Examples of BCC: Ulcerated, Nodular, Pigmented
Basal Cell Carcinoma
This is the most common form of skin cancer. It develops in areas of sun exposure and may take 20 – 30 years to grow. Also, known as “Rodent Ulcers” for there propensity to burrow through skin, muscle and bone if neglected. These skin cancers rarely spread to other organs. The most common appearance is an elevated, pearly white colored, irregular shaped and ulcerated lesion. However, they can be pigmented, nodular shaped or appear as an irritated reddish plaque.
- Complete surgical removal is the primary mode of therapy.
- Radiation therapy can be used to help maintain local spread of the disease.
- Cryotherapy (freezing)
- Topical Creams for early Basal Cell Carcinoma
- 5 – Fluorouracil (trade names Efudex and Carac)
- Imiquimod (trade name Aldara)
What is Moh’s Chemosurgery
This is a form of serial excision where the skin cancer is removed, the specimen then placed on a grid and inspected under a microscope. The tumor cells are then mapped out. If the cells involve or come close to the cut surgical margin, further skin is removed precisely in the mapped out area. The process is repeated until no tumor cells are visible under the microscope.
What is Rapid Frozen Section Surgical Removal
The skin cancer is removed and then the tissue specimen is frozen. Next, several cuts are made through the frozen tissue and inspected for tumors cells either close or touching the surgical cut margin. If the cells are found in this area, another specimen of skin is removed, analyzed in a similar manner and repeated until no tumor cells are present under the microscope. Since the skin cancer is not completely mapped out and only isolated areas are looked at, rapid frozen section has only about a 95% accuracy rate. Therefore, about 5% of the time, when the same tissue specimen is examined fully a few days later, tumor cells may be found to be present, thereby requiring further treatment.
Advantages and Disadvantages of Either Moh’s or Rapid Frozen Section Treatment
Moh’s has the advantage of a more accurate initial analysis of the tissue. This is of value in areas where preservation of skin is important for reconstruction of the area, such as the nose and lip. The main disadvantage of Moh’s is that it might take several hours to complete. Moh’s is many cases is unnecessary and time consuming, especially in those areas of the face and body which have plenty of skin available for reconstruction.