Basal cell carcinoma - 基底细胞癌
影响老年人鼻子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) 可能会出现不规则的边界和溃疡。
基底细胞癌 (Basal cell carcinoma) 可能会被误认为是疣。
References
Basal cell carcinoma (BCC) 是最常见的皮肤癌类型。阳光照射是主要原因。几乎所有 BCC 病例在分子分析中都显示出过度活跃的 Hedgehog 信号传导。根据复发风险、组织保存的重要性、患者偏好和疾病程度，可以选择不同的治疗方法。
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 是 50 岁及以上皮肤白皙的成年人中最常见的皮肤癌类型。它们的数量在世界范围内不断增加，主要是由于暴露在阳光下。某些遗传条件会使人们在年轻时容易患上这些癌症。 Basal cell carcinomas 严重程度各不相同，从容易治疗的浅表或结节性病变到需要专业医疗团队讨论的更广泛的病变。预后取决于癌症复发的可能性或其损害附近组织的能力。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机会。侵入性较小的方法可以有效治疗浅表病变。
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，特别是在关键部位，建议进行显微控制手术。低风险浅表性基底细胞癌患者可能会考虑局部治疗或破坏性方法。光动力疗法对于浅表和低风险结节性基底细胞癌效果很好。对于局部晚期或转移性 BCC，建议使用 Hedgehog 抑制剂 (vismodegib or sonidegib) 。如果疾病进展或对 Hedgehog 抑制剂不耐受，可以考虑使用 anti-PD1 antibody (cemiplimab) 进行免疫治疗。对于无法进行手术的患者，尤其是老年患者，放射治疗是一个不错的选择。如果无法选择手术或放疗，可以考虑电化学疗法。
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.
危险因素包括暴露于紫外线、放射治疗、长期暴露于砷和免疫系统功能不良（例如器官移植）。儿童时期暴露于紫外线尤其有害。
通过活检诊断后，通常通过手术切除进行治疗。如果癌症很小，可以通过简单的切除来实现；如果癌肿不小，一般建议莫氏手术。
基底细胞癌至少占全球所有癌症的 32%。在除黑色素瘤以外的皮肤癌中，约 80% 是基底细胞癌。在美国，大约 35% 的白人男性和 25% 的白人女性在一生中的某个阶段受到基底细胞癌的影响。
○ 诊断和治疗
#Dermoscopy
#Skin biopsy
#Mohs surgery