Removal of basaliomas

According to medical statistics, basalioma is the most common tumor disease. It accounts for 75% of all skin pathologies. Despite destructive growth and the ability to germinate in tissues and even bones, such a pathology does not tend to metastasize. It is this fact that is decisive for specialists who give an unambiguously positive prognosis for the treatment of this kind of skin diseases.

In cases where drug treatment and traditional medicine do not give a positive result, it is worth thinking about removing the basalioma. Modern methods of removing this kind of formations cannot be classified as particularly expensive operations. Thanks to the achievements of medicine, in particular, the laser, it became possible to carry out quick and high-quality removal of tumors on the skin in the least traumatic way, which also guarantees not only an excellent therapeutic, but also a cosmetic effect.

General characteristics of the disease

A neoplasm that affects the layer of the epithelium of the skin closest to the dermis (basal) is referred to in medicine as “basalioma”. A similar tumor develops from the cells of this epithelium. In the event that adequate measures are not taken, the pathology tends to grow to a significant size in a few years and grow into bone and muscle tissue without metastasizing. In such cases, a positive prognosis for the treatment of basalioma does not exceed 10%.

However, some of the clinical varieties of this pathology can take years to grow. A similar feature of the tumor gave reason to physicians to attribute it to neoplasms, which are intermediate between benign and malignant.

Symptoms and causes of the disease

This disease most often affects people of the older age category, regardless of gender. It begins with the appearance of dense nodules in open areas of the body, face or head, ranging in size from two to five millimeters. At first, these firm, flat or slightly raised, pink or skin-colored papules are not particularly worrying. However, over time, these nodules can turn into thick plaques with a bleeding center. Over time, they tend to reach 10 or more centimeters in diameter and become covered with a crust that periodically bleeds. On the skin, either mushroom-shaped scaly nodes are formed, or rather deep ulcers that can affect nearby tissues and bones.

According to experts, in most cases the process is chronic and at the stage of aggravation the prognosis is disappointing.

Despite numerous studies, the causes of skin basalioma still remain a mystery to physicians. However, a number of factors capable of provoking such a disease, experts, nevertheless, have established. The disease most often affects fair-skinned people and people living in the sunniest (southern) regions. The tumor activates in areas of the skin that are most exposed to sunlight and harmful substances (nose, cheeks, around the eyes, temples, lips, neck and scalp, as well as other open areas of the body).

Based on this, scientists name the following factors that increase the risk of such tumors on the skin:

1. Prolonged exposure to direct sunlight, including ultraviolet radiation in a solarium.
2. Influence of high temperatures.
3. Exposure to radioactive radiation.
4. Contact with carcinogenic chemicals (resins, dyes, oils and other harmful substances).
5. Permanent injury to a specific area of ​​uXNUMXbuXNUMXbthe skin.
6. The use of medications for artificial suppression of immunity (immunosuppressants).
7. Chronic diseases accompanied by immunosuppression (immune suppression).

It is especially noted that the most favorable soil for the appearance of tumors are skin with scars, inflammation or dermatitis, as well as experiencing constant surface friction.

Varieties of basalioma

Depending on the location and appearance, several clinical forms of neoplasms on the skin are distinguished, the basic of which are superficial basalioma, tumor, ulcerative and pigmentary.

Superficial pathology is characterized by pink spots with clear boundaries, the surface of which is dotted with round nodules. Due to the connection of the nodules into a single ulcer with a slight depression in the center, the development of the disease is observed, the prognosis of which is positive – in other words, the disease is treatable.

With a tumor basalioma, small glossy nodules of a pale pink color tend to grow rapidly, reaching five or more centimeters.

Against the background of a superficial or tumor form of the disease, an ulcerative basalioma of the skin is formed, classified by physicians as one of the forms of cancer. Its symptom is the appearance of bright red sores, which in their shape resemble a funnel. At the same time, the pinkish edges of the sores are raised above the uneven bottom.

Pigmentary pathology of this disease in appearance resembles melanoma of the skin. This type of basalioma is represented by pigmentation that has a brown color, which may accompany the malignant course of the disease.

Diagnosis of basalioma

Given the fact that such tumors tend to recur, the key to successful disposal of basalioma is to identify the disease at an early stage. So, cases of a tumor reaching a diameter of two centimeters are already considered by doctors as neglected. Therefore, the most effective treatment is considered to be started before the pathology reaches the indicated dimensions and the beginning of its germination in tissues and bones. A complete cure here occurs in 95-98% of cases, while the removal of larger basaliomas is fraught with the appearance of scars and cosmetic defects.

Given the nature of the tumor, only a visual examination is often enough to diagnose a basalioma. A more accurate diagnosis can be made using a dermatoscope, a device that can be used to examine the deeper layers of the skin. At the same time, digital LED dermatoscopy is the most accurate, which makes it possible to observe the growth of a neoplasm using high-resolution digital images.

And, finally, a cytological study of pathology allows us to classify a specific type of basalioma.

Basalioma removal methods

Treatment of basalioma is individual in each case. As previously reported, when confirming the diagnosis, it is important not to allow the tumor to grow to penetrate into the subcutaneous tissue, tissues and bones. When choosing a method for removing skin pathology, the size of the neoplasm, its location, the shape of the tumor and the depth of the lesion are taken into account. It is also important whether the disease is primary or relapse.

The arsenal of physicians involves a fairly wide range of methods for treating this skin pathology, which will be discussed below, as well as a number of their combinations:

1. Surgical excision with suturing is relevant only in cases where the tumor is located in places safe for surgical intervention and has not affected adjacent tissues. The indication for surgical intervention is the resistance of the neoplasm to radiotherapy and cases of recurrence of basalioma. During surgical removal, local anesthesia is used with drugs such as Novocaine, Lidocaine and others. The number of relapses with conventional surgical removal reaches 10,1%.
2. Cryodestruction – freezing the tumor with liquid nitrogen – is relatively fast and practically painless, but it is effective only with the superficial location of the tumors. At the same time, cryogenic destruction is also indicated for extensive and recurrent pathologies and gives no more than 7,5% of relapses.
3. Electrocoagulation – cauterization of neoplasms with high-frequency alternating electric current – is most effective for shallow primary pathologies. This procedure is quite painful, so electrosurgical excision of the basalioma is performed under local anesthesia. This procedure enables histological examination of the removed tissue. In the cystic form of basalioma, a treatment method using curettage and electrodissection can be used, but the result of the operation directly depends on the experience of the oncologist: the probability of relapse here can reach 40%.
4. Radiation therapy (X-ray therapy) is indicated in cases of recurrent and extensive tumor growths. With the latter, it is very often combined with remote gamma therapy. If the neoplasm is small, then close-focus X-ray therapy is used to remove it.
5. Radio wave surgery is based on the evaporation of the water contained in the cells and is a low-traumatic and almost bloodless method of treating basaliomas. Modern electron therapy makes it possible to remove basaliomas that are located in open areas of the body and in hard-to-reach places: on the eyelids and auricles, as well as to irradiate neoplasms of any size and shape. This method gives about 8,7% of relapses.
6. Laser surgery is based on the destruction of the tumor by means of high-energy laser radiation. Laser coagulation is especially indicated for the elderly, for whom traditional surgical intervention often ends in undesirable complications. This method, which has a local effect directly on the tumor, is one of the most sparing methods for removing basalioma. In addition, laser removal is practically bloodless, since coagulation of blood vessels occurs simultaneously with the removal of the tumor. Due to its excellent cosmetic effect, it is widely used in the removal of basaliomas with localization on the face. Laser removal is carried out, as a rule, on an outpatient basis and in one procedure. It does not give complications and is most effective in the superficial form of the tumor. This method is not used in the fight against overgrown, as well as recurrent basaliomas.
7. Photodynamic therapy (PDT) has established itself as the most progressive method in modern surgery, in which the occurrence of relapses is reduced to 6,7%, and the cosmetic defect after surgery is very insignificant. The procedure is performed on an outpatient basis and does not require special preparation. The essence of the method lies in the ability of tumor cells to accumulate and retain for a long time photosensitizers – special substances (photoditazine, heliophor), registered as drugs that kill affected cells under the influence of light and do not affect healthy tissues. In skin basalioma, such therapy can replace surgery and radiation therapy, and is indicated for the most difficult tumor localizations, for example, on the eyelids or in the medial corner of the eyes.
8. Local chemotherapy is based on the treatment of basal tumors with external chemotherapy drugs. Given the fact that basaliomas never metastasize, this method of treating skin tumors can be considered not only a classic auxiliary, but also the main one. So, professional ointments, such as 0,5% colhamic and 5-fluorouracil, allow in 95% of 75-85% of cases, respectively, not only to get rid of the neoplasm, but also to prevent recurrence of the disease. Local chemotherapy is used according to a special scheme: a thin layer of ointment is applied to the affected area of ​​the skin with a capture of 5 mm of healthy tissue and covered with a sterile bandage. Healthy tissue around the focus is protected from the effects of chemotherapy with an indifferent paste (Lassara or zinc). After 24 hours, the compress is removed and the skin is treated with hydrogen peroxide to remove necrotic tissues.

Among the combined options for the treatment of basaliomas, it should be noted the combination of radio wave surgery and human leukocyte interferon (HLI) preparations – immunotherapy. At the first stage of treatment, immunocorrection is carried out: 20 procedures are prescribed in the form of CLI inhalations, after which radio wave removal of the basalioma with a surgitron is performed (Surgitron device, American company Ellman International). Among the advantages of this method of treatment should be called low-impact and rapid healing of tissues (9-15 days), minimal scarring and the possibility of biopsy.

Also, to fight cancer cells in the treatment of basalioma, cream and ointments are used that contribute to the production of natural interferon. In such cases, immunotherapy is the initial stage of chemotherapy.

In the treatment of basaliomas, a combination of photodynamic therapy with laser beams is also practiced. The use of only laser removal of tumors of a basal nature is gradually relegated to the background due to the impossibility of sufficiently deep penetration of laser beams into the neoplasm. In addition, some types of tumors are insensitive to the laser, due to which the recurrence rate can jump up to 40%. Laser irradiation is activated 48-72 hours later with intravenous administration of a photosensitizer, 1,5-2 hours after external application and 2-24 hours after intralesional administration.

In the period from one to five days, an additional session of laser irradiation is possible, if there are indications for this.

Advantages and contraindications of various methods of basalioma removal

The development of non-invasive treatment technologies is gradually nullifying the surgical excision of basalioma. In addition, the surgical method leaves cosmetic defects, so it is not recommended to use it in the area of ​​the nose, eye or ear. Contraindications to its use are also the elderly age of the patient, severe illness and intolerance to anesthesia. Therefore, at present, in world practice, it is used only in cases of tumor resistance to ionizing radiation. In cases where surgical intervention is not possible, it can be replaced by combined treatment: local chemotherapy followed by laser removal of the basalioma.

Laser technology has supplanted most other methods of tumor treatment. Its advantages: painlessness and speed of the procedure, excellent cosmetic effect and fast rehabilitation. Contraindications to the use of laser removal of basalioma are cardiovascular and infectious diseases, as well as diabetes mellitus. Also, during laser surgery, it is necessary to exclude the risk of ignition of the patient’s hair and alcohol-based antiseptics, as well as damage to the retina of the operated patient’s eyes.

In the case of concomitant diseases, the effectiveness of the operation can increase significantly with the use of cryodestruction. This method is available to remove a skin tumor on any part of the body and regardless of its size, does not require the use of anesthesia, passes without blood loss and leaves minor cosmetic defects. It is used even during pregnancy. However, there are also side effects: cryodestruction of a basalioma very often causes significant tissue edema, which disappears over time. Also, this method of treatment is contraindicated in patients who cannot tolerate cold.

In general, physical methods of dealing with basalioma, such as cryodestruction and electrocoagulation, give a considerable percentage of relapses. In addition, electrocoagulation is contraindicated for patients with pacemakers, in the presence of metal plates in the body, as well as in pigmented neoplasms and some types of basal tumors. This method is effective only for minor tumors located far from the eyes and ears, which are harmed by the current.

Radiation therapy is most often used on the face and is more suitable for older people. Despite a number of advantages, including the painlessness of the operation, minimal damage to surrounding tissues and coagulation of blood vessels, as well as rapid regeneration, they still have their drawbacks. Operation by this method is contraindicated in the presence of bleeding, damage to the central nervous system, increased excitability. Also, over time, it may turn out that healthy cells were also damaged during the irradiation. Therefore, this type of treatment is not recommended for young and middle-aged people.

Radio wave surgery is contraindicated in cardiopulmonary insufficiency, hepatitis, diabetes, any disease in remission and the patient has a pacemaker.

Photodynamic therapy has much fewer contraindications compared to other methods of basalioma removal, which is why this method is recommended for use in the treatment of debilitated patients. However, it is not indicated for blood diseases, porphyria, acute renal and hepatic insufficiency, as well as increased photosensitivity in the patient.

With local chemotherapy, there are practically no side effects characteristic of systemic chemotherapy, since, by killing cancer cells on the skin, the drug is absorbed into the body in small quantities. However, the use of cytostatics can lead to minor changes in the skin: redness, inflammation, pain and itching, as well as scarring at the site of skin treatment and cause increased photosensitivity.

Recommendations after removal of the basalioma

There are no serious consequences after the operation for the removal of the basalioma. Medical statistics record a number of postoperative complications, including post-traumatic bleeding (1%), allergic reactions, infection of the operated area (2,5%) and ischemia of its skin, which can rarely occur on the first day or days after surgery.

Surgical excision of a basalioma inevitably leaves scars and a feeling of numbness of the skin at the site of intervention. As a rule, it passes within a year. Allergic inflammation of the skin (contact dermatitis) is caused by a patch or bandage, after the abolition of which antihistamines are taken and the wound is treated with special ointments.

In case of wound infection, a course of antibiotics and skin treatment with antiseptics are prescribed, which are also recommended for partial rejection of tissues. Complete tissue necrosis is an indication for a second operation, which is performed a week after the removal of the basalioma.

When treating with photodynamic therapy, in order to avoid skin burns, it is not recommended to be under bright lighting for a week, work at a computer, watch TV and take biologically active drugs and vitamins.

Basal tumors in 40% of cases tend to recur in the same place or other areas of the skin. Therefore, patients should be observed by physicians for 5 years after surgery.

Also, patients who have undergone surgery are advised to visit the oncology room every three months during the year and avoid direct sunlight and exposure to toxic substances on the skin.