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AMA Citation Chapter Basal Cell Carcinoma. Usatine R. Richard P. Usatine, et al. The Color Atlas of Family Medicine, 2e. McGraw-Hill; Accessed July 15, APA Citation Chapter MLA Citation "Chapter Download citation file: RIS Zotero. Reference Manager. There are mainly three patterns of aggressiveness, based mainly the cohesion of cancer cells: .
Fibroepitheliomatous pattern anastomosing basaloid epithelial strands enclosing round islands of fibrous stroma . Basal-cell carcinoma is a common skin cancer and occurs mainly in fair-skinned patients with a family history of this cancer. Sunlight is a factor in about two-thirds of these cancers; therefore, doctors recommend sunscreens with at least SPF However, a Cochrane review examining the effect of solar protection sunscreen only in preventing the development of basal-cell carcinoma or cutaneous squamous cell carcinoma found that there was insufficient evidence to demonstrate whether sunscreen was effective for the prevention of either of these keratinocyte-derived cancers.
One-third occur in non-sun-exposed areas; thus, the pathogenesis is more complex than UV exposure as the cause. The use of a chemotherapeutic agent such as 5-Fluorouracil or imiquimod can prevent development of skin cancer. It is usually recommended to individuals with extensive sun damage, history of multiple skin cancers, or rudimentary forms of cancer i.
A weakness with standard surgical excision is a reported higher recurrence rate of basal-cell cancers of the face, especially around the eyelids,  nose, and facial structures.
For ill-defined or recurrent basal-cell cancer on the face after previous surgery, special surgical margin controlled processing CCPDMA —complete circumferential peripheral and deep margin assessment   using frozen section histology Mohs surgery is one of the methods should be considered. Or one should simply process the tissue utilizing a method approximating the Mohs method described in most basic histopathology text books or described in this reference  during frozen section processing.
Unfortunately, these methods are difficult when applied to frozen sections; and they are very tedious to process. When not utilizing frozen section, the surgeon might have to wait a week or more before informing the patient if more tumour is left, or if the surgical margin is too narrow.
For poorly defined or recurrent tumours on the face, Mohs surgery or frozen section histology with either margin control ccpdma or thin serial bread-loafing should be considered. Mohs surgery or Mohs micrographic surgery is an outpatient procedure, which was developed by Frederic E. Mohs in the s,  in which the tumor is surgically excised and then immediately examined under a microscope. The base and edges are microscopically examined to verify sufficient margins before the surgical repair of the site.
If the margins are insufficient, more is removed from the patient until the margins are sufficient. It is also used for squamous-cell carcinoma ; however, the cure rate is not as high as Mohs surgery for basal-cell carcinoma. Cryosurgery is an old modality for the treatment of many skin cancers. When accurately utilized with a temperature probe and cryotherapy instruments, it can result in very good cure rate.
Disadvantages include lack of margin control, tissue necrosis, over or under treatment of the tumor, and long recovery time. Overall, there are sufficient data to consider cryosurgery as a reasonable treatment for BCC. There are no good studies, however, comparing cryosurgery with other modalities, particularly with Mohs surgery, excision, or electrodesiccation and curettage so that no conclusion can be made whether cryosurgery is as efficacious as other methods.
Also, there is no evidence on whether curetting the lesions before cryosurgery affects the efficacy of treatment. Electrodesiccation and curettage EDC, also known as curettage and cautery, simply curettage  is accomplished by using a round knife, or curette, to scrape away the soft cancer.
The skin is then burned with an electric current. This further softens the skin, allowing for the knife to cut more deeply with the next layer of curettage.
The cycle is repeated, with a safety margin of curettage of normal skin around the visible tumor. Cure rate is very much user-dependent and depends also on the size and type of tumor. Generally, this method is used on cosmetically unimportant areas like the trunk torso. Some physicians believe that it is acceptable to utilize EDC on the face of elderly patients over the age of However, with increasing life expectancy, such an objective criterion cannot be supported.
The cure rate can vary, depending on the aggressiveness of the EDC and the free margin treated. Some advocate curettage alone without electrodesiccation, and with the same cure rate. Some superficial cancers respond to local therapy with 5-fluorouracil , a chemotherapy agent.
Imiquimod may be used prior to surgery in order to reduce the size of the carcinoma. One can expect a great deal of inflammation with this treatment. Some advocate the use of imiquimod prior to Mohs surgery to remove the superficial component of the cancer.
Removing the residual superficial tumor with surgery alone can result in large and difficult to repair surgical defects.
One often waits a month or more after surgery before starting the Imiquimod or 5-fluorouracil to make sure the surgical wound has adequately healed. Some people [ who? These experimental procedures are not standard care. The study reported that topical IMQ appears effective in the treatment of primary small superficial BCCs but only "may possibly" have a role in the treatment of primary nodular BCC.
Vismodegib and sonidegib are drugs approved for specially treating BCC, but are expensive and cannot be used in pregnant women. Immunotherapy research suggests that treatment using Euphorbia peplus , a common garden weed, may be effective. Imiquimod is an immunotherapy but is listed here under chemotherapy. Radiation therapy can be delivered either as external beam radiotherapy or as brachytherapy internal radiotherapy.
Although radiotherapy is generally used in older patients who are not candidates for surgery, it is also used in cases where surgical excision will be disfiguring or difficult to reconstruct especially on the tip of the nose, and the nostril rims. Radiation treatment often takes as few as 5 visits to as many as 25 visits.
Usually, the more visits scheduled for therapy, the less complication or damage is done to the normal tissue supporting the tumor. Radiotherapy can also be useful if surgical excision has been done incompletely or if the pathology report following surgery suggests a high risk of recurrence, for example if nerve involvement has been demonstrated. Usually, recurrent tumors after radiation are treated with surgery, and not with radiation.
Further radiation treatment will further damage normal tissue, and the tumor might be resistant to further radiation. Radiation therapy may be contraindicated for treatment of nevoid basal-cell carcinoma syndrome. I've been using your techniques for about 2 weeks now and I'm already starting to feel more like a woman! I can wear all sexy clothes and please my boyfriend in ways I've never been able to before.
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