Basal cell carcinoma - 基底細胞がん
高齢者の鼻の皮膚に生じた潰瘍性病変は、しばしば 基底細胞がん (Basal cell carcinoma) と診断されます。鼻はこのタイプの皮膚がんがよく発生する部位です。
基底細胞がん (Basal cell carcinoma) には不規則な境界や潰瘍が現れることがあります。
基底細胞がん (Basal cell carcinoma) はイボと間違われる可能性があります。
References
Basal cell carcinoma (BCC) は最も一般的な種類の皮膚がんです。日光への曝露が主な原因です。ほぼすべての BCC 症例は、分子分析で過剰な Hedgehog シグナル伝達を示します。さまざまな治療法が利用可能であり、再発リスク、組織保存の重要性、患者の希望、疾患の程度に基づいて選択されます。
Basal cell carcinoma (BCC) is the most common malignancy. Exposure to sunlight is the most important risk factor. Most, if not all, cases of BCC demonstrate overactive Hedgehog signaling. A variety of treatment modalities exist and are selected based on recurrence risk, importance of tissue preservation, patient preference, and extent of disease.
Basal cell carcinoma (BCC) is the most common malignancy. Exposure to sunlight is the most important risk factor. Most, if not all, cases of BCC demonstrate overactive Hedgehog signaling. A variety of treatment modalities exist and are selected based on recurrence risk, importance of tissue preservation, patient preference, and extent of disease.
Basal cell carcinomas は、50 歳以上の色白の成人に最も多いタイプの皮膚がんです。その数は主に太陽光への曝露が原因で世界中で増加しています。特定の遺伝的条件により、若い年齢でこれらのがんを発症しやすくなる可能性があります。 Basal cell carcinomas 重症度は、簡単に治療できる表面性または結節性の病変から、専門の医療チームでの議論が必要なより広範な病変まで多岐にわたります。予後は、がんが再発する可能性、またはがんが近くの組織を損傷する能力によって決まります。ほとんどの場合、手術が標準治療であり、正確な切除と再発の可能性が低くなります。侵襲性の低い方法で表在性病変を効果的に治療できます。
Basal cell carcinomas are the most frequent skin cancers in the fair-skinned adult population over 50 years of age. Their incidence is increasing throughout the world. Ultraviolet (UV) exposure is the major carcinogenic factor. Some genodermatosis can predispose to formation of basal cell carcinomas at an earlier age. Basal cell carcinomas are heterogeneous, from superficial or nodular lesions of good prognosis to very extensive difficult-to-treat lesions that must be discussed in multidisciplinary committees. The prognosis is linked to the risk of recurrence of basal cell carcinoma or its local destructive capacity. The standard treatment for most basal cell carcinomas is surgery, as it allows excision margin control and shows a low risk of recurrence. Superficial lesions can be treated by non-surgical methods with significant efficacy.
Basal cell carcinomas are the most frequent skin cancers in the fair-skinned adult population over 50 years of age. Their incidence is increasing throughout the world. Ultraviolet (UV) exposure is the major carcinogenic factor. Some genodermatosis can predispose to formation of basal cell carcinomas at an earlier age. Basal cell carcinomas are heterogeneous, from superficial or nodular lesions of good prognosis to very extensive difficult-to-treat lesions that must be discussed in multidisciplinary committees. The prognosis is linked to the risk of recurrence of basal cell carcinoma or its local destructive capacity. The standard treatment for most basal cell carcinomas is surgery, as it allows excision margin control and shows a low risk of recurrence. Superficial lesions can be treated by non-surgical methods with significant efficacy.
BCCの主な治療法は手術です。高リスクまたは再発性 BCC の場合、特に重要な領域では、顕微鏡で管理された手術が推奨されます。低リスクの表在性 BCC 患者は、局所治療または破壊的方法を検討する可能性があります。光線力学療法は、表在性および低リスクの結節性 BCC に効果があります。局所進行性または転移性 BCC の場合は、ヘッジホッグ阻害剤 (vismodegib or sonidegib) が推奨されます。疾患の進行がある場合、またはヘッジホッグ阻害剤に対する不耐性がある場合は、 anti-PD1 antibody (cemiplimab) による免疫療法を検討できます。放射線療法は、手術ができない患者、特に高齢の患者にとっては良い選択肢です。手術や放射線療法が選択肢にない場合は、電気化学療法が検討される可能性があります。
The primary treatment for BCC is surgery. For high-risk or recurring BCC, especially in critical areas, micrographically controlled surgery is recommended. Patients with low-risk superficial BCC might consider topical treatments or destructive methods. Photodynamic therapy works well for superficial and low-risk nodular BCCs. For locally advanced or metastatic BCC, Hedgehog inhibitors (vismodegib, sonidegib) are recommended. If there's disease progression or intolerance to Hedgehog inhibitors, immunotherapy with anti-PD1 antibody (cemiplimab) can be considered. Radiotherapy is a good option for patients who can't have surgery, especially older patients. Electrochemotherapy could be considered if surgery or radiotherapy isn't an option.
The primary treatment for BCC is surgery. For high-risk or recurring BCC, especially in critical areas, micrographically controlled surgery is recommended. Patients with low-risk superficial BCC might consider topical treatments or destructive methods. Photodynamic therapy works well for superficial and low-risk nodular BCCs. For locally advanced or metastatic BCC, Hedgehog inhibitors (vismodegib, sonidegib) are recommended. If there's disease progression or intolerance to Hedgehog inhibitors, immunotherapy with anti-PD1 antibody (cemiplimab) can be considered. Radiotherapy is a good option for patients who can't have surgery, especially older patients. Electrochemotherapy could be considered if surgery or radiotherapy isn't an option.
危険因子には、紫外線への曝露、放射線療法、ヒ素への長期曝露、免疫系機能の低下（臓器移植など）が含まれます。幼少期に紫外線にさらされると特に有害です。
生検による診断後、治療は通常、外科的切除によって行われます。がんが小さい場合は単純な切除で済みます。がんが小さくない場合は、一般にモース手術が推奨されます。
基底細胞癌は、世界中のすべての癌の少なくとも 32% を占めています。黒色腫以外の皮膚がんのうち、約 80% が基底細胞がんです。米国では、白人男性の約 35%、白人女性の 25% が人生のある時点で基底細胞癌に罹患しています。
○ 診断と治療
#Dermoscopy
#Skin biopsy
#Mohs surgery