Stages of basal cell carcinoma. Basalioma - skin photo, initial stage, dangerous signs, treatment and removal

Many consider it an intermediate stage between benign and malignant tumors.

Basalioma - skin cancer occurs in 70-75% of all cases of malignant skin tumors. Per 100 thousand population, 26 men and 21 women may develop basal cell carcinoma. This skin disease is more common in the south of Russia, in the Rostov and Astrakhan regions, Stavropol and Krasnodar territories.

Light-skinned people and working people are at risk for the disease. for a long time outdoors: fishermen, construction workers, agricultural workers and road repair workers.

Skin basal cell carcinoma, what is it?

Despite the absence of metastases, basal cell carcinoma, like any malignant neoplasm, can germinate and destroy neighboring tissues and recur after proper treatment. It is selected individually in each case in accordance with the characteristics of the tumor.

Basal- cell carcinoma skin

Not knowing what basal cell carcinoma looks like or what it is, many, when they find one or several fused nodules on the skin, rising above the skin, do not pay attention to them, because they do not experience pain in these places in the early stages.

After some time, the nodule takes the form of a yellow or off-white plaque with a surface covered with scales. Usually people try to tear off the crust, under which bleeding from the capillary may occur. When they notice that the formation begins to ulcerate, patients understand that they need to consult a dermatologist. Experienced specialists immediately refer patients to an oncologist, since one type of tumor can suspect basal cell carcinoma.

Forms of basal cell carcinoma - classification

Most often, a tumor forms (basal cell carcinoma) on the head:

Less common is basal cell carcinoma of the skin of the back and extremities.

The classification includes the following forms or types of basal cell carcinoma:

nodular basalioma (ulcerative);
pagetoid superficial basalioma (pagetoid epithelioma);
nodular large nodular or solid basal cell carcinoma;
adenoid basal cell carcinoma;
perforating;
warty (papillary, exophytic);
pigmented;
sclerodermiformis;
cicatricial-atrophic;
Spiegler's tumor (“turban” tumor, cylindroma).

Clinical classification:

Designations and their explanation:

T Primary tumor
Tx There is insufficient data to evaluate the primary tumor
T0 Primary tumor cannot be determined
Тis Preinvasive carcinoma (carcinoma in situ)
T1 Tumor size – up to 2 cm
T2 Tumor size – up to 5 cm
T3 Tumor size is more than 5 cm, soft tissue is destroyed
T4 Tumor grows into other tissues and organs

Stages of basal cell carcinoma

Since basal cell carcinoma in the initial stage (stage T0) looks like an unformed tumor or pre-invasive carcinoma (carcinoma in situ - Tis), it is difficult to determine despite the appearance of cancer cells.

When diagnosed with stage 1 basal cell carcinoma, the tumor or ulcer reaches a diameter of 2 cm, is limited to the dermis and does not spread to nearby tissues.
In the very large size Stage 2 skin basalioma reaches 5 cm, grows through the entire thickness of the skin, but does not spread to the subcutaneous tissue.
Stage 3 skin basal cell carcinoma grows deeper than 5 cm. The surface becomes ulcerated and the subcutaneous fatty tissue is destroyed. Next comes damage to the muscles and tendons - soft tissues.
If stage 4 skin basal cell carcinoma is diagnosed, then the tumor, in addition to ulcerations and damage to soft tissues, destroys cartilage and bones.

Degree of prevalence of basal cell carcinoma

We explain how to identify basal cell carcinoma using a simpler classification. It includes basalioma:

The initial stage includes T0 and T1 of precise classification. Basaliomas look like small nodules with a diameter of less than 2 cm. There are no ulcerations.

The advanced stage includes T2 and T3. The tumor will be large, up to 5 cm or more, with primary ulcerations and soft tissue lesions.

Terminal stage includes T4 precise classification. The tumor grows up to 10 centimeters or more and invades the underlying tissues and organs. In this case, multiple complications may develop due to the destruction of organs.

Risk factors for basal cell carcinoma

Children and adolescents rarely get this type of cancer. Basal cell carcinoma appears more often on the face of men and women after 50 years of age. The tumor also affects other exposed areas of the skin.

Due to excessive exposure to direct sunlight and smoking, basal cell carcinoma of the nasal skin may occur. For chronic diseases of the facial skin - basal cell carcinoma of the eyelid. If there are carcinogenic substances in the production environment, for example, basal cell carcinoma auricle and hands, with old scars from periodic and frequent burns - appears on the skin of the torso and limbs, on the neck.

If basal cell carcinoma appears, the causes may be related to the following factors:

genetic;
immune;
unfavorable external;
skin (with senile keratosis, radiodermatitis, tuberculous lupus, nevi, psoriasis, etc.).

You can't mistake a lump for acne. It needs to be treated because it can destroy even the bones of the skull, lead to thrombosis of the meninges and death.

How does the disease manifest itself?

Manifestation of basal cell carcinoma

Anatomically, the formation looks like a flat plaque, nodule, superficial ulcer or extensive deep ulceration with a dark red bottom.

Signs of basal cell carcinoma at the microscopic level are characterized by emerging strands and complexes consisting of intensely colored small cells. They are limited on the periphery by prismatic cells with the presence of nuclei located basally. The nuclei have long axes located at right angles to the border of the complex or cord. In this case, the grouping of cells will be parallel.

Inside the cells there is a small amount of cytoplasm with dark round, oval or elongated nuclei. Are different small cells from basal epithelial skin cells by the absence of intercellular bridges. The cells inside the complexes and cords are even smaller in size and their arrangement is random and more loose.

Clinical symptoms of basal cell carcinoma first appear as a dense, pinkish, pinkish-yellowish or matte white micro-nodule in the form of a pearl. It protrudes above the skin and tends to merge with a group of similar nodules, forming a plaque with telangiectasias (meshes or asterisks) - persistent dilatation of capillaries, venules or arterioles, the nature of which is not associated with inflammation.

In the center of the plaque, spontaneous disappearance of individual nodules or their ulceration may occur with the formation of a ridge consisting of dull whitish nodules along the periphery. In the future, the disease can manifest itself in two tumor states:

ulceration with the formation of erosion in the center with the presence of an uneven bottom or ulcer, the edges of which will have a crater-like shape. With the gradual spread of the ulcer in depth and over the area, the underlying tissues will be destroyed: bones or cartilage and acute pain will occur;
tumor without ulceration. Her skin will be very thin and shiny and will have telangiectasia. Sometimes the tumor protrudes above the skin and has a lobed, cauliflower-shaped structure with a wide or narrow base.

Nodular-ulcerative basalioma of irregular shape manifests itself with all clinical symptoms and is most often formed in the area of the eyelid, the inner corner of the eye and the nasolabial fold.

A perforating tumor can appear in the same places due to frequent trauma to the skin. But it grows faster and destroys surrounding tissue more actively than nodular-ulcerative tissue.

A nodular large-nodular or solid tumor in the form of a single node above the skin is covered with spider veins - solid cords and complexes with scalloped outlines that tend to merge into massive formations. It grows outward and is surrounded by a “pearl” cushion. Due to the dark pigmentation in the center or along the edges, it is mistaken for melanoma of the skin.

An adenoid formation (cystic) consists of cyst-like structures and glandular tissue, giving it a lace-like appearance. The cells here are bordered in regular rows by small cysts with basophilic contents.

Symptoms of superficial multicentric (pagetoid) basal cell carcinoma are manifested by a round or oval plaque with a border of nodules along the periphery and a slightly sunken center covered with dry scales. Telangiectasia in the thinned skin can be seen underneath them. At the cellular level, it consists of many small lesions with small dark cells in the superficial layers of the dermis.

A warty (papillary, exophytic) tumor can be mistaken for a cauliflower-shaped wart due to dense hemispherical nodes growing on the skin. It is characterized by the absence of destruction and does not grow into healthy tissues.

Pigmented neoplasm or pagetoid epithelioma comes in a variety of colors: bluish-brown, brownish-black, pale pinkish and red with raised pearl-like edges. With a long, torpid and benign course, it reaches 4 cm.

In the cicatricial-atrophic (flat) form of the tumor, a nodule is formed, in the center of which an ulcer (erosion) forms, which spontaneously scars. The nodules continue to grow on the periphery with the formation of new erosions (ulcers).

During ulceration, an infection occurs and the tumor becomes inflamed. With the growth of primary and recurrent basalioma, the underlying tissues (bones, cartilage) are destroyed. It can move into nearby cavities, for example, from the wings of the nose - into its cavity, from the earlobe - into the cartilage of the shell, destroying them.

A sclerodermiform tumor is characterized by a transition from a pale nodule as it grows into a dense and flat plaque with a clear contour of the edges. Over time, ulcers appear on the rough surface.

Spiegler's tumor (cylindroma) is characterized by the appearance of multiple benign pink-violet nodes covered with telangiectasia. When localized under the hair on the head, it lasts for a long time.

Diagnosis of basal cell carcinoma

If, after a visual examination, a doctor suspects a basal cell carcinoma in a patient, the diagnosis is confirmed by cytological and histological examination of fingerprint smears or scrapings from the surface of the tumor. In the presence of strands or nest-like clusters of spindle-shaped, round or oval cells with thin rims of cytoplasm around them, the diagnosis is confirmed. Tests for skin cancer (smear impression) are taken from the bottom of the ulcer and the cellular composition is determined.

If, for example, the tumor marker CA-125 is used to diagnose ovarian cancer, then there are no specific oncological blood markers to determine the malignancy of basal cell carcinoma. They could accurately confirm the development of cancer in her. In the rest laboratory tests leukocytosis can be detected, increased speed erythrocyte sedimentation, positive thymol test, increased C-reactive protein. These indicators are consistent with others inflammatory diseases. There is some confusion in the diagnosis, so they are rarely used to confirm the diagnosis of neoplasms.

However, due to the varied histological picture of basal cell carcinoma, as well as its clinical forms, differential diagnosis is carried out to exclude (or confirm) other skin diseases. For example, lupus erythematosus, lichen planus, seborrheic keratosis, Bowen's disease should be differentiated from flat superficial basal cell carcinoma. Melanoma (cancer of a mole) - from the pigmented form, scleroderma and psoriasis - from the sclerodermiform tumor.

Informative video: biopsy and CO2 laser removal of basal cell carcinoma of the skin of the dorsum of the nose

Treatment methods for basal cell carcinoma. Removal of basal cell carcinoma

When cellular skin cancer is confirmed, treatment methods are selected depending on the type and how much the tumor has grown and grown into neighboring tissues. Many people want to know how dangerous basal cell carcinoma is and how to treat it so that there are no relapses. The most proven method of treating small tumors is surgical removal of basal cell carcinoma using local anesthesia: lidocaine or ultracaine.

When the tumor grows deep inside and into other tissues, surgical treatment of basal cell carcinoma is used after irradiation, i.e. combined method. In this case, the cancerous tissue is completely removed to the border (edge), but if necessary, they enter the nearest healthy areas of the skin, retreating 1-2 cm from it. With a large incision, a cosmetic suture is carefully applied and removed after 4-6 days. The sooner the formation is removed, the higher the effect and the lower the risk of relapse.

Treatment is also carried out using the following effective methods:

radiation therapy;
laser therapy;
combined methods;
cryodestruction;
photodynamic therapy;
drug therapy.

Radiation therapy

Radiation therapy is well tolerated by patients and is used for small tumors. The treatment is long-term, at least 30 days, and has side effects, since the rays affect not only the tumor, but also healthy skin cells. Erythema or dry epidermitis appears on the skin.

Mild skin reactions go away on their own, “persistent” ones require local therapy. Radiation therapy in 18% of cases is accompanied by various complications in the form trophic ulcers, cataracts, conjunctivitis, headaches, etc. Therefore, symptomatic treatment is carried out or with the use of hemostimulating agents. Treatment of the sclerosing form of basalioma with radiation therapy is not carried out due to its extremely low effectiveness.

Laser therapy

Once the diagnosis of basal cell skin cancer or basal cell carcinoma is confirmed, laser treatment has almost completely replaced other methods of tumor removal. During one session it is possible to get rid of the disease with a carbon dioxide laser. The tumor is exposed to CO2 and is evaporated layer by layer from the skin surface. The laser does not touch the skin and only affects the affected area with temperature, without touching healthy areas.

Patients do not feel pain, since during the procedure there is anesthesia while being protected by cold. There is no bleeding at the removal site, a dry crust appears, which will disappear on its own within 1-2 weeks. You should not peel it off yourself with your nails to avoid infection.

Laser removal of basal cell carcinoma

This method is suitable for patients of all ages, especially the elderly. If basal cell carcinoma or basal cell carcinoma is detected, laser treatment will be preferable due to the following advantages of this method:

relative painlessness;
bloodlessness and safety;
sterility and non-contact;
high cosmetic effect;
short rehabilitation;
exclusion of relapses.

Cryodestruction

What is basalioma and how to treat it if there are many formations on the face or head, there are large, neglected ones and growing into the bones of the skull? This is a cell from the basal layer of the skin that, by dividing, has grown into a large tumor. In this case, cryodestruction will help, especially for those patients who develop rough (keloid) scars after operations, who have pacemakers and receive anticoagulants, including Warfarin.

Information! According to the results of the study, after cryodestruction, relapses occur in 7.5%, after surgery– in 10.1%, after radiation therapy – in 8.7% of all cases.

The list of advantages of cryodestruction includes:

excellent cosmetic results when removing large formations on any part of the body;
performing outpatient treatment without the use of anesthesia, but under local anesthesia;
no bleeding and long rehabilitation period;
the ability to use the method in elderly patients and pregnant women;
the ability to treat with cold for concomitant diseases in patients who are contraindications for the surgical method.

Information! Cryodestruction, unlike radiation therapy, does not destroy the DNA of the cells surrounding the basalioma. It promotes the release of substances that enhance immunity against the tumor and prevents the formation of new basal cell carcinomas at the site of removal and in other areas of the skin.

After a biopsy confirming the diagnosis, to prevent discomfort and pain during cryodestruction, local anesthetics are used (Lidocaine - 2%) and/or Ketanol (100 mg) is given to the patient an hour before the procedure for pain relief.

If liquid nitrogen is used as a spray, then there is a risk of nitrogen spreading. Cryodestruction can be carried out more accurately and deeper using a metal applicator that is cooled liquid nitrogen.

It is important to know! Freeze yourself with tampons with Wartner Cryo or Cryopharm squamous cell carcinoma or basalioma is not possible (does not make sense), since freezing occurs only to a depth of 2-3 mm. It is impossible to completely destroy basal cell carcinoma cells using these means. The tumor is covered with a scar on top, and oncogenic cells remain in the depths, which is fraught with relapse.

Photodynamic therapy

Photodynamic therapy for basal cell carcinoma is aimed at selective destruction of tumor cells with substances called photosensitizers when exposed to light. At the beginning of the procedure, a medicine, such as Photoditazine, is injected into the patient's vein to accumulate in the tumor. This stage is called photosensitization.

When a photosensitizer accumulates in cancer cells, basalioma is examined under ultraviolet light to mark its border on the skin, since it will glow pink and fluorescence occurs, which is called video fluorescent marking.

Next, the tumor is illuminated with a red laser with a wavelength corresponding to the maximum absorption of the photosensitizer (for example, nm for Photoditazine). The laser density should not heat living tissue above 38°C (100 MW/cm). The time is set depending on the size of the tumor. If the tumor is the size of 10 kopecks, then the irradiation time is minutes. This stage is called photo exposure.

When oxygen enters chemical reactions the tumor dies without damaging healthy tissue. In this case, cells of the immune system: macrophages and lymphocytes absorb the cells of the dead tumor, which is called photoinduction of immunity. Relapses do not occur at the site of the original basal cell carcinoma. Photodynamic therapy is increasingly replacing surgical and radiation treatment.

Drug therapy

If research confirms basal cell carcinoma, treatment with ointment is prescribed in courses of 2-3 weeks. Ointments for occlusive dressings are used locally:

fluorouracil – 5% after pre-treatment skin Dimexide;
omainova (kolhaminova) – 0.5-5%;
fluorafuric acid – 5-10%;
podophylline – 5%;
glyciphonic acid – 30%;
prospidinova – 30-50%;
metvix;
curaderm;
solcoseryl;
as applications - colchamine (0.5%) with the same part of Dimexide.

The ointment should be applied, covering the surrounding skin by 0.5 cm. To protect healthy tissues, they are lubricated with zinc or zinc salicylic paste.

If chemotherapy is carried out, then Lidaza and Wobe-mugos E are used. Multiple basal cell carcinomas are treated with intravenous or intramuscular infusion of Prospidin before cryodestruction of the lesions.

For tumors up to 2 cm, if they are localized in the corners of the eyes and on the eyelids, interferons are used inside the auricle, since laser, chemotherapy or cryodestruction, as well as surgical excision cannot be used.

Treatment of basal cell carcinomas is also carried out with aromatic retinoids, which can regulate the activity of the components of the cyclase system. If drug therapy is interrupted or there are tumors larger than 5 cm, undifferentiated and invasive basal cell carcinomas, relapses may occur.

Traditional therapy for the treatment of skin basal cell carcinoma. Recipes for ointments and tinctures

Important! Before treating basalioma with folk remedies, it is necessary to do an allergy test to all herbs that will be used so as not to aggravate the condition.

The most popular folk remedy is a decoction based on celandine leaves. Fresh leaves(1 tsp.) Place in boiling water (1 tbsp.), Let stand until cool and take 1/3 tbsp. three times a day. You need to prepare a fresh decoction every time.

If there is a single or small basalioma on the face, treatment with folk remedies is carried out by lubricating:

fresh celandine juice;
fermented celandine juice, i.e. after infusing for 8 days in a glass bottle with periodic opening of the cap to remove gases.

Golden mustache juice is used as a compress during the day, applying moistened cotton swabs, securing them with a bandage or plaster.

Ointment: powder from burdock and celandine leaves (¼ cup each) is mixed well with melted pork fat and simmered in the oven for 2 hours. Apply to the tumor 3 times a day.

Ointment: burdock root (100 g) is boiled, cooled, kneaded and mixed with vegetable oil (100 ml). Continue boiling the mixture for 1.5 hours. Can be applied to the nose, where it is inconvenient to use compresses and lotions.

Ointment: prepare a collection by mixing birch buds, spotted hemlock, meadow clover, great celandine, burdock root - 20 grams each. Finely chopped onion (1 tbsp) is fried in olive oil (150 ml), then it is collected from the frying pan and pine resin (resin - 10 g) is placed in the oil, after a few minutes - a collection of herbs (3 tbsp) , after 1-2 minutes, remove from heat, pour into a jar and close tightly with a lid. Infuse for a day in a warm place. Can be used for compresses and to lubricate tumors.

Remember! Treatment of basal cell carcinoma with folk remedies serves as a complement to the main method of treatment.

Life expectancy and prognosis for skin basal cell carcinoma

If basal cell carcinoma is detected, the prognosis will be favorable, since metastases do not form. Early treatment of the tumor does not affect life expectancy. In advanced stages, tumor size more than 5 cm and frequent relapses, survival rate within 10 years is 90%.

As measures to prevent basal cell carcinoma, you should:

protect the body, especially the face and neck, from prolonged exposure to direct rays of the sun, especially if you have fair skin that does not tan;
use protective and nourishing creams preventing dry skin;
radically treat non-healing fistulas or ulcers;
protect skin scars from mechanical damage;
strictly observe personal hygiene after contact with carcinogenic or lubricants;
promptly treat precancerous skin diseases;
eat healthy and healthy.

Conclusion! To prevent and treat basal cell carcinoma, comprehensive methods should be used. If new growths appear on the skin, you should immediately consult a doctor for early treatment. This will preserve the nervous system and prolong life.

Informative video: basal cell skin cancer and new treatment options

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Basal cell skin cancer, photos, treatment and prognosis.

How does basal cell skin cancer differ from basal cell carcinoma?

Basal cell carcinoma is the same as basal cell carcinoma. This term is used by oncologists (including me) when it is necessary to reach common sense or the instinct of self-preservation in careless patients. Also the term basal cell carcinoma usually used by histologists, and written in the histological report after a basal cell carcinoma biopsy. From a scientific point of view, it is more correct and better reflects the characteristics of the disease. After all, most tumors ending in oma (except for the term carcinoma) are benign.

Basal cell carcinoma, prevalence.

In people of European appearance, the risk of developing basal cell skin cancer during their lifetime is 30% (it will appear in one in three). Men get sick 2 times more often than women. People over 50 years of age usually get sick. Interestingly, basal cell carcinoma is more common in women under 40 years of age than in men. This is due to the fact that there is a fashion for tanning in hot countries and solariums.

Causes of basal cell carcinoma.

Like any cancer, basal cell cancer has many causes, most often a combination of them leads to the disease. Here we distinguish between external and internal. The main cause of basal cell carcinoma is sunlight damaging the DNA of skin cells, leading to mutations in them.

Causes of basal cell carcinoma

Basal cell carcinoma, manifestations on the skin, photo.

Typically, basal cell carcinoma appears as a pearly pink or light mole with dilated blood vessels. The cancer can also be translucent or slightly reddened with raised, roll-like edges, sometimes barely noticeable. In the area of basal cell carcinoma, the skin may bleed, become scarred, or crust over, but does not hurt. Eighty percent of tumors appear on the scalp and neck, 15% on the torso, and only 5% on the arms and legs. For accurate diagnosis The oncologist must take a piece of the tumor and send it for histological examination (histology).

Types of basal cell skin cancer, photo.

The nodular variety is the most common. Consists of one or more nodules, waxy or red, translucent with dilated vessels. There may be a depression in the center and an ulcer under the crust.

Superficial basal cell carcinoma is often larger than other types and appears primarily on the torso. It looks like a red plaque with peeling, slight scarring, and irregular jagged borders. Superficial basal cell skin cancer may resemble psoriasis, fungus, or eczema.

Pigmented basal cell carcinoma appears more often in people with dark skin. It looks like a mole or melanoma with its dark coloring. Other signs are approximately the same as

in the nodal variety.

Cystic basal cell skin cancer is filled with fluid. The shape is more rounded appearance than in nodular cancer.

Sclerosing (morpheaform) variety. It resembles a scar, appears as a depressed plaque with poorly defined edges, dense to the touch. Its treatment is difficult.

The basosquamous (metatypical) type resembles the more squamous cell skin cancer. It is a variant of basal cell carcinoma with faster growth, a greater tendency to recurrent metastases, and treatment is difficult.

The ulcerative (infiltrative) variety is ultimately the result of further development of any of the other forms of basal cell skin cancer. Previously, a tumor of this type was called a “gnawing ulcer” abroad. This transition significantly worsens the effectiveness of treatment and prognosis.

Pincus fibroepithelioma is also a type of basal cell carcinoma, but is quite rare, resembles a flesh-colored mole, sometimes crusts over and bleeds.

Basal cell carcinoma, treatment methods.

Basal cell carcinoma should be treated immediately after it appears. Before treatment, the oncologist assesses the size, determines the type of tumor, and takes a piece of the tumor for a biopsy.

Conventional surgical removal, or removal with flap closure, is performed in the vast majority of cases, for any type of tumor, if there are no contraindications. Radiation therapy (irradiation) takes about a month and is acceptable for any type of basal cell carcinoma. Radiation is recommended only for patients over 65 years of age due to the increased risk of new skin cancer developing in adjacent areas of healthy skin.

Cryodestruction can be performed for any shape and size of basal cell carcinoma. But you will have to take care of the wound in the future. In Russia, the availability of cryodestruction is not high.

Laser treatment without a photosensitizer or electrodissection can be performed only for small basal cell carcinomas of a favorable variety, but the relapse rate is still high. Basal cell carcinoma of sclerosing, ulcerative, and metatypic varieties cannot be treated with these methods.

Photodynamic therapy can be carried out for superficial forms, even if the basal cell carcinoma is more than 2 cm in diameter. Its cost is high. Recurrence rate from 12% to 22% If the basal cell carcinoma is of the deep ulcerative or sclerosing variety, the laser beams will not penetrate into the depths, this method should be avoided.

Recurrence of basal cell carcinoma.

The reappearance of basal cell skin cancer in the same location after treatment is a relapse. Relapses are less responsive to treatment and have a greater risk of further growth, metastasis, and mortality.

Basal cell carcinoma relapses, the frequency of which depends on the method of treatment, the attending physician, the size and type of basal cell carcinoma.

Recurrence rate of basal cell carcinoma for tumors up to 2 cm in size.

For tumors larger than 2 cm, the relapse rate can double. If basal cell carcinoma is more than 5 cm in diameter, the recurrence rate increases approximately 3 times.

Basal cell carcinoma, prognosis

Typically, basal cell skin cancer grows slowly over many years and does not bother patients. The development of cancer is unpredictable; it can remain small for many years and then grow very quickly. Or grow in steps, sometimes even significantly decreasing in size, and then increasing even more. Often, elderly patients expect that they will die from concomitant diseases before basal cell carcinoma causes them any trouble. And, therefore, they refuse treatment, thereby dooming themselves to suffering. Because the tumor grows faster and faster over time. It is necessary to start treatment as early as possible to increase its effectiveness and reduce mortality from basal cell skin cancer.

Such features as size larger than 2 cm, location in the central part of the face, in the ear area, long duration, unclear tumor boundaries have a bad effect on the prognosis. If basal cell carcinoma grows into the underlying tissues and bones and grows to gigantic sizes (more than 10 cm), treatment is often not possible.

Basal cell carcinoma metastases, mortality.

Basal cell skin cancer very rarely metastasizes, ranging from 0.0025% to 0.55% of cases. Metastases usually occur against the background of large advanced tumors on the head and neck, mainly in men. The incidence of metastases is most closely related to tumor size and depth. If basal cell carcinoma exceeds 3 cm in diameter, the risk of metastases is 1-2%. If the tumor is more than 5 cm, metastases appear in 20-25% of people. If the cancer has grown more than 10 cm, the risk of metastasis is already up to 50%. First of all, metastases go to regional lymph nodes, less frequently to the lungs, bones and other organs. The appearance of metastases significantly increases mortality from basal cell carcinoma. On average, people with basal cell carcinoma metastases live 10 months. Only 20% of people will live with basal cell carcinoma metastasis for more than 1 year, and only 10% for more than 5 years.

Basalioma (basal cell skin cancer, basal cell epithelioma) is a skin neoplasm that originates in the upper (basal) layers of the skin. The disease occurs in people over 50 years of age, and is less common in adolescents and newborns. Single tumors prevail, located in open areas of the body and scalp. Bzalioma of the auricle, chin, nose, neck, arm and leg are the most common diagnoses among oncological skin pathologies.

Basal cell epithelioma is most common in Australia, the USA, and Europe. The incidence rate increases by 2% annually. Young people are more often exposed to superficial skin cancer, while old people are more likely to suffer from severe forms of the pathology, which worsens the prognosis for recovery. Men get sick more often than women.

The ICD disease code is C44; it is often used to mark medical histories, making it easier to maintain statistics. Able-bodied people and children are assigned disability for the duration of treatment or rehabilitation. If the neoplasm is treated with liquid nitrogen or laser, then a sick leave is issued.

Classification of the disease

The disease is classified according to various principles. Most often, the form and stage of neglect are determined as the main indicators. To prescribe adequate treatment, it is very important to determine the type of basal cell carcinoma. The disease is most often divided into the following forms:

superficial basalioma;
nodular basal cell carcinoma;
solid basal cell carcinoma;
flat basalioma;
pigment basal cell carcinoma;
warty basalioma;
scleroderma-like basalioma;
adenoid basal cell carcinoma;
ulcerative basalioma.

There is a classification of the disease according to stages of development (neglect). There are only four of them:

first (I) – initial stage. The size of the neoplasm is up to 2 cm. The surrounding dermis is not changed, it has completely normal color and turgor.
second (II). The tumor has grown to the entire depth of the epidermis, but has not had time to affect the subcutaneous fat;
third (III). Epidermal skin cancer varies in size but affects all soft tissue underneath the affected area;
fourth (IV) – advanced stage. Not only skin and soft tissues suffer, but also bones and cartilage tissue.

Causes

The causes of basal cell carcinoma have not been fully elucidated. It begins its development from the basal cells of the skin or hair follicle. But this theory has hundreds of opponents, many evidentiary arguments are subject to great doubt. Oncologists say that the pathology can be provoked various factors. Let's list them:

contact with the skin of carcinogenic substances (arsenic, petroleum products, soot, some types of dyes);
birth defects;
tars contained in cigarettes;
extremely high/low temperatures affecting skin cells;
intense insolation (stay in the bright midday sun);
frequent visits to the solarium;
various pathologies of the skin (senile keratosis, radiodermatitis, tuberculous lupus, psoriatic rashes);
rough old scars;
long-term work activity outdoors;
albinism, naturally fair skin;
excessive pigmentation of epidermal cells;
dryness skin.

Many world luminaries of medicine “blame” reduced immunity and psychosomatics for the development of basal cell carcinomas. Cancer begins to develop from skin cells when the body’s defenses are reduced, internal natural barriers are weakened, and the endocrine system is disrupted. There are endless debates surrounding the mechanism of disease development. With the development of science, many hypotheses regarding the causes of the development of basal cell carcinomas are refined or rejected. It will take time until answers to all questions are found.

Diagnostic methods

In the early stages, diagnosis of the disease is difficult due to the similarity of symptoms with other skin pathologies. After carefully collecting an anamnesis of the disease (when and how the disease developed) and a life history (presence of bad habits, occupational hazards), you need to begin examining the nearby lymph nodes. In advanced stages of oncology, they are enlarged and dense on palpation.

The doctor's main task is to distinguish benign tumor from a malignant neoplasm. Further treatment of these pathologies differs fundamentally; an error in diagnosis is fatal. To verify the diagnosis, histological analysis of a sample of the affected tissue is required. In parallel, all women are prescribed a cytogram.

The histology of the tumor is determined by a histologist in the cytology laboratory available at each regional oncology clinic and large oncology clinic. Histological analysis will also show the type of cancer (skin cancer itself, melanoma). To determine the morphology it is enough:

smear;
scraping;
biopsies.

The material is collected from the punctate or the most ulcerated surface, trying to capture as much of the discharge as possible. A tissue biopsy is taken for analysis. Histology and cytology are the main methods for diagnosing all neoplasms. Ultrasound, computed tomography, and dermatoscopy are used less frequently.

Symptomatic picture

Symptoms of flat basal cell carcinoma are always the same: a plaque appears, located at the level of the skin. A ridge-like edge separates the neoplasm from healthy tissue. It is slightly raised above the epidermis. This form of basal cell carcinoma has the most favorable prognosis for recovery.

What does the nodular form of basalioma look like? The nodular form of basalioma is always raised above the skin. It has a pronounced depression “crowning” the center of the tumor. Even with minimal trauma, the neoplasm bleeds (bleeding appears), which subsequently quickly leads to anemia and cachexia (exhaustion) of the patient.

Removal of basal cell carcinoma (skin tumor). Video of the operation.

removal of basal cell carcinoma of the nasal skin with Limberg plastic surgery

Biopsy and CO2 laser removal of basal cell carcinoma of the skin of the dorsum of the nose.

Laser removal of basal cell carcinoma

MOHS surgery removal of skin basal cell carcinoma in the forehead area

The superficial form of basal cell carcinoma is easily recognized by its elastic consistency, which takes on a round or oval shape. The edges are no different from the surface of the neoplasm itself. The tumor spreads throughout the body (lower leg, shoulder, back), so superficial and nodular basal cell carcinoma of the skin of the back is a common diagnosis among cancer patients.

The pigmented form of basal cell carcinoma can have a dark, almost black tint, which makes it possible to confuse it with skin melanoma. Basalioma looks like a smooth and shiny plaque of dense consistency. Verification of the diagnosis is carried out only by histological analysis of tissues.

Symptoms of other forms of the disease

The signs of the warty form of basalioma resemble in structure cauliflower. It only grows outwards. The tumor is represented by a combination of nodes of different sizes, which imitates a benign wart. Treatment methods and techniques are already known that provide a 100% prognosis of recovery for this type of illness.

The scleroderma-like (papillary) form of basalioma is limited from healthy tissue by a clear contour. It looks like a plaque, often pale in color. The surface is flat, rough to the touch, and has a dense consistency.

The ulcerative form of basal cell carcinoma may resemble an old ulcer in its symptoms. It is large in size, there is a photo where the tumor exceeds 10 cm in diameter. Ulcerative basal cell carcinoma quickly grows inward, affecting and disrupting the functioning of muscles and nerve trunks. It is very dangerous due to the fact that it grows quickly and is aggressive. Localized in the head and eyes. These are the main manifestations of the ulcerative form of basal cell carcinoma.

What is a relapse?

Many types of basal cell carcinoma tend to be recurrent. After treatment, the tumor re-forms, worsening the prognosis of the disease. You can see what a relapse looks like in the photo. If it is suspected, you should immediately visit your oncologist. Typically, recurrent tumors require serious combined treatment.

Scalpel removal is required, and local chemotherapy, laser therapy, cryogenic or radiation treatment is prescribed before or after surgery. If a new tumor is detected, clinical observation is intensified. You should see a doctor once every 3 months. A general blood test can be prescribed by a doctor once every 6 months (if there is stable remission and no relapses). Excision of a new tumor is done using a scalpel technique.

Types of therapy and principles of treatment

To get rid of skin cancer in almost any location, including behind the ear, laser therapy, cryodestruction, radiation, surgery, combination treatment, and chemotherapy are used. These are specialized types of treatment for the disease, which only an oncologist has the right to prescribe. After identifying a pathology, the patient is required to be sent to an oncology clinic at his place of residence. The oncology office keeps records of patients with a verified diagnosis. The therapeutic regimen is selected taking into account:

stage of basal cell carcinoma (advanced disease);
presence of concomitant diseases;
individual characteristics of the body (fatness, presence of allergies, age, etc.);
types of basal cell carcinomas;
degree of severity of the clinical picture (involvement of nearby tissues, bones, cartilage).

Treatment is carried out in an oncology clinic. This is the most effective, because the patient is advised by a chemotherapist, a surgeon, and a radiation treatment specialist (radiologist). After consultations and the necessary diagnostic tests and studies, the optimal therapeutic regimen is collectively selected at a medical council.

Radiation treatment

The method of treating cancer with close-focus X-rays (x-ray therapy) is the most well-known technique that has undergone decades of clinical use. It is often supplemented with remote gamma therapy. The treatment method is effective in the initial stages of the disease. We list the biggest “disadvantages” of this type of therapy:

decrease in the body's defenses;
deterioration of general health;
hair loss of varying degrees of intensity;
the skin suffers, an area of redness, peeling, and dryness appears;
loss of appetite, up to complete denial of food;
disorders of the digestive and cardiovascular systems;
changes in the central nervous system: heaviness in the head, memory impairment, problems with remembering new information.

Treatment is carried out in the conditions of the radiology department, which exists at every major oncology clinic. All of these negative effects (complications) of radiation therapy are short-term, mild, and quickly disappear with symptomatic therapy. To cure the disease, the course of treatment can be extended to one month or more.

Laser treatment

Laser treatment of basal cell carcinoma is a progressive method of therapy. During treatment, pain and burning may be felt, so use local anesthesia. Applying pain-relieving ointments is usually sufficient. For large tumors, tissue injections with injectable drugs are used. The “advantages” of the procedure include:

no relapses;
good cosmetic effect (minimal scars), which allows the technique to be used on open, visible areas of the body;
minimum rehabilitation period, lasting from several days to 2 weeks;
relative absence of pain, especially with the use of modern local anesthetics.

The cost of laser treatment is in a huge range: it can start from 500 and reach up to 38,000 rubles. But as practice shows, the average value is 6000-9000 rubles. A lot of positive reviews confirm the effectiveness of the procedure. Ideal for the treatment of elderly people due to minimal complications.

Treatment with low temperatures (cryodestruction, cryogenic therapy)

Cryodestruction, as a method of treating cancer, has been used for decades. The mechanism of action is quite simple: under the influence low temperatures, cancer cells die and are destroyed. Relapses after cryodestruction are extremely rare. The technique is suitable for small tumors, especially those localized in areas close to bones and cartilage tissue. But not suitable for treating the area around the eyes.

The neoplasm is treated with liquid nitrogen. The cost of the procedure is 300-1150 rubles. The average price of the procedure is 750 rubles. Large oncology clinics provide a similar service, therefore, due to fierce competition among medical institutions, there is no need to overpay for manipulation. The video will show you what the manipulation looks like.

Photodynamic therapy

Photodynamic therapy - a type laser treatment, the overall efficiency reaches from 78 to 92 percent. The results depend on the qualifications of the doctor and the medications used. The essence of the procedure is the introduction of special drugs into the body that enhance the effect laser beam. The technique is quite expensive.

Manipulation is pointless for tumors large sizes, ulcerative and sclerosing types of basalioma, multiple neoplasms. The method is contraindicated during pregnancy, many systemic diseases(diabetes mellitus, some heart and vascular diseases, etc.).

Chemotherapy

Chemotherapy is used when it is impossible to use another type of treatment. Treatment of basal cell carcinoma with medications has low effectiveness in the early stages of the disease. But the technique has no equal in the formation of metastases, especially to distant organs. Ingestion of anticancer drugs is fraught with complications, poor tolerance, general intoxication.

Local chemotherapy is more effective. It treats almost all forms of basal cell carcinoma, including nodular one. Ointments with cytostatics are applied in the form of applications. The exposure and dosage are selected by the chemotherapist. Treatment is carried out in the chemotherapy department at oncology dispensaries or large oncology clinics. Curaderm cream is suitable for local chemotherapy (you can buy it in Russia for 9,000 rubles), which reduces the risk of relapse.

Surgery

What is surgical treatment? This is the most common type of therapy. Do not use in hard-to-reach locations of basal cell carcinoma (corner of the eye, eyelid, internal ear canal ear). Since scars remain after a scalpel intervention, for a disease that affects the cheeks, forehead and other visible areas of the body, they try to resort to other types of treatment.

Surgery involves excision of the tumor. Resection is done by extending at least 0.5 cm beyond the affected tissue. Scalpel intervention is indispensable for persistent recurrence and the appearance of metastases. Although basalioma is a neoplasm that is sensitive to radiation therapy, in some cases radioresistance (insensitive to radiation therapy) is observed, then without surgical treatment can't get by.

Additionally, surgery may be necessary to close large areas. postoperative wounds. For this purpose, auxiliary intervention is provided using skin flaps. With this approach, the postoperative field heals faster, the risk of colloid scar formation and the penetration of pathogenic flora into the tissue is reduced. Sometimes excision is performed with electrocoagulation.

Traditional treatment

Previously, people used folk methods to get rid of basal cell carcinomas. But this is a rather risky step if you decide to take it without the consent of the oncologist. Only after receiving a full consultation, as an addition to the main therapeutic regimen, do they take drugs according to the prescriptions of healers. Here are a few recipes:

Fraction ASD-3. You should apply lotions for several hours, applying a dampened rag to the affected area.
Celandine. This plant has long been used to treat many skin diseases. Cauterization of the neoplasm is carried out with freshly squeezed juice, for which it is enough to simply break the rod or grind the celandine flower. Use celandine with great care in the eye area (especially in the lower corner), the nipple of the mammary gland, and on the lip.
Ointment from celandine and burdock. Half a glass of dry crushed herbal raw materials is poured into a glass of hot goose fat. Heat the oven low and simmer the mixture for 2 hours, strain, and apply for external local use.

Consequences

The tumor can develop for years without causing discomfort to the person. But this doesn't always happen. Without adequate, complete treatment, the oncological process begins to grow not only in breadth, but also in depth. Invading new areas of the epidermis, the tumor area increases, cutaneous innervation and sensitivity are disrupted, and the vascular bed, especially the capillary network, begins to suffer.

If the tumor begins to grow inward, the muscle fibers and nerve lines are affected. It leads to gross violations functions of the arm, leg, neck and other parts of the body. With advanced basal cell skin cancer (stage 4), bone tissue is destroyed, becoming fragile and brittle. The bone frame cannot cope with the anatomical load, leading to disability of the patient at the oncology clinic.

There are cases when epidermal cancer of the skin of the chest led to self-destruction of the ribs and sternum, complicating the act of breathing, disrupting the functioning of the lungs. People with basal cell carcinoma of the temporal region often die from bone pathology. With each year the disease develops, the risk of metastases to other organs increases and lymphatic system. These are the unpleasant consequences of skin cancer, which is why the disease is dangerous.

Prevention rehabilitation prognosis

Prevention of basal cell carcinomas should begin in early childhood and continue throughout human life. You should avoid excessive insolation (stay in the sun), solarium, give up bad habits, and lead a measured lifestyle. Active sunbathing in the midday sun is prohibited; not only basal cell carcinoma, but also melanoma and keratoma may appear. It is justified to use sunscreen or protect exposed areas of the body in the summer. This applies not only to the elderly and children, but also to the adult population.

An important point in the prevention of any form of basal cell carcinoma is diet. The diet should be filled as much as possible with plant proteins, vegetables, and seasonal fruits. Accidental injuries to old scars, especially rough ones consisting of colloidal tissue, should be avoided. Timely sanitation of difficult-to-heal wounds or extensive burn surfaces will help avoid the development of an oncological process.

The duration of rehabilitation depends on the stage of the disease. If the tumor is detected at the beginning of its development, then rehabilitation measures are not so serious: vitamin complexes, establishing nutrition, systematic hygiene of the skin, promoting health in general. Basalioma is not contagious and does not require isolation of the sick person for the period of rehabilitation after any type of treatment.

With timely detection of the lesion and receipt of adequate treatment, the prognosis is favorable due to the absence of a pronounced tendency to form metastases. If the tumor is more than 20 mm in diameter and detected in late stages, it can be fatal. The larger the tumor itself, the more pronounced the cosmetic defect.

The most interesting on the topic

Many types of basal cell carcinoma tend to be recurrent. After treatment, the tumor re-forms, worsening the prognosis of the disease.

You can see what a relapse looks like in the photo. If it is suspected, you should immediately visit your oncologist.

Typically, recurrent tumors require serious combined treatment.

You should see a doctor once every 3 months. A general blood test can be prescribed by a doctor once every 6 months (if there is stable remission and no relapses).

Excision of a new tumor is done using a scalpel technique.

Basal cell carcinoma is distinguished by its persistent relapsing course. Quite often, invasion occurs in almost all skin layers, including the deepest ones.

This process can cause cosmetic functional defects on the skin surface. People of all ages are affected by the disease, however, as statistics show, every fourth person before and after 50 years of age who is sensitive to sun exposure and has fair skin is at risk.

Basalioma - general characteristics and mechanism of tumor development

Basalioma is also called basal cell carcinoma of the skin, corrosive

Or skin carcinoid. All these terms are used as synonyms to refer to the same pathology, namely, skin tumors from atypically changed cells of the basal layer of the epidermis.

Currently, basal cell carcinomas account for 60 to 80% of all types of skin cancer. Tumors develop mainly in people over 50 years of age.

In more at a young age Basaliomas are practically not found. In the population, the tumor affects men somewhat more often.

The total lifetime risk of developing this type of skin cancer is 30–35% for men and 20–25% for women. That is, the tumor occurs quite often - in every third man and every fourth woman.

Causes of skin cancer

The reasons that provoke the development of basal cell carcinoma are almost the same as in other cases of malignant skin diseases.

Why does she appear

Namely:

constant exposure of the skin to sunlight (UV) rays (this results in the formation of dimeric thymine - structural damage to the DNA molecule, which provokes the development of tumors)
negative impact of ionizing radiation;
occupational hazards (working with carcinogenic substances);
hereditary (genetic) predisposition to skin diseases

At present, the issue of histogenesis (the set of processes leading to the formation) has not yet been completely resolved. of this disease. Many are of the opinion that basal cell skin cancer develops from pluripotent epithelial cells.

Differentiation can occur in different directions. Let us list some reasons that, according to most experts, can provoke the development of this pathology:

Genetic predisposition.
Disturbances in the functioning of the immune system.
External influences of unfavorable factors.
Development against the background of senile keratosis, radiodermatitis, tuberculous lupus, psoriasis.

Types of basal cell carcinoma

Taking into account the main symptoms of basal cell carcinoma, the following forms can be distinguished:

Nodular-ulcerative; fibroepithelial; pigmented; superficial; scleroderma-like morphea type.

By external manifestations and localization sites, basal cell carcinoma is divided into several types:

Nodular basalioma. This type of basal cell carcinoma is considered “classic”. It looks like a pink round formation, as if growing outward, which quickly ulcerates and provokes the destruction of surrounding tissues. Nodular basal cell carcinoma is:

coarsely nodular
conglobed
warty
tumor-ulcerative.

We can say that other types of tumors are formed from the nodular type of baseloma.

what types of basal cell carcinoma exist?

2. Scarring basalioma. This is a superficial type of basal cell carcinoma, looking like a growing lesion, which consists of a central (scar-like) part and a surrounding area. This area may be covered with crusts, ulcers, and erosions.

3. Erythematous (pagetoid) basalioma is also superficial.

It looks like a spot (one or more) of red or reddish-brown color, the entire surface of which is covered with uneven crusts or scales.

The spot is separated from healthy skin by raised edges, similar to a thin roller. In the center there may be ulcers, scars, blood crusts, vascular networks (telangiectasia).

Erythematous basalioma grows very slowly, most often localized on the face and torso.

4. Pigmented basalioma. This type differs from others in its brownish coloration (net-like or dotted). It is usually localized on the face and torso.

5. Sclerodermiform basalioma.

This is a rare type of basal cell carcinoma that appears as a small, well-defined spot (flat or slightly raised) with a whitish-yellowish coloration.

The ridge surrounding it is usually absent. The center of the lesion may be covered with telangiectasias, colorless spots, and in very rare cases, ulcerations.

It is usually located on the face.

6. Vegetating basalioma.

This type is also very rare. It looks like a nodular formation, raised high above the surface of the skin.

On top, the formation may be warty or erosive. One of distinctive features Vegetating basalioma is its size, which is often quite large (sometimes they are 20 cm in diameter).

This type of basal cell carcinoma can develop due to incomplete removal of another form of basal cell carcinoma, which can “go” under the skin and affect nearby lymph nodes. also in medical literature Deep vegetative basal cell carcinomas have been described, which grow rapidly, choosing locations in the lower lip, arms and legs, torso and genitals.

According to the forms, skin basal cell carcinoma can be:

superficial basalioma;
nodular basal cell carcinoma;
solid basal cell carcinoma;
flat basalioma;
pigment basal cell carcinoma;
warty basalioma;
scleroderma-like basalioma;
adenoid basal cell carcinoma;
ulcerative basalioma.

There is a classification of the disease according to stages of development (neglect). There are only four of them:

first (I) – initial stage. The size of the neoplasm is up to 2 cm. The surrounding dermis is not changed, it has completely normal color and turgor.
second (II). The tumor has grown to the entire depth of the epidermis, but has not had time to affect the subcutaneous fat;
third (III). Epidermal skin cancer varies in size but affects all soft tissue underneath the affected area;
fourth (IV) – advanced stage. Not only skin and soft tissues suffer, but also bones and cartilage tissue.

To get rid of skin cancer in almost any location, including behind the ear, laser therapy, cryodestruction, radiation, surgery, combination treatment, and chemotherapy are used.

These are specialized types of treatment for the disease, which only an oncologist has the right to prescribe. After identifying a pathology, the patient is required to be sent to an oncology clinic at his place of residence.

The oncology office keeps records of patients with a verified diagnosis. The therapeutic regimen is selected taking into account:

stage of basal cell carcinoma (advanced disease);
presence of concomitant diseases;
individual characteristics of the body (fatness, presence of allergies, age, etc.);
types of basal cell carcinomas;
degree of severity of the clinical picture (involvement of nearby tissues, bones, cartilage).

Treatment is carried out in an oncology clinic. This is the most effective, because the patient is advised by a chemotherapist, a surgeon, and a radiation treatment specialist (radiologist).

After consultations and the necessary diagnostic tests and studies, the optimal therapeutic regimen is collectively selected at a medical council.

This type of cancer is also called basal cell carcinoma. It most often develops on the face, neck or nose. Prefers to affect the male population over 40 years of age. It has been noted that representatives of the Mongoloid and Negroid races are not susceptible to this species cancer.

The name “basal cell carcinoma” comes from the fact that cancer cells begin their development from the basal layer of the skin, which is located deepest.

If we consider the histology, then this pathology classified as undifferentiated and differentiated cancer. The first category includes:

solid basal cell carcinoma;
pigment;
morphea-like;
superficial.

Differentiated is divided into:

keratotic basal cell carcinoma;
cystic;
adenoid.

According to the international classification, the following types of skin cancer are distinguished:

There is a classification of this pathology according to the type of manifestation. The following types are distinguished:

Nodular-ulcerative basalioma. Consider this basal cell skin cancer. The initial stage (the photo confirms this) is characterized by the appearance of a nodule on the eyelids and in the corners of the mouth. The surrounding skin is pink or reddish in color with a matte or shiny surface. After some time, the nodule turns into an ulcer with a greasy coating. After some time, a vascular network appears on the surface, the ulcer becomes covered with a crust, and seals form along the edges. Gradually, the ulcer begins to bleed and grow into the deeper layers of the skin, but metastases do not form.
If the ulcer heals in the center and continues to grow at the edges, then we are talking about cicatricial atrophic basal cell carcinoma.
Perforating basal cell carcinoma develops most often in areas that are frequently injured. Very similar to the nodular-ulcerative form, but develops at a much faster rate.
The warty form of cancer resembles a head of cauliflower in appearance.
The nodular appearance is a single nodule that develops upward and protrudes above the surface of the skin.

Only after the form and type of the disease is determined, the doctor determines how to treat basal cell carcinoma. Of course, there can be no talk of any self-medication.

The presented photos show basal cell carcinoma in each of its main variants. Attempts have been made to classify basal cell carcinomas based on growth pattern or differentiation patterns, but such methods are not universally accepted. Thus, there is no generally accepted classification for basal cell carcinomas, about 26 different varieties have been described. The most common types are: 1) nodular, 2) pigmentary, 3) cystic, 4) ulcerative, 5) superficial, 6) fibrosing (scleroderma-like), 7) basosquamous (also known as metatypic cancer), and 8) Pincus fibroepithelioma. Most often basal -cell carcinoma has the form of one of three subtypes: nodular, superficial or ulcerative. You will also see in the photo how basal cell carcinoma has signs of several varieties at once.

Signs of the initial stage of basal cell carcinoma

stages of basal cell carcinoma development, photo

The classification of basal cell carcinoma by stage is based on the clinical picture, taking into account characteristics - the area of the lesion, the depth of germination into adjacent tissues and signs of their destruction, without signs of involvement of lymph nodes in the process.

According to such indications, four stages of damage are determined, which are caused by the manifestation of neoplasms in the form of tumors or ulcers.

The initial stage of basal cell carcinoma (first) includes neoplasms not exceeding 2 cm. Localization is limited, without germination into adjacent tissues.
The second stage includes nodular tumors larger than 2 cm with signs of germination into all skin layers, without involving fatty tissue.
The third stage is characterized by a significant size of the neoplasm (up to 3 or more cm), growing into all tissue structures, right up to the bone.
The fourth stage of skin basal cell carcinoma includes tumors that grow and affect the bone structure or cartilage tissue (see photo).

photo of the initial stage of basal cell carcinoma

The tumor is typically located in various areas of the facial and cervical zone. Localization of various forms of basal cell carcinoma on the skin of the nose is also not uncommon. It manifests itself as small painless skin-colored nodules, in the form of ordinary pimples, usually on the forehead or in the folds near the wings of the nose.

In the initial stage, basal cell carcinomas look like small pearly nodular formations, which tend to become wet after a while. A crust forms on their surface, through which the ulcerated surface is visible.

The process is not accompanied by pain or discomfort. Such pearly nodules can appear as a whole “company” and unite into one, forming an angiitis spot (plaque) with a lobulated surface.

Typically, the formation of telangiectasis signs (small capillary stains) on the plaque surface. Soon, a bubble edging begins to form around the neoplasm, subsequently turning into a dense edging in the form of a roller, which is a characteristic feature of basal cell carcinoma.

When stretching the skin at the site of formation, you can clearly see the red ring of the inflammatory process.

The classification of pathology into stages is based on the characteristics manifested in the clinical picture, such as the area of the lesion, the depth of germination, signs of destruction, and others. In accordance with these characteristics, it is customary to distinguish four stages of basal cell carcinoma:

The initial stage of basal cell carcinoma is characterized by the appearance of tumors, the size of which is no more than two centimeters. They are locally limited and have not had time to grow into neighboring tissues.
Nodular tumors, the size of which is more than two centimeters, belong to the second stage of the disease. There are signs that basal cell carcinoma has grown into all layers of the skin, but the fatty tissue remains unaffected.
New growths measuring three centimeters or more are classified as stage three. At this stage of development, the tumor grows to the bone.
Stage four basaliomas are neoplasms that affect bone and cartilage tissue.

A characteristic feature of the tumor is its location in different areas of the neck and face. Localized on the skin of the nose, which is also not uncommon.

At the very beginning, the tumor appears in the form of small and painless nodules, matching the color of the skin. Most often they appear on the forehead or in the nasolabial folds and resemble ordinary pimples.

At the initial stage, basal cell carcinoma looks like a small pearly nodule. After some time, it begins to get wet, and a crust begins to form on the surface, through which the ulcerated surface can be discerned.

There is no pain or discomfort. Such nodules can appear in whole groups and then merge into one whole. As a result, an angiitis plaque is formed with a lobulated surface. This is what basal cell carcinoma is.

Symptoms and signs of basal cell carcinoma

This cancerous skin lesion is characterized by the appearance of a small nodule. It may be red or flesh-colored.

The formation slowly increases in size, but it does not bother the person at all. There is no pain or discomfort.

As the tumor progresses, a crust forms on the surface of the tumor gray. After its removal, a slight depression is observed on the skin, which disappears over time.

A characteristic feature developing disease is the appearance of a thin roll of dense consistency. Upon careful examination, you can notice small grains on its surface, similar to pearls.

In order for treatment to be carried out as soon as possible and lead to remission of the disease, early diagnosis of basal cell carcinoma is very important. To do this, you need to know the main signs of basal cell carcinoma.

The patient can detect them on his own if he periodically examines his body for new growths or changes in existing moles.

There are five main signs that basal cell carcinoma is developing:

asymmetry of moles;
uneven or unclear edges of moles;
changes in the color of moles (uneven coloring, grayish or black);
mole diameter exceeding 6 mm;
Start rapid growth moles or changes in their size.

When one or more symptoms appear, immediate consultation with an oncologist is required. It is not necessary that the symptoms indicate the development of cancer, but you need to make sure that there is no basal cell carcinoma or start treatment as soon as possible.

Its effectiveness largely depends on the stage of basal cell carcinoma at which treatment is started.

Stages of the disease

Like any cancer, basal cell carcinoma has its own stages:

Stage zero is characterized by the formation of cancer cells in the skin, but the absence of a formed tumor. Only an oncologist can tell what basal cell carcinoma looks like in the initial stage, because sometimes the symptoms are extremely minor, and sometimes they are completely absent.
The first stage is when basal cell carcinoma is just beginning to form; stage 1 is the most favorable for treatment. In this case, the size of the tumor does not exceed 2 cm.
The second stage means the formation of flat basilioma. Stage 2 of skin basilioma is characterized by tumor growth, which can now be up to 5 cm in diameter.
The third stage is diagnosed in the presence of deep basal cell carcinoma. Stage 3 skin basalioma has an ulcerated surface, the tumor grows into the dermis of the skin, muscles, fatty tissue, tendons and even bones. The patient may feel soreness of the skin in the area of the tumor.
The fourth stage is the stage of papillary basal cell carcinoma. Stage 4 skin basal cell carcinoma is accompanied by destruction of the bones that are located under the skin in the area of tumor formation.

How to identify basal cell carcinoma at an early stage? To do this, you need to carefully monitor the moles on your body and consult a doctor if they change.

Diagnosis of skin basal cell carcinoma

The initial diagnosis can be made by the patient himself. To do this, he must examine his moles and, if they begin to increase in size, change structure or color, consult a doctor. This especially applies to those people who are at risk.

If basal cell carcinoma is suspected, the diagnosis should be made by an oncologist after testing. Such analyzes include:

radiography;
CT scan;
ultrasonography;
Magnetic resonance imaging;
biopsy;
cytological and histological examinations;
tests for tumor markers.

Skin cancer (basal cell carcinoma) manifests itself in various clinical forms.

Ulcus rodens – nodular-ulcerative. Common locations are the inner surface in the corners of the eye, the skin surface of the eyelids, and in the folds at the base of the nose. Protrudes above the skin in the form of a pinkish or red dense nodular formation with a shiny surface. The gradual enlargement of the node is accompanied by its ulceration, the bottom of the ulcer becomes covered with a greasy coating. The surface is characterized by signs of telangiectisia (vascular dilatations) and the appearance of a crust surrounded by a “pearly” dense ridge.
Perforating basalioma is a rare form of basalioma of the facial skin with signs of rapid infiltration. In appearance it is not much different from the previous form.
Warty, exophytic, papillary - appear above the skin surface as dense rounded nodules, reminiscent of cauliflower. Not prone to infiltration.
Large nodular nodular – characterized by a single localization of nodular formation. Signs of telangiectisia are clearly visible on the surface.
Pigmented basal cell carcinoma, very similar in appearance to melanoma. The difference is the dark internal pigmentation of the node and the “pearl” ridge surrounding it.
An atrophic scar form that looks like flat ulcerations surrounded by a dense border of “pearl” color. Characterized by growth erosive spot at the moment of scarring in its center.
Sclerodermiform basal cell carcinoma prone to scarring and ulceration. At the beginning of the process, it appears as small dense nodes, which quickly turn into dense flat spots with vascular translucency.
Pagetoid superficial tumor. It is characterized by the manifestation of many flat neoplasms reaching large sizes. Plaques with raised edges do not rise above the skin and appear in all shades of scarlet. They often appear accompanied by various diffuse processes - costal anomalies or the development of cysts in the mandibular zone.
Turban basal cell carcinoma, affecting the scalp. The purple-pink tumor “sits” on a fairly wide base (10 cm in diameter). Develops over a long period of time. It has a benign clinical picture.

Basalioma (photo below) can manifest itself in several clinical forms:

Mature symptoms

Basalioma has the appearance of a small single plaque, rising above the skin level and consisting of numerous small nodules. The color of the tumor may be pink or pinkish-red, but may not differ from the shade of healthy human skin. Usually, a small depression forms in its center, covered with a thin crust, under which bleeding erosion is found. Along the edges of the ulcer there are ridge-like thickenings of numerous nodules - “pearls”, which have a characteristic pearlescent tint.

The initial stage of development of basal cell carcinoma practically does not give any clinical symptoms. Mostly, patients complain of the appearance of a constantly growing tumor on the skin of the face, lips and nose, which does not hurt, only sometimes causing mild itching.

Depending on the size and degree of local spread of basalioma, there are four clinical stages development of the disease:

I. The size of the basal cell carcinoma does not exceed 2 cm and is surrounded by healthy dermis.

II. The tumor has a diameter of over 2 cm, grows throughout the entire depth of the skin, but does not involve the subcutaneous fat layer.

III. An ulcer or plaque reaches any size, involving all the soft tissues underlying it.

IV. The tumor-like neoplasm affects nearby soft tissues, including cartilage and bones.

In approximately 10% of cases, a multiple form of basal cell carcinoma occurs, when the number of plaques reaches several dozen or more, being a manifestation of non-basocellular Gorlin-Goltz syndrome.

Progression of the disease leads to the growth of cancer. New nodules appear on the skin, which eventually merge with each other.

Oncology provokes vasodilation, causing spider veins to appear between tumors. Gradually the formation turns into a large ulcer.

If left untreated, it grows into surrounding tissues. At this stage, severe pain syndrome appears.

The main symptom of cancer is a constant increase in tumor growth. Whether it is a tumor or a spot, its size can vary from a few millimeters to two centimeters. In addition, symptoms are:

changes in color or inclusions in the tumor;
the appearance of ulcers that are localized exactly in the center of the growth, but can also spread to the edges;
change in the shade of the bottom of the ulcer, from pale pink to red.

What does the nodular form of basalioma look like? The nodular form of basalioma is always raised above the skin. It has a pronounced depression “crowning” the center of the tumor.

Even with minimal trauma, the neoplasm bleeds (bleeding appears), which subsequently quickly leads to anemia and cachexia (exhaustion) of the patient.

How does basal cell carcinoma differ from papilloma? Basalioma is

In this episode of the TV show “Live Healthy!” with El�

The superficial form of basal cell carcinoma is easily recognized by its elastic consistency, which takes on a round or oval shape. The edges are no different from the surface of the neoplasm itself.

The tumor spreads throughout the body (lower leg, shoulder, back), so superficial and nodular basal cell carcinoma of the skin of the back is a common diagnosis among cancer patients.

Symptoms of other forms of the disease

Quite often, if there is basal cell skin cancer, the initial stage (photo confirmation of this) occurs completely without symptoms. In rare cases, slight bleeding may occur.

Patients may complain that a small ulcer has appeared on the skin, which slowly increases in size, but it is absolutely painless, sometimes itching appears.

Clinical manifestations of basal cell carcinoma depend on the shape of the tumor and its location. The most common is nodular basal cell carcinoma.

It is a hemispherical node with a smooth pink surface, in the center of which there is a small depression. The node grows slowly and resembles a pearl.

With the superficial form of cancer, a plaque appears with clear boundaries, raised and having waxy-shiny edges. Its diameter can be from 1 to 30 mm. It grows very slowly.

Diagnostic methods

The disease is diagnosed through clinical and laboratory tests, including:

1. Examination of the scalp, skin and visible mucous membranes of the patient, including visual examination of the area where the basal cell carcinoma is located using a magnifying glass. In this case, the shape, color and presence of shining “pearl” nodules along the edges of the tumor are necessarily noted.

2. Palpation of regional and distant lymph nodes for their enlargement.

In the early stages, diagnosis of the disease is difficult due to the similarity of symptoms with other skin pathologies. After carefully collecting an anamnesis of the disease (when and how the disease developed) and a life history (presence of bad habits, occupational hazards), you need to begin examining the lymph nodes located nearby.

In advanced stages of oncology, they are enlarged and dense on palpation.

The main task of the doctor is to distinguish a benign tumor from a malignant neoplasm. Further treatment of these pathologies differs fundamentally; an error in diagnosis is fatal.

To verify the diagnosis, histological analysis of a sample of the affected tissue is required. In parallel, all women are prescribed a cytogram.

Diagnosis of a complex disease begins with an initial examination of the formation on the upper layers of the skin. Basalioma is not difficult to identify, but for a more accurate diagnosis you will need to carry out:

cytological examination;
histological testing;
general blood analysis;
external examination of the skin condition.

Radiation treatment

When treating basal cell carcinoma, various conservative and radical methods are used, the choice of which depends on the type, nature and number of tumors, the age and gender of the patient, and the presence of concomitant diseases:

1. Surgical removal is used for non-aggressive basal cell carcinomas located in the patient’s back or chest.

The tumor is excised with a scalpel with an indentation of 2 cm into healthy tissue, the wound is closed with a skin flap or skin stretched from the sides of the incision. In order to prevent relapse and more serious consequences is a one-time radiation therapy up to 3 Gy.

2. If the tumor has grown deep into the tissue and cannot be removed surgically, irradiation is carried out, the total dose of which can be 50-75 Gy.

3. Small tumors with a diameter of up to 0.7 mm are removed by diathermocoagulation and curettage, having previously anesthetized the surgical site.

4. Cryodestruction – nitrogen freezing of small superficial basal cell carcinomas, not exceeding 3 cm in diameter, localized on the nose or forehead. It is not used to treat tumors located in the corner of the eye, on the nose or part of the ear.

The disease in its early stages is easily treatable. Modern medicine has sufficient knowledge and techniques to eliminate skin cancer. The choice of treatment method is influenced by the prevalence of the disease, its location and the depth of the lesion.

The most popular treatment methods for facial skin basal cell carcinoma today are:

Curettage and fulguration.
Cryosurgery.
Mohs surgery.

Curettage and fulguration are two common techniques used to eliminate cancer on the surface of the body. At the core surgical intervention involves peeling with further burning of the tissue. During the procedure, not only the tumor is removed, but also the bleeding is stopped.

Cryosurgery is appropriate in the presence of superficial formations. It is based on the use of liquid nitrogen.

The procedure involves freezing and then removing the tumor. As an alternative technique, your doctor may recommend laser removal.

It is possible to use surgical excision; this method is appropriate for aggressive disease.

Mohs surgery is a micrographic technique. It was developed specifically to eliminate cancerous lesions on the skin.

Used on sensitive areas, particularly the face. The technique is based on layer-by-layer freezing of the formation.

This allows the defect to be completely removed with minimal risk of scar development. This technique is the most effective; it significantly reduces the risk of relapse.

Each of the presented methods allows you to cure basal cell carcinoma. The main thing is to start the fight at an early stage. The aggressive course is a more complex process, but timely medicine gives good results.

Important to know: Basalioma after removal

The diagnostic criterion for examining basal cell carcinoma tumors is considered to be histological and cytological indicators from scrapings, smears, or a biopsy from the tumor area.

At differential diagnosis, use a highly informative dermatoscopy technique that identifies basal cell carcinoma by morphological characteristics.

An important diagnostic method that helps in the correct choice of treatment tactics - therapeutic or surgical intervention - is ultrasound examination. Ultrasound specifies the extent of the lesion, its location and characteristics of the tumor process.

It is on such data that the choice of treatment methods is based, including:

1) Drug therapy for skin basal cell carcinoma using local chemotherapy with cytostatic drugs such as Cyclophosphamide and application treatment with Methotrexate or Fluorouracil.

2) Surgical removal of basal cell carcinoma, covering one to two centimeters of tissue adjacent to the tumor. Cartilaginous and bone tissues are subject to resection if they are involved in the process.

This method is not used to treat basal cell carcinoma on the face, since extensive intervention is very difficult to correct with plastic surgery. It is used in operations to remove tumors from parts of the body, including the limbs.

Contraindications include advanced age, complex background pathologies, and inability to use anesthesia.

3) Cryodestruction – removal of skin basal cell carcinoma using liquid nitrogen. The low temperature of nitrogen has a destructive effect on tumor tissue. This technique is used to remove small lesions located mainly on the arms or legs.

Cryodestruction is not used to remove large basal cell carcinomas, with deep infiltration and neoplasms located on the face.

4) Radiation therapy is used as a treatment for basal cell carcinoma, as independent technique, and as a possible combination with other treatments. It is used to remove superficial formations (with a diameter of no more than 5 cm) in the early period of development, localized in any area of the face.

The radiation technique is acceptable for elderly patients and those with advanced forms of the disease. Comprehensive, mixed treatment with drug therapy is possible.

5) Removal of small formations with neodymium and carbon dioxide laser. The effectiveness of the method is 85%.

6) Photodynamic therapy of basal cell carcinoma due to the influence laser radiation on the tumor process with a photosensitizer administered to the patient.

The effect of laser on the sensitizer accumulated by tumor cells causes necrosis of its tissues and death of cancer cells without causing harm connective tissues. This is the most popular and effective method for removing primary and recurrent tumors, especially on the face.

The prognosis for treatment of skin basal cell carcinoma, despite frequent relapses, is generally favorable. Complete cure is achieved in almost 8 out of 10 patients. And local and non-advanced forms of the disease can be completely cured with timely diagnosis.

The treatment method for basal cell carcinoma is selected individually for each patient. To do this, factors such as the type of cancer, shape and size, the location where the tumor formed, whether treatment has already been carried out and how exactly it was carried out are taken into account. Based on the data obtained, the patient may be prescribed one of the following methods for removing basal cell carcinoma: The method of treating cancer with close-focus X-rays (x-ray therapy) is the most well-known technique that has undergone decades of clinical use. It is often supplemented with remote gamma therapy. The treatment method is effective in the initial stages of the disease. We list the biggest “disadvantages” of this type of therapy:

decrease in the body's defenses;
deterioration of general health;
hair loss of varying degrees of intensity;
the skin suffers, an area of redness, peeling, and dryness appears;
loss of appetite, up to complete denial of food;
disorders of the digestive and cardiovascular systems;
changes in the central nervous system: heaviness in the head, memory impairment, problems with remembering new information.

Treatment is carried out in the conditions of the radiology department, which exists at every major oncology clinic. All of these negative effects (complications) of radiation therapy are short-term, mild, and quickly disappear with symptomatic therapy.

To cure the disease, the course of treatment can be extended to one month or more.

Laser treatment of basal cell carcinoma is a progressive method of therapy. During treatment, pain and burning may be felt, so local anesthesia is used. Applying pain-relieving ointments is usually sufficient. For large tumors, tissue injections with injectable drugs are used. The “advantages” of the procedure include:

no relapses;
good cosmetic effect (minimal scars), which allows the technique to be used on open, visible areas of the body;
minimum rehabilitation period, lasting from several days to 2 weeks;
relative absence of pain, especially with the use of modern local anesthetics.

The cost of laser treatment is in a huge range: it can start from 500 and reach up to 38,000 rubles. But as practice shows, the average value is 6000-9000 rubles.

A lot of positive reviews confirm the effectiveness of the procedure. Ideal for the treatment of elderly people due to minimal complications.

Cryodestruction, as a method of treating cancer, has been used for decades. The mechanism of action is quite simple: under the influence of low temperatures, cancer cells die and are destroyed.

Relapses after cryodestruction are extremely rare. The technique is suitable for small tumors, especially those localized in areas close to bones and cartilage tissue.

But not suitable for treating the area around the eyes.

What is surgical treatment? This is the most common type of therapy. Do not use when basal cell carcinoma is located in a difficult-to-reach location (corner of the eye, eyelid, internal auditory canal of the ear).

Since scars remain after a scalpel intervention, for a disease that affects the cheeks, forehead and other visible areas of the body, they try to resort to other types of treatment.

Surgery involves excision of the tumor. The resection is done by intervening at least 0.0 times behind the affected tissue.

5 cm. Scalpel intervention is indispensable for persistent recurrence and the appearance of metastases.

Although basalioma is a neoplasm that is sensitive to radiation therapy, in some cases radioresistance (insensitive to radiation therapy) is observed, then surgical treatment cannot be avoided.

Fraction ASD-3. You should apply lotions for several hours, applying a dampened rag to the affected area.
Celandine. This plant has long been used to treat many skin diseases. Cauterization of the neoplasm is carried out with freshly squeezed juice, for which it is enough to simply break the rod or grind the celandine flower. Use celandine with great care in the eye area (especially in the lower corner), the nipple of the mammary gland, and on the lip.
Ointment from celandine and burdock. Half a glass of dry crushed herbal raw materials is poured into a glass of hot goose fat. Heat the oven low and simmer the mixture for 2 hours, strain, and apply for external local use.

Treatment methods include:

Drug therapy using local chemotherapy using cytostatic drugs, for example, Cyclophosphamide. It is also possible to use applications with the drugs “Fluorouracil” and “Methotrexate”.
Surgery. Facial basal cell carcinoma is completely removed. In this case, adjacent tissues are captured by approximately 1-2 centimeters. If the cartilage tissue is damaged, it is also subject to resection.

What ointment to use for basal cell carcinoma of the face?

At the initial stage or in case of relapse of the pathology, the following ointments can be used:

"Omain ointment."
"Solcoseryl".
"Curaderm cream"
"Iruksol".
"Metvix."

Contraindications for surgery – complex background pathology, advanced age, inability to use anesthesia:

Cryodestruction. Allows you to remove basalioma using liquid nitrogen. The destruction of tumor tissue occurs as a result of exposure to too low a temperature. This technique is suitable exclusively for the destruction of small tumors located on the legs or arms. If the tumor is large, deeply infiltrated, or located on the face, this method is contraindicated.
Radiation therapy for basal cell carcinoma of the face. Can be used as an independent method of treatment, or in combination with others. It can be used to remove formations no larger than 5 centimeters in size and located on the surface. In this case, the period of development should be early, but localization does not matter. This technique is acceptable when treating elderly patients and in cases of advanced forms of the disease. Therapy can be complex, mixed with medication.
Removal with carbon dioxide or neodymium laser. The use of this technique is possible if the tumors are small in size. The method is highly effective, the effectiveness reaches 85%.
Photodynamic therapy. It is carried out by exposing basalioma to laser radiation. The patient must first be given a photosensitizer.

A malignant tumor, basal cell carcinoma, can be treated quite quickly if a person seeks qualified help in a timely manner. After clarifying the diagnosis, the patient is prescribed complex therapy.

In cases where the tumor has managed to enlarge and grow, the only available option to get rid of the tumor is surgical intervention. Studying the edge of the nodule in the lower layer of the epidermis allows you to remove only potentially dangerous areas of the skin.

A similar procedure occurs under general anesthesia, so the person does not feel severe pain or discomfort.

IN postoperative period An unpleasant scar forms at the site of the tumor. Remove this defect (an inevitable consequence surgical intervention) can healing ointments and cosmetic plastic surgery.

Alternative technique

Going through the main course of treatment using other methods of getting rid of basal cell carcinoma is an alternative available to the patient. Basal cell skin cancer can be treated with the following mandatory procedures:

gradual cryodestruction;
photodynamic therapy;
drug treatment of the tumor.

The disease, which cannot be transmitted by airborne droplets or contact, requires a strong impact on cancer cells, but freezing with nitrogen or radiation therapy is determined by the attending physician.

Skin cancer basal cell carcinoma in its early stages can be quickly treated with subsequent rehabilitation. Tumors that have grown into healthy areas of the skin are removed gradually to reduce stress on the body.

A person’s moral well-being plays an important role in the effectiveness of therapeutic therapy.

Photodynamic therapy is one of the methods of treating basal cell carcinoma

The prognosis worries every patient. An external skin defect affects not only physical but also moral well-being.

The general prognosis, due to the absence of metastases, is favorable and positive. Deaths occur only in the absence of treatment and neglect of one’s own health.

After undergoing a one-time treatment (getting rid of the tumor), the patient is prescribed rehabilitation and subsequent prevention. Relapses of the disease are a common phenomenon that can only be avoided by persistent, positive-minded people.

If the tumor size has not reached twenty millimeters in diameter, then the prognosis Get well soon is over 90%. Simple therapy, diligent adherence to doctors’ recommendations and faith in a bright future are the key to quick, effective treatment.

Complications

If you do not consult a doctor in a timely manner or simply do not want to be treated, basal cell carcinomas of the facial skin can increase in size up to ten centimeters, and destruction of tissue and cartilage will occur (an advanced form of the disease is considered to be larger than two centimeters).

The tumor can develop for years without causing discomfort to the person. But this doesn't always happen.

Without adequate, complete treatment, the oncological process begins to grow not only in breadth, but also in depth. Invading new areas of the epidermis, the tumor area increases, cutaneous innervation and sensitivity are disrupted, and the vascular bed, especially the capillary network, begins to suffer.

If the tumor begins to grow inward, the muscle fibers and nerve lines are affected. This leads to gross dysfunction of the arm, leg, neck and other parts of the body.

With advanced basal cell skin cancer (stage 4), bone tissue is destroyed, becoming fragile and brittle. The bone frame cannot cope with the anatomical load, leading to disability of the patient at the oncology clinic.

Preventive actions

Prevention of basal cell carcinoma consists of avoiding risk factors that provoke the appearance of tumors:

Prevention of basal cell carcinomas should begin in early childhood and continue throughout human life. You should avoid excessive insolation (stay in the sun), solarium, give up bad habits, and lead a measured lifestyle.

Active sunbathing in the midday sun is prohibited; not only basal cell carcinoma, but also melanoma and keratoma may appear. It is justified to use sunscreen or protect exposed areas of the body in the summer.

This applies not only to the elderly and children, but also to the adult population.

An important point in the prevention of any form of basal cell carcinoma is diet. The diet should be filled as much as possible with plant proteins, vegetables, and seasonal fruits.

Accidental injuries to old scars, especially rough ones consisting of colloidal tissue, should be avoided. Timely sanitation of difficult-to-heal wounds or extensive burn surfaces will help avoid the development of an oncological process.

Basalioma is not contagious and does not require isolation of the sick person for the period of rehabilitation after any type of treatment.

With timely detection of the lesion and receipt of adequate treatment, the prognosis is favorable due to the absence of a pronounced tendency to form metastases.

If the tumor is more than 20 mm in diameter and detected in late stages, it can be fatal. The larger the tumor itself, the more pronounced the cosmetic defect.

The most interesting on the topic

Those who have already encountered basal cell skin cancer once should take special care to prevent recurrence. After treatment of basal cell carcinoma, you should follow all the doctor’s recommendations:

During the period of solar activity, that is, in summer, it is necessary to limit your stay on the street from 11 a.m. to 5 p.m. At this time, ultraviolet radiation is most aggressive, so you must avoid its exposure. If you need to go outside, you should apply a special protective cream to your skin and use hats and glasses.
Without proper nutrition It is impossible to maintain your immune system at the proper level. It is necessary to limit the amount of animal proteins; they can be replaced with plant proteins, such as nuts and legumes.
The diet should include more vegetables and fruits.
If there are old scars on the skin, then measures must be taken to prevent injury to them.
All ulcers and wounds on the skin should be treated promptly. If they tend to heal poorly, you should consult a doctor.

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Some diagnoses, such as “pneumonia”, “gastritis” or “neurosis”, are understandable without any explanation to most people who are far from medicine. But the term “basalioma” often causes confusion - only a few know that it is, more precisely, one of its several varieties.

Basalioma - what is it?

To date, it is not clear exactly from which cells the tumor originates. Cytological examination of basal cell carcinoma reveals structural units very similar to the cells of the basal layer of skin, which lies at the border of the dermis and epidermis. However, most doctors are inclined to argue that epidermal cells can also give rise to such a tumor.

Basalioma is a malignant neoplasm of the skin of epidermal origin. This tumor is characterized by slow growth and low propensity to metastasize: over the entire history of the study, about 100 cases of detection of daughter tumors have been described.

Basically, basalioma affects people whose age exceeds 50 years. Light-skinned men and women are at risk. It has also been established that basal cell carcinoma can be inherited.

However, the main reason for its development is considered to be the systematic aggressive effect of UV rays on the skin. In this regard, the risk of developing basal cell carcinoma increases among people who work outdoors and who like to visit a solarium. Excessive insolation causes mutations in skin cells, leading over time to their malignancy.

In addition to UV irradiation, basal cell carcinoma can be caused by ionizing radiation, regular traumatization of moles, the effect on the body of carcinogens (tars, soot, arsenic, tar, combustion products of hydrocarbons, etc.) and past viral infections, especially herpes.

Basal cell carcinoma, like many other skin cancers, is characterized by a multiplicity of manifestations. The following forms of the disease are distinguished:

nodular;
superficial;
ulcerative;
“turban” (on the head);
nodal;
warty;
pigmented;
cicatricial-atrophic.

One of the most dangerous is cicatricial-atrophic. Its inner part is pressed into the skin and resembles a scar, and ulceration is noted along the periphery. This type of basal cell carcinoma actively spreads throughout the skin, grows, and over time its internal part becomes necrotic.

However, in the later stages, many basal cell carcinomas become ulcerative and “eat up” healthy tissue right down to the bones. Only warty formations never penetrate deep into the body. They are distinguished by their outer growth and resemble cauliflower in shape.

Pigmented basal cell carcinoma can be confused with melanoma, but it is more different from the latter dark color and the presence of a characteristic ridge along the periphery.

And the superficial form at the beginning of the process is mistaken for a psoriatic plaque due to the scaly, flaky surface. In contrast to these types, turban basalioma, localized on the head, has the characteristic morphology of a dense burgundy-red formation on a thick, wide stalk. Often such tumors are multiple.

Why is basal cell carcinoma dangerous? Should it be removed?

basalioma (photo) initial stage and symptoms of development

Although basal cell carcinoma in most cases progresses slowly and very rarely metastasizes, it should not be ignored. Such a tumor of any form requires removal, however, this is not always technically feasible.

For example, basal cell carcinoma of the skin of the nose or eye cannot be excised through traditional surgery, since such an operation can easily damage the organ of vision or smell, and the resulting defects in appearance cannot be compensated for by plastic surgery methods.

However, treatment of such tumors is still carried out, since the neoplasm, penetrating into healthy tissues, steadily destroys them. In this case, not only subcutaneous fatty tissue suffers, but also muscles, nerves, cartilage and even bone tissue.

Basal cell carcinoma of the face is dangerous because, developing on the eyelid or in the corner of the eye, it can grow all the way to the organ of vision, which can lead to its loss.

In addition, even if the tumor appears on the cheek or other part of the face, penetrating deep into the tissues, it damages nerves and muscle fibers, which leads to the destruction of neuromuscular connections and, as a result, disturbances in facial expressions.

Basaliomas of the scalp are very dangerous. Without proper treatment, they can destroy not only the bones of the skull, but also brain tissue.

Basal cell tumors on the extremities and body cause less trouble, but they, unlike tumors on the face and head, are less common. However, this does not mean that skin cancer of this localization should not be treated. It is successfully removed along with adjacent tissues.

Clinical signs and stages of basal cell carcinoma

skin basilioma photo 3 - face, head and hands

Since basal cell carcinoma metastasizes extremely rarely, the typical stage classification for it differs somewhat from the generally accepted international TNM classification of oncological diseases. It is not characterized by the M parameter (metastases).

The first stage of basal cell carcinoma is a limited neoplasm, not exceeding 2 cm in diameter. It is painless, has a grayish or pinkish color, is mobile, and is not fused to the skin.

At the second stage, basal cell carcinoma has already grown into the epidermal layers of the skin, but has not yet reached the subcutaneous fatty tissue. The size of the tumor increases to 5 cm, but no more.

Exceeding this threshold already indicates the third stage of the process, when germination into fatty tissue and deeper, beyond its limits is observed. Possible painful sensations and enlargement of nearby lymph nodes.

At stage 4, basal cell carcinoma already affects not only the skin and muscles, but also cartilage and bones.

Initial stage of basal cell carcinoma, photo

photo of the initial stage of basilioma - a growing pearly pimple

Like many malignant neoplasms, at the initial stage, basilioma is practically painless until the tumor begins to grow deep into the tissue. At first, a painless, dense blister resembling a pimple appears on the skin. It is transparent or has a pearlescent-grayish characteristic shade, called “pearl”.

Often, entire clusters of such formations form on the skin of the forehead, near the nose and in other parts of the face or neck. They grow slowly and merge with each other, forming a tumor surrounded by a dense ridge of the same pearl shade. On the skin inside the neoplasm, blood vessels are clearly visible (telangiectasia).

Over time, the initial stage of basilioma progresses and the malignant process causes tissue destruction. It manifests itself in the form of ulceration of the internal part, the formation of erosions on it. Often the tumor formation is covered with a scab, which can be removed to reveal a crater-shaped depression.

If you do not start treatment (removal) of basal cell carcinoma at the initial stage or a little later, the destruction of deep tissues begins - compression and damage to the nerves in this case causes painful sensations. Their occurrence is a sure specter of the spread of the oncological process beyond the skin.

Removal or treatment of basal cell carcinoma?

Basalioma, like all malignant neoplasms, requires serious treatment, the approach to which must be individualized.

In addition to surgery, chemotherapy and/or radiation therapy are often used for basal cell skin cancer. In some cases, such methods are the only possible ones. So, if the tumor is localized on the face, it is often not possible to remove it using the traditional surgical method.

In this case, radiation therapy is used to kill the degenerated cells. It is suitable for combating tumors of any location that have not reached a size of 5 cm. For many elderly patients who are unable to undergo traditional surgery, radiation therapy becomes the only salvation. It is often combined with drug treatment.

As part of chemotherapy, local cytostatic drugs are used in the form of applications (lotions) to the tumor area. The most commonly used drugs are fluorouracil and metatrexate.

A relatively new method in the fight against skin cancer is phototherapy.

Compared with radiation treatment, it produces fewer side effects because healthy cells are not harmed in the process. Knowledge of the functioning of malignant cells helps to achieve this effect. They absorb photosensitizing substances more actively than normal ones, and, accordingly, with subsequent exposure to ultraviolet radiation, they die faster.

Basilioma removal

However, the most effective was and remains radical treatment- removal of basilioma. Unfortunately, when the process is advanced, when the tumor has already grown beyond the skin, penetrated into the muscles or bones, relapses often occur after removal. At the same time, at earlier stages of basilioma, such therapy gives a good effect.

Oncologist surgeons perform Moss surgery to remove skin cancer. Its essence boils down to layer-by-layer cutting of tissue until the last section remains free of tumor cells. The doctor finds them through microscopic examination of pathological material.

The disadvantage of the method is its limited applicability. For cosmetic reasons and due to the complexity of organizing the process, Moss surgery is not performed when tumors are localized on the face.

In the early stages, basal cell carcinomas are often removed with liquid nitrogen, carbon dioxide or neodymium laser, or by electrocoagulation. However, these methods are effective only as long as the tumor has not penetrated into the deeper layers of the skin. Cryodestruction with liquid nitrogen is painless and does not leave scars on the body. When performing electrocoagulation, the neoplasm is exposed to electric current.

Forecast

Due to the fact that skin basal cell carcinoma grows slowly and is usually clearly visible, patients in 80% of cases seek medical help on time, which significantly improves the prognosis of treatment. In general, 8 out of 10 cases recover.

Relapses occur in patients when the tumor manages to penetrate the cartilage and bone structures.

Treatment of early-stage basal cell carcinoma has a favorable prognosis in 98% of cases. It is worth noting that tumors over 2 cm in diameter are considered advanced.

If a suspicious growth appears on the skin with a reddish, inflamed rim and a pearly ridge, you should not wait and try to get rid of it yourself. This approach leads to the loss of precious time: the tumor ulcerates, the tissues become necrotic, inner part the neoplasm becomes lumpy with a greasy coating. Coping with such a far-reaching process will no longer be easy.

Basalioma (basal cell skin cancer) is a malignant tumor that originates from the superficial layer of the skin. Neoplasia cells are similar to those of the basal layer of squamous epithelium, which is why the tumor got its name. In terms of prevalence, basal cell carcinoma ranks almost first in the world, ahead of breast, stomach, and lung cancer. About 2.5 million new cases of the disease are diagnosed every year, and basal cell carcinoma accounts for up to 80% of all malignant skin tumors.

The diagnosis of basal cell carcinoma does not cause as much emotion and fear as other types of cancer, mainly due to the slow growth of the tumor. Basalioma is not prone to cancer, for a long time it does not cause any inconvenience other than a cosmetic defect, so patients are in no hurry to visit a doctor; at best, they simply ignore the fact of the presence of a neoplasm, and sometimes even self-medicate. Hoping that the tumor will go away on its own, patients bide their time, delaying their visit to a specialist for years. Such carelessness leads to the diagnosis of advanced forms of basal cell carcinoma, which could easily be cured even at the earliest stages of its development.

Basilioma (basal cell skin cancer = basal cell carcinoma)

Extremely rare metastasis does not exclude this tumor from being malignant, and the ability to grow into surrounding tissues and destroy them often leads to dire consequences. There are known cases where elderly patients, not trusting doctors, were treated at home with folk remedies or even household chemicals in the form of aggressive cleaning products (yes, yes, this happens!). The tumor grew, although slowly, but quickly ulcerated, destroyed the surrounding tissues, blood vessels, and nerves, so the doctors were powerless, and the tragic outcome was a foregone conclusion.

Basal cell carcinoma can be classified as one of those types of cancer that are not only treatable, but can be completely cured if diagnosed in a timely manner. It is also important to note that even in the later stages, the prognosis for life after tumor removal can be good, but the operation that the surgeon will be forced to perform can be crippling and disfiguring.

Some time ago, basalioma was given an intermediate position between malignant and benign neoplasms, and dermatologists and surgeons could treat it. In recent years, the approach has changed, and patients with this type are referred to an oncologist.

Among the patients, elderly people predominate; men and women are equally susceptible to the tumor. Basal cell carcinoma is more often diagnosed in fair-skinned, blue-eyed people who tan in solariums and in the open sun. The opportunity to travel south to the sea for residents of the northern regions not only gives them the opportunity to bask in the sun, but also poses the danger of excess ultraviolet radiation, which increases the risk of skin cancer significantly. The favorite localization of the tumor is exposed areas of the body - face, neck, eyelids.

Causes of basal cell carcinoma

The skin is the largest organ of the human body, constantly in contact with the external environment and experiencing the full range of adverse effects. With age, the likelihood of skin tumors increases, so the vast majority of patients have crossed the 50-year mark. In children and adolescents, basal cell carcinoma practically does not occur, and cases of its diagnosis are most often associated with the presence of congenital anomalies (Gorlin-Goltz syndrome, including basal cell carcinoma and other developmental defects).

The factors leading to the appearance of skin basal cell carcinoma are:

Exposure to ultraviolet radiation.
Ionizing radiation.
Carcinogenic and toxic substances.
Injuries, skin burns, scar changes.
Pathology of immunity.
Viral infections.
Hereditary predisposition.
Elderly age.

Among all the risk factors highest value exposed to ultraviolet radiation, be it solar radiation or solarium lamps. Prolonged exposure to the sun, especially during hours of maximum activity, and work in the open air have a detrimental effect on the surface layer of the skin, causing damage and mutations in it, which becomes the background for a cancerous tumor. A decrease in the density of the ozone layer leads to the penetration of more solar radiation, which is why the number of diseases is expected to increase in the future.

Light-skinned people who lack the protective pigment melanin are especially susceptible to sunburn. The closer the region is to the equator, the higher the incidence of tumors, especially in predisposed individuals. People of Celtic descent are thought to have a higher chance of getting the disease than others.

Since basal cell carcinoma appears from the influence of external causes, as a rule, exposed areas of the skin are affected - the face, neck, corner of the eye. It has been noticed that in the UK population, basal cell carcinoma often grows on the right side of the body, while in residents of many other countries it grows on the left. This unusual pattern is explained by uneven tanning when driving a car.

Ionizing radiation leads to damage to the chromosomal apparatus of skin cells, increasing the risk of cancer. External carcinogens and toxic substances (hydrocarbons, arsenic, soot) upon contact with the skin have an irritating and damaging effect on its cells, so persons who are forced to come into contact with such substances due to their professional activities need to be extremely careful.

Scars, chronic ulcers, hereditary anomalies, such as albinism and xeroderma pigmentosum, make the skin very vulnerable, and the risk of cancer in such patients is very high. In addition, the state immunosuppression, caused by congenital causes, taking antitumor drugs or radiation, is often accompanied by the appearance of basal cell and other types of skin cancer.

various precancerous changes and skin tumors

A certain value is assigned and viral infection when the microorganism itself lives in skin cells and causes their mutations, as well as in cases of HIV infection in the stage of developed immunodeficiency.

Manifestations of basal cell skin cancer

The manifestations of basal cell carcinoma when a tumor is formed are quite characteristic, which allows a fairly accurate diagnosis to be made already upon examination of the patient. External signs are determined by the type of tumor.

At the initial stage, basal cell carcinoma may look like an ordinary “pimple” that does not cause any inconvenience. Over time, as the tumor grows, the formation takes the form of a node, ulcer or dense plaque.

localizations typical for various tumors

Forms of basalioma:

Nodular-ulcerative.
Superficial.
Ulcerative.
Warty.
Scar-atrophic.
Pigmented.

In accordance with the International Classification, it is customary to distinguish three types of tumor growth:

Surface.
Scleroderma.
Fibrous-epithelial.

The most common type of basalioma is the nodular variant, manifested by the appearance of a small painless pinkish nodule on the surface of the skin. As the nodule grows, it tends to ulcerate, so a depression covered with a crust appears on the surface. The tumor slowly increases in size, and the appearance of new similar structures is also possible, which reflects the multicentric superficial type of tumor growth. Over time, the nodules merge with each other, forming a dense infiltrate that penetrates deeper into the underlying tissue, involving not only the subcutaneous layer, but also cartilage, ligaments, and bones. The nodular form most often develops on the skin of the face, eyelid, and in the area of the nasolabial triangle.

types of basalioma: superficial, nodular, cicatricial-atrophic, pigmentary, ulcerative

Nodal form is also manifested by the growth of neoplasia in the form of a single node, but, unlike the previous version, the tumor does not tend to grow into the underlying tissue, and the node is oriented outward.

Superficial growth option characteristic of dense plaque-like forms of the tumor, when the lesion spreads 1-3 cm in width, has a red-brown color, and is equipped with many small dilated vessels. The surface of the plaque is covered with crusts and can be eroded, but the course of this form of basal cell carcinoma is favorable.

Warty (papillary) basalioma It is characterized by superficial growth, does not cause destruction of underlying tissues and is similar in appearance to cauliflower.

Pigmented variant of basal cell carcinoma contains melanin, which gives it a dark color and similarity to another very malignant tumor -.

Cicatricial atrophic basalioma (scleroderma-like) resembles an outwardly dense scar located below the skin level. This type of cancer occurs with alternating scarring and erosion, so the patient can observe both already formed tumor scars and fresh erosions covered with crusts. As the central part ulcerates, the tumor expands, affecting new areas of skin along the periphery, while scars form in the center.

Ulcerative form of basalioma quite dangerous because it tends to quickly destroy the underlying and surrounding tissues of the tumor. The center of the ulcer is sunken, covered with a gray-black crust, the edges are raised, pinkish-pearly, with an abundance of dilated vessels.

The most common and, at the same time, the most dangerous places for basal cell carcinoma are the corners of the eyes, eyelids, nasolabial folds, and scalp.

The main symptoms of basal cell carcinoma boil down to the presence of the structures described above on the skin, which long time do not bother, but still an increase in their size, even over several years, the involvement of surrounding soft tissues, vessels, nerves, bones and cartilage in the pathological process is very dangerous. IN late stage tumor patients experience pain, dysfunction of the affected part of the body, possible bleeding, suppuration at the site of tumor growth, and the formation of fistulas in neighboring organs. Tumors that destroy the tissues of the eye and ear, penetrate into the cranial cavity and grow into the membranes of the brain pose a great danger. The prognosis in these cases is unfavorable.

differences between skin tumors: 1 - normal mole, 2 - nevus dysplasia (moles), 3 - actinic keratosis, 4 - squamous cell carcinoma, 5 - basal cell carcinoma (basalioma), 6 - melanoma

Tumor metastases are extremely rare, but possible. The growth of neoplasia into soft tissues and the lack of clear boundaries can create certain difficulties when removing it, so relapse of basal cell carcinoma is not a rare phenomenon.

Diagnosis of basal cell carcinoma

Since basalioma is located superficially, there are no great difficulties in diagnosis. As a rule, a visual examination of the tumor is sufficient for this. Laboratory confirmation is carried out using cytological and histological methods.

For cytological diagnostics A fingerprint smear or scraping is taken from the surface of the neoplasia, in which characteristic cells of the neoplasm are found. At histological examination Using a tissue fragment, it is possible not only to accurately determine the type of neoplasia, but also to differentiate it from other types of skin diseases.

If the tumor spreads deep into the tissues, ultrasound, CT, and radiography can be performed to determine the depth and degree of involvement of bones, cartilage, and muscles in the pathological process.

Video: specialist on skin cancer detection

Treatment of basal cell carcinoma

The choice of treatment tactics is determined by the location of the tumor, the nature of the damage to the underlying tissues, the age of the patient and concomitant pathology. It is also important to know whether the process is primary or a relapse, since basal cell carcinoma tends to recur after its removal.

Most effective way The treatment for basal cell carcinoma is surgical removal. However, the surgeon may encounter significant obstacles on the path, mainly due to the location of the basal cell carcinoma. Thus, damage to the tissues of the eyelid and corners of the eyes often does not make it possible to completely remove the tumor due to consequences incompatible with normal functioning eye afterwards. In such cases, only early diagnosis and timely referral of the patient to an oncologist can make it possible to radically remove the tumor without a cosmetic defect.

Radical excision of the tumor allows for its morphological examination and is indicated for more aggressive forms, when the risk of recurrence is high. When the lesion is localized on the face, in some cases, during surgery, a surgical microscope is used, which allows one to clearly control the necessary boundaries of the intervention.

If it is necessary to very carefully remove basal cell carcinoma with maximum preservation of unaffected tissue, the Mohs method is used, when during the operation a sequential histological examination of tumor sections is performed, which allows the surgeon to “stay” in time.

Radiation therapy is used as part of a combination treatment for advanced forms of the disease, and also as an adjuvant treatment after tumor excision to prevent relapses. If it is impossible to perform the operation, oncologists also resort to radiation. For this purpose, X-ray therapy or external irradiation is used for large lesions.

The method is effective, but one should take into account the high risk of radiation dermatitis and the growth of other tumors that occur after irradiation of basal cell carcinoma, so in all cases it is worth carefully weighing the feasibility of this type of treatment.

Chemotherapy for basal cell carcinoma it can only be used topically in the form of applications (fluorouracil, methotrexate).

tumor cryodestruction

Currently widespread gentle techniques tumor treatment - cryodestruction, electrocoagulation, curettage, laser therapy, which are successfully carried out by dermatologists.

Cryodestruction involves removing the tumor using liquid nitrogen. The procedure is painless and easy to perform, but is only possible for small superficial tumors and does not exclude the possibility of relapse.

Laser treatment is very popular in dermatology, but it is also used quite successfully in oncology. Due to its good cosmetic effect, laser therapy is applicable when the tumor is localized on the face, and in elderly patients, in whom surgery may be associated with various complications, such treatment is preferable.

The effectiveness of photodynamic therapy and the introduction of interferons into tumor tissue continues to be studied, but the use of these methods is already showing good results.

In all cases, it is worth considering the possible cosmetic consequences of tumor removal, so oncologists are always faced with the task of choosing the most gentle treatment method. Given the high frequency of advanced cases, it is not always possible to remove a tumor without a visible defect.

Due to the distrust of many patients in traditional medicine and the tendency to get carried away with traditional recipes, Separately, it is worth pointing out the inadmissibility of treating any type of malignant skin tumor with folk remedies. Basalioma is no exception, although it grows slowly and most often has a favorable course. The tumor itself tends to ulcerate, and various lotions and lubricants can further aggravate this process and cause inflammation with the addition of infection. After such self-medication, the doctor finds himself faced with the need to carry out radical and disfiguring operations, and in the worst case, the patient may not have time to see a specialist at all.

To prevent tumors, you should take care of your skin, avoid excessive sun exposure, and think carefully before visiting a solarium. During periods of solar activity, on the beach, or while relaxing in the open sun, you should always use sunscreen, and sunglasses will help protect your eyes and eyelids from harmful influences.

If basalioma does appear, then you should not despair, This tumor is a completely curable type of skin cancer, but only subject to timely detection and adequate therapy. More than 90% of patients who consult a doctor on time are completely cured of neoplasia.

Video: basal cell carcinoma in the “Live Healthy!” program

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Unfortunately, face-to-face consultations and assistance in organizing treatment are not provided at the moment.