Brain Cancer Essay, Research Paper

Every hour one American is killed by skin cancer and every thirty seconds one

American gets skin cancer. Cancer is a deadly disease that alters the DNA of a

skin cell and causes it to reproduce at a rapid pace. This overproduction of

cells can be harmful and in many cases deadly. Out of these cancers the most

common is Basal cell carcinoma. Many steps have been made in the treatment of

Basal Cell Carcinoma, some have been very successful and some not. The cells

that have the altered DNA are called malignant or cancerous cells. These cells

are found in the outer layers of the skin. The skin’s main job is to protect the

body from infections and to insulate the body to keep it at the proper

temperature. The first layer of skin is called the epidermis. This is the layer

that is closest to the surface of the skin. There are three types of cells in

this layer. The first is the squamace. The squamace cells are flat and scaly and

are located closest to the surface of the skin. Second are the basal cells and

finally are the melanocytes, which give the skin its color. The second layer of

skin is the dermis, which is much thicker than the epidermis. This layer

contains sweat glands, nerves and blood vessels. The dermis also contains

follicles, which are tiny pockets from which the hair grows. The most common

malignant cells are the basal cells. Cancer in the basal cell is called

nonmelanoma cancer. This means that the cancer did not start in the melanocytes

located in the epidermis. Basal Cell Carcinoma is caused by overexposure to the

sun. The sun gives off ultraviolet rays, which are harmful to the human body.

Basal cell carcinoma will affect body parts such as the eyes, ears and nose. If

it is detected before it gets deep into the skin there will most likely be no

problem treating the cancer. A problem will occur if it isn’t detected quickly

enough and it has progressed into the deep portions of the tissue. If Basal cell

carcinoma is left untreated it can be very hard to treat and may even cause

death. The common methods of treatment involve the use of Mohs micrographic

surgery, radiation therapy, electrodesiccation and curettage, and simple

excision. Each of these methods is useful in specific clinical situations.

Depending on the case, these methods have cure rates ranging from 85% to 95%.

Mohs micrographic surgery, a newer surgical technique, has the highest cure rate

for surgical treatment of both primary and recurrent tumors. This method uses

microscopic control to determine the extent of tumor invasion. Although Mohs

micrographic surgery method is complicated and requires special training, it has

the highest cure rate of all surgical treatments because the tumor is

microscopically outlined until it is completely removed. While other treatment

methods for recurrent basal cell carcinoma have failure rates of about 50%, cure

rates have been reported at 96% when treated by Mohs micrographic surgery.

"Mohs micrographic surgery is also indicated for tumors with poorly defined

clinical borders, tumors with diameters larger than two cm, tumors with

histopathologic features showing morpheaform or sclerotic patterns, and tumors

arising in regions where maximum preservation of uninvolved tissue is desirable,

such as eyelid, nose and finger." Next there is a treatment involving

simple excision with frozen or permanent sectioning for margin evaluation. This

traditional surgical treatment usually relies on surgical margins ranging from

three to ten millimeters, depending on the diameter of the tumor. Tumor

recurrence is not uncommon because only a small fraction of the total tumor

margin is examined pathologically. Recurrence rate for primary tumors greater

than 1.5 cm in diameter is at least twelve percent within five years. If the

primary tumor measures larger than three cm, the five year recurrence rate is

23.1%. Primary tumors of the ears, eyes, scalp, and nose have recurrence rates

ranging from 12.9% to 25%. Third there is electrodesiccation and curettage. This

method is the most widely employed method for removing primary basal cell

carcinomas. Although it is a quick method for destroying tumor, adequacy of

treatment cannot be assessed immediately since the surgeon cannot visually

detect the depth of microscopic tumor invasion. Tumors with diameters ranging

from two to five mm have a fifteen percent recurrence rate after treatment with

electrodesiccation and curettage. When tumors larger than three cm is treated

with electrodesiccation and curettage, a 50% recurrence rate should be expected

within five years. The fourth type is radiation therapy. Radiation is a logical

treatment choice, particularly for primary lesions requiring difficult or

extensive surgery (e.g., eyelids, nose, and ears). It eliminates the need for

skin grafting when surgery would result in an extensive defect. Cosmetic results

are generally good to excellent with a small amount of hypopigmentation or

telangiectasia in the treatment port. Radiation therapy can also be utilized for

lesions that recur after a primary surgical approach. "Radiation therapy is

contraindicated for patients with xeroderma pigmentosum, epidermodysplasia

verruciformis, or the basal cell nevus syndrome because it may induce more

tumors in the treatment area". "Following treatment for basal cell

carcinoma, the patient should be clinically examined every six months for five

years." Thereafter, the patient should be examined for recurrent tumor or

new primary tumors at yearly intervals. It has been prospectively found that 36%

of patients who develop a basal cell carcinoma will develop a second primary

basal cell carcinoma within the next five years. Early diagnosis and treatment

of recurrent basal cell carcinomas or another primary basal cell carcinoma is

desirable since the treatment of the disease in its earliest stages results in

less patient morbidity. Carbon dioxide laser is most frequently applied to the

superficial type of basal cell carcinoma. It may be considered when a bleeding

diathesis is present, since bleeding is unusual when this laser is used. Topical

fluorouracil (5-FU) may be helpful in the management of selected superficial

basal cell carcinomas. Careful and prolonged follow-up is required, since deep

follicular portions of the tumor may escape treatment and result in future tumor

recurrence In conclusion Basal Cell Carcinoma has many different treatment that

are very helpful. Some more than others. Instead of going through the hassle of

treating Basal Cell Carcinoma one should prevent it from entering into your

system. "Basal cell carcinoma is 100% preventable with the daily use of

sunscreen beginning in the childhood years". Sunscreen prevents the

ultraviolet rays from coming in contact with the skin thus preventing the cancer

from entering into you body.

(1) Abide, JM, Nahai F, Bennett RG. The Meaning of Surgical Margins: Plastic

and reconstructive Surgery. : 492-497, 1984. (2) Dabski K, Helm F. Tropical

Chemotherapy: Schwartz RA: Skin Cancer: Recognition and Management. New York,

NY: Springer-Verlag, 1988, pp 378-389. (3) Elson, Melvin. Internet Reference.

"http://www.colombia.net/consumer/datafile/skincanc.html. (4) Internet

Reference. "http://maui.net/~southsky/introto.html (5) Jablonski, Francis.

Personal Interview. 10 March 1997 (6) Lippman SM, Shimm DS, Meyskens FL:

Nonsurgical treatments for skin cancer: retinoids and alpha-interferon. Journal

of Dermatological Surgery and Oncology: 862-869, 1988. (7) Preston DS, Stern RS:

Nonmelanoma cancers of the skin. New England Journal of Medicine 327(23):

1649-1662, 1992. (8) Thomas RM, Amonette RA: Mohs micrographic surgery. American

Family Physician/GP 37(3): 135-142, 1988. Skin Cancer Jack Ciallella Lab Bio

October 21, 1999 Bibliography Works Cited (1) Abide, JM, Nahai F, Bennett RG.

The Meaning of Surgical Margins: Plastic and reconstructive Surgery. : 492-497,

1984. (2) Dabski K, Helm F. Tropical Chemotherapy: Schwartz RA: Skin Cancer:

Recognition and Management. New York, NY: Springer-Verlag, 1988, pp 378-389. (3)

Elson, Melvin. Internet Reference. "http://www.colombia.net/consumer/datafile/skincanc.html.

(4) Internet Reference. "http://maui.net/~southsky/introto.html (5)

Jablonski, Francis. Personal Interview. 10 March 1997 (6) Lippman SM, Shimm DS,

Meyskens FL: Nonsurgical treatments for skin cancer: retinoids and

alpha-interferon. Journal of Dermatological Surgery and Oncology: 862-869, 1988.

(7) Preston DS, Stern RS: Nonmelanoma cancers of the skin. New England Journal

of Medicine 327(23): 1649-1662, 1992. (8) Thomas RM, Amonette RA: Mohs

micrographic surgery. American Family Physician/GP 37(3): 135-142, 1988.