Basal cell carcinoma

Abstract

Basal cell carcinoma is the most common type of malignant tumor in the United States. The five types of basal cell carcinoma (noduloulcerative, pigmented, morpheaform, and superficial basal cell carcinoma, and premalignant fibroepithelioma) vary in clinical presentation and behavior. Diagnosis is made by skin biopsy. The size, type, and site of a lesion and the age and sex of the patient affect the choice of treatment. Electrodesiccation and curettage, cryosurgery, surgical excision, Mohs' surgery, and radiation therapy are available. Knowledge of these therapies and of when they should and should not be used is important in proper management of basal cell carcinoma.

Curettage, electrosurgery and skin cancer

“…Should curettage at any time penetrate subcutaneous fat, it should be abandoned in favour of scalpel excision, because deep tumour extension is likely and the ability to differentiate normal from diseased tissue is lost (fat is as susceptible to curettage as tumour). 6,7,21,30,35,36 Once the bulk of the lesion has been removed, the margins and base of the wound are vigorously probed and explored with progressively smaller curettes (1–2 mm) for pockets and finger‐like extensions of tumour. 6–8,15,18,20–23,26,37,38 This eliminates potential foci of recurrence 30 and contributes to a tapered surgical edge, enhancing cosmesis.…”

“…52 Although unproven, these claims are echoed throughout the literature and form the basis for a widespread preference for electrodesiccation (superficially destructive) over electrocautery (deeply destructive) following curettage. 10,19,27,36,50,52 …”

“…When held a slight distance from tissue, the monoterminal electrode of the electrodesiccator produces a spark, charring tissue superficially. 7,33,36 High voltage, markedly damped currents do not penetrate deep tissue layers (penetrance is a function of amperage) and the initially charred tissue forms an insulating barrier, additionally protecting deep tissue. 30 The proper setting for electrodesiccation lies just beyond that required for haemostasis.…”

“…Controversy exists as to the optimum number of C & ED cycles required to treat skin cancers. Authors variously recommend one, 26,35 two, 5,6,10,14,17,19,20,22,23,27,28,46,50,53 or three 7,14,15,21,27,30,33,34,36,47 cycles of C & ED.…”