Basal Cell Carcinoma (Treatment)
Basal cell carcinoma may be treated by a variety of means, depending upon its size, location, and type. For those patients needing to avoid surgery, radiation therapy is an option. Because this treatment is protracted ( carried out over a period of weeks), and does not produce cure quite as often as surgery, most patient choose some form of excision.
When the tumor is small, scraping ("curettement") with an electrical device, or burning ( with liquid nitrogen) may suffice. Because these "destructive techniques" do not allow microscopic examination of the tissues, one cannot objectively confirm the adequacy of treatment. Also, since the defect created must heal on its own after treatment, this treatment must be used only when the cosmetic consequence from scarring would be minimal. Notwithstanding these limitations, destructional techniques remain a very important treatment modality for tumors caught early when they are small.

Surgical excision is best carried out when tumors are larger than would allow simple destruction. A wedge of skin and fat is removed with a surrounding border of normal tissue. The tissue removed ( called the "specimen") can then be examined microscopically to see if the tumor has been completely removed. When all the edges of the resection are microscopically normal, the treatment is presumed to be adequate. Standard surgical excision is best used when the edges of the tumor are fairly easy to see, making total excision likely in one try. Some surgeons will employ a rapid pathological examination known as "frozen section" to examine the tissues while the patient is still in the operating room. Although this may be helpful in cases where complex reconstruction will be needed immediately, it probably adds little in cases where the surgical defect can be approximated with sutures. The reason for this is that frozen sections are relatively inaccurate and may be contradicted by the "permanent section" pathology results which become available days later. Happily, when pathological examination of the tissue shows a "positive margin" indicating the need for further tissue removal, the patient's cure has not been compromised. If a second procedure succeeds in removing the remaining tumor, cure rates are as high as in those cases where complete removal was accomplished in one try.

For recurrent tumors or those with indistinct edges located in cosmetically sensitive areas ( e.g. the nose or corner of the eye), a technique known as Moh's surgery may be best. Moh's surgery (also called "micrographic" surgery) is practiced by a dermatologist or plastic surgeon who has studied the appropriate excision techniques as well as dermatopathology. These doctors will remove tumors in "slices," examining each immediately under the microscope to learn where more tumor needs to be resected. This piece-meal technique will often allow complete tumor removal while minimizing the sacrifice of normal, surrounding tissues. The disadvantages of the technique include its expense and the frequent need of a secondary reconstructive procedure when the physician performing the excision is not trained in complex reconstruction.

2/21/00

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