Basal cell carcinoma is the most common type of skin cancer in Europe, Australia and the USA. Its global annual incidence is around ten million cases and some research indicates that the number of new cases diagnosed each year increases by about 10%.
Basal cell carcinoma develops in the basal layer of the epidermis and, like most skin cancers, its onset is favored by prolonged or excessive exposure to the sun. This tumor mainly affects the head, neck and other areas of the body that are most photo-exposed.
Generally, basal cell carcinomas can be removed surgically with ease, however, in a small percentage of patients (by some estimates, around 1%), the disease progresses or spreads to other parts of the body becoming difficult to treat or potentially mortal. Advanced basal cell carcinoma can result in devastating, disfiguring and debilitating lesions, and ultimately be fatal. These neoplasms are classified as locally advanced basal cell carcinomas (laBCC) or metastatic basal cell carcinomas (mBCC). 18633
Symptoms – Basal cell carcinoma
The symptoms in the two phases and the risk factors
As Professor Ketty Peris, director of the Dermatological Clinic of the University of L’Aquila explains, “there are some intrinsic risk factors (such as clear skin and eyes, typical of people most susceptible to sun damage), but there are also a series of risk behaviors. I am referring above all to the strong exposure to ultraviolet radiation and therefore, for example, the inadequate use of sunscreen or exposure to tanning lamps. Furthermore, basal cell carcinoma can arise in patients with genetic syndromes, such as Gorlin’s syndrome ”.
In the initial phase, basal cell carcinoma occurs on the skin of the head, neck and other areas of the body most exposed to the sun, in the form of:
– Nodules, scar or eczematous changes;
– Small ulcer with raised margins.
In an advanced stage, the cancer progresses or spreads to other parts of the body becoming difficult to treat or potentially fatal and can result in devastating, disfiguring and debilitating injuries. 18634
Treatment and Therapy – Basal cell carcinoma
A new drug
«The first approach is always the surgical one. In cases where the patient is not a candidate for surgery, due to the location of the tumor or its size, radiotherapy can be used. For inoperable and non-irradiable cases, or when both surgery and radiotherapy are contraindicated, there is a new molecular target drug, vismodegib, which is administered orally once a day. It acts selectively on the Hedgehog pathway, a pathway that is altered in more than 90% of basal cell carcinomas, regardless of severity and type. The new therapy represents good news especially for patients and in Italy many centers, both dermatology and oncology, have participated in the recruitment in a phase II study. Vismodegib has been shown to be effective in the treatment of locally advanced and metastatic basal cell carcinoma ”, explains Professor Ketty Peris, Director of the Dermatological Clinic of the University of L’Aquila.
The Hedgehog signaling pathway plays an important role in the proper regulation of growth and development of the organism in the early stages of life and then becomes inactive in the adult. However, molecular mutations have been found in various types of tumors that reactivate Hedgehog signaling. Abnormal signaling in the Hedgehog pathway is believed to play a role in the majority of cases of basal cell carcinoma. It has been shown that patients with basal cell carcinoma can be successfully treated by blocking the signaling of the Hedgehog pathway.
Vismodegib works by blocking the abnormal signaling of the Hedgehog pathway and inhibits the growth of cancer cells. This new molecule has demonstrated its safety and efficacy in patients with advanced basal cell carcinoma in phase I and II clinical trials, representing a new treatment option for patients in whom standard therapy is not effective.
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Surgery – Basal cell carcinoma
Surgery is not always possible
Early stage basal cell carcinomas can be removed surgically with ease because they are slow growing and rarely metastasize. Locally advanced carcinomas, on the other hand, are considered inoperable or surgical therapy is considered contraindicated. They can seriously disfigure the patient and involve important sense organs, such as the eyes, nose, ears and even invade the bony structures present under the skin.
When cancer spreads from primary to secondary sites of the body, usually the lungs, liver, lymph nodes, or bones, it is called metastatic basal cell carcinoma and affected patients have a prognosisunfavorable; their median survival is eight months and five-year survival is only one in ten patients.
There is no effective standard of care. Currently, treatment options for advanced basal cell carcinoma are scarce, most have significant side effects and in many cases may be unsuitable, such as: extensive surgery, with potentially disfiguring effects; radiotherapy; chemotherapy with agents of unproven efficacy; experimental therapies; supportive therapy / palliative care . 18635
Psychological aspects – Basal cell carcinoma
The tumor that disfigures: the investigation
«In cases of advanced cancer, the patient can suffer significant psychological implications and his social life can be severely compromised. Patients are often afraid of being seen because they are ashamed of their skin lesions, but this behavior can turn out to be a vicious circle: hiding and neglecting oneself are, in turn, one of the reasons why we often arrive at an advanced form. In many cases, patients also hide from their families, they tend to blindfold themselves and disguise themselves with caps or gauze ”, explains Professor Ketty Peris, Director of the Dermatological Clinic of the University of L’Aquila.
The relationship of patients with the disease and the psychological impact it has on everyday life were at the center of the investigationBasalioma, under the mask , led by Gfk Eurisko and promoted by Roche. It emerges that the basalioma is a little known tumor: no patient had previous knowledge and the diagnosis of basalioma represented a shock or a bolt from the blue for everyone.Illness is a source of great distress and is experienced by patients with confusion and fear; the tumor is perceived as an unknown presence, but all too visible and disgusting on one’s body. Distressing, sneaky and disgusting: these are the three adjectives most used by those who know advanced basal cell carcinoma closely.In advanced forms, which can disfigure and disfigure the face or body, basalioma undermines self-esteem and activates a strong sense of guilt for neglecting the first signs of the disease. It also involves a serious self-limitation of one’s activities and social relationships: it is a mark to be denied and hidden from oneself and from others.
Basalioma also has an impact on the patient’s professional life: in some cases, in fact, it hinders the possibility of maintaining an active working life. The closest family members are confirmed as the main source of support for the patient, often going so far as to change their programs and habits. On the one hand, the family members are alarmed by the basalioma and the psychological reaction of the relative, on the other hand they try to hide their concern and reassure him.
Finally, patients fear above all a reappearance of the tumor or to incur aggravations and metastases . They ask for greater attention to the basalioma by the health system and public awareness to feel more integrated into society
