinoma Eyelid | Mohs Surgery Mumbai, India – Dr. Debraj Shome





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