Basal cell carcinoma - 基底细胞癌
影响老年人鼻部皮肤的溃疡性病变通常被诊断为基底细胞癌 (Basal cell carcinoma)。鼻子是此类皮肤癌的常见发生部位。
基底细胞癌 (Basal cell carcinoma) 可能表现为不规则的边界和溃疡。
基底细胞癌 (Basal cell carcinoma) 有时会被误认为是疣。
relevance score : -100.0%
ReferencesBasal cell carcinoma (BCC) 是最常见的皮肤癌类型，主要由阳光照射引起。几乎所有 BCC 病例在分子分析中均显示 Hedgehog 信号通路过度活跃。根据复发风险、组织保存的重要性、患者偏好以及疾病程度，可选择不同的治疗方案。
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.
在 50 岁及以上、皮肤白皙的成年人中，Basal cell carcinomas 是最常见的皮肤癌类型。它们的发病率在全球不断上升，主要与长期暴露在阳光下有关。某些遗传因素会使人们在年轻时更易患此类癌症。Basal cell carcinomas 的严重程度各不相同，既有易于治疗的浅表或结节性病变，也有需由专业医疗团队讨论的更广泛病变。预后取决于癌症复发的可能性以及其侵蚀邻近组织的能力。手术是大多数病例的标准治疗方法，可确保精确切除并降低复发风险。微创方法能够有效治疗浅表病变。
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 的主要治疗方法是手术。对于高风险或复发性基底细胞癌，尤其位于关键部位的患者，建议采用显微控制手术。低风险、浅表的基底细胞癌患者可考虑局部治疗或破坏性方法。光动力疗法对浅表及低风险结节性基底细胞癌疗效良好。局部晚期或转移性 BCC 推荐使用 Hedgehog 抑制剂 (vismodegib or sonidegib)。若疾病进展或对 Hedgehog 抑制剂不耐受，可考虑 anti-PD1 antibody (cemiplimab) 进行免疫治疗。对于无法手术的患者，尤其是老年人，放射治疗是一个可行的选择。若手术和放疗均不可行，可考虑电化学疗法。
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.
危险因素包括紫外线照射、放射治疗、长期砷暴露以及免疫功能低下（如器官移植者）。儿童时期的紫外线暴露尤为危险。
确诊后通常采用手术切除治疗。病灶较小者可行局部切除；病灶较大时一般推荐 Mohs surgery (莫氏手术)。
基底细胞癌约占全球所有癌症的 32%。在除黑色素瘤外的皮肤癌中，约 80% 为基底细胞癌。美国约有 35% 的白人男性和 25% 的白人女性在其一生的某个阶段患上基底细胞癌。
○ 诊断和治疗
#Dermoscopy
#Skin biopsy
#Mohs surgery