Basal Cell Carcinoma (BCC) is the most common form of skin cancer, and it occurs frequently compared to all the other forms of cancer. The disease often arises from uncontrolled and abnormal growth of basal cells, and its prevalence heightens the need to understand the public’s knowledge about it. BCC is always triggered by mutations in an individual DNA, which mostly result from UV radiation from the sun to the basal cells that are often block-like and found in the lower layers of the epidermis, which results in the cell’s change and growth abnormally. While numerous clinical variants of basal cell carcinoma exist, the superficial, morphea, and nodular-like BCC are the most recognized variants of BBC. Even so, there have been numerous advancements in technology innhance the diagnostic accuracy of BBC diagnosis and the spur i,n the development of innovative tools has improved the diagnosis of the condition. Innovative modalities are being exploited to facilitate early detection to develop treatment plans and control the prevalence. This paper explores basal cell carcinoma’s epidemiology, pathogenesis, and clinical manifestations to enhance patient care.
Basal cell carcinoma (BCC) has a low mortality rate, which has resulted in numerous countries with cancer registries failing to include the data on BBC. Even so, an estimate of the data from official statistics and insurance agencies in the United States of America concludes that BBC-reported incidences have been approximated to hit 4.3 million cases every year (Dika et al., 2020). In addition, the reported incidences of BCC showcase a significant rise after individuals hit 40 years (Dika et al., 2020). Even so, the increased exposure to UV light, especially from artificial sources and the sun, has changed the dynamics, and recently, the younger population has recorded increased scenarios of BCC condition, specifically among women. Exposure to recreational sunlight and indoor tanning salons have also been recorded as factors contributing to the development and prevalence of BCCs (McDaniel et al., 2022). In adolescents and those in early childhood stages, the skin type exposure intensity and duration of cumulative UV dose play a significant role in the development of BCC. However, an individual might suffer the risk of BCC because of various other factors such as arsenic pressure, genetic predisposition, ionizing radiation exposure, and immunosuppression.
Pathogenesis and Clinical Manifestations
The aberrant activation of key signaling pathways, such as the Hedgehog pathway, is often presented as the critical molecular stimulator in BCC pathogenesis. The recent improvements in sequencing technology have allowed scientists and physicians to adopt genome-scale strategies in the endeavor to understand and discover the mutation of BCC, thus recognizing new pathways and genes that are possibly part of BCC carcinogenesis (Pellegrini et al., 2017). Therefore, the cancer-linked genes in BBC carcinogenesis are more complex and have more genetic network than the initially hypothesized genes. BCC’s defined morphological subtypes include the superficial, morphea, and nodular (McDaniel et al., 2022). BCC’s superficial subtype is always different because it has numerous little buds of basaloid cells that often descend from the epidermis without the invasion of the dermal. On the other hand, the nodular subtype is the most prevalent among the BCCs. Nodular BCCs entail numerous islands of cells with a haphazard arrangement and peripheral palisading of the more central cells. In addition, the more extensive lesions may have ulceration. The morphea variant is a tumor that is always flesh or white colored with ill-defined borders and induration sections. In most cases, Morphea-form BCCs resemble a plaque or a scar of morphea. The tumor can sometimes ulcerate and enlarge, presenting the borders with a rodent or rolled ulcer appearance.
Diagnostic Modalities and Therapeutic Approaches
The outcome of BCC is often based on expeditious analysis and diagnosis, which are essential in improving the condition. When preventive measures are implemented in adolescence and childhood, they may prove to be efficient and effective. The first process in the diagnosis of BCC is inspection, which is then followed by dermoscopy with a biopsy confirmation and examination through the histopathologic process. Further, the surgeon can identify the site when conducting the definitive procedure through the application of the photography of the lesion. Even so, the surgeon should be aware of the wrong site definitive processes that are always the fundamental errors in the procedure. The histological process of the multiplication of promulgating homogenous basaloid cells with little poorly identified cytoplasm and hyperchromatic nucleus, retraction artifact, and peripheral palisading (Naik & Desai, 2022). Standardized follow-up is beneficial for patients suffering from BCC since it allows early diagnosis of secondary malignancies and local recurrence and should be conducted in a risk-qualified approach. The prevalent approach of BCC treatment entails surgical modalities like electrodesiccation and curettage (EDC), excision, Mohs micrographic surgery, and excision. The methods are technically set in place for localized BCC and they often present extreme 5-year cure rates (McDaniel et al., 2022). In addition, it can be treated through radiotherapy which always entails extreme radiation doses that are used to kill the cancer cells, and anti-cancer gels, ointments, and creams (Thomson et al., 2020). BCC can result in significant disfigurement, particularly on the face, even though it is not always life-threatening.
Prevention and Prognosis
Epidemiological and clinical data have linked cumulative dosages of solar and various skin sunburns as the main causes of skin damage and the increased prevalence of the BCC condition. The commended preventive measures include the usage of physical barriers such as hats, clothing, and sunglasses, measures to help individuals avoid direct sunlight such as seeking shade and controlling exposure to the sun during peak times, while also maintaining the usage of sunscreen (Hung et al., 2022). When individuals wear sun-protective clothes and keep off exposure to the sun, it lowers their exposure to UV radiation and thus lowers their risk of sunburn. However, the preventive measures have their flaws because it is hard for people to constantly put on protective clothes, and when individuals seek shade, they also raise their body’s exposure to UV if they opt to stay outdoors for longer times. Thus, it is essential to identify the links between demographic characteristics and the usage of the presented measures in order to derive an extremely focused education and more effective prevention and intervention efforts while also encouraging surveillance and regular follow-up. Nevertheless, the available data and platforms of research on BBC and the ways to prevent it are limited thus the need for more informed knowledge on the condition. It can be addressed through an intensive exploration of the therapeutic targets, addressing the increasing cases of BCC, and a total refinement of the diagnostic tools.
In conclusion, BCC is a prevalent and significant public health challenge that calls for prompt and evidence-based approaches to addressing the condition. There is a need for continuous research to ensure that the health and well-being of the people are protected and safeguarded. Understanding the numerous variants of BCCs can be crucial in developing measures and strategies that contribute to reducing the burden of the disease and improving patiet outcomes. The prevalence of BCC calls for drastic measures to address the condition through technological improvements and newly customized treatment approaches.
References
Dika, E., Scarfì, F., Ferracin, M., Broseghini, E., Marcelli, E., Bortolani, B., Campione, E., Riefolo, M., Ricci, C., & Lambertini, M. (2020). Basal Cell Carcinoma: A Comprehensive Review. International Journal of Molecular Sciences, 21(15), 5572. https://doi.org/10.3390/ijms21155572
Hung, M., Beazer, I. R., Su, S., Bounsanga, J., Hon, E. S., & Lipsky, M. S. (2022). An Exploration of the Use and Impact of Preventive Measures on Skin Cancer. Healthcare, 10(4), 743. https://doi.org/10.3390/healthcare10040743
McDaniel, B., Badri, T., & Steele, R. B. (2022). Basal Cell Carcinoma. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482439/
Naik, P. P., & Desai, M. B. (2022). Basal Cell Carcinoma: A Narrative Review on Contemporary Diagnosis and Management. Oncology and Therapy. https://doi.org/10.1007/s40487-022-00201-8
Pellegrini, C., Maturo, M. G., Di Nardo, L., Ciciarelli, V., Gutiérrez García-Rodrigo, C., & Fargnoli, M. C. (2017). Understanding the Molecular Genetics of Basal Cell Carcinoma. International Journal of Molecular Sciences, 18(11). https://doi.org/10.3390/ijms18112485
Thomson, J., Hogan, S., Leonardi-Bee, J., Williams, H. C., & Bath-Hextall, F. J. (2020). Interventions for basal cell carcinoma of the skin. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd003412.pub3
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