Basal cell carcinoma - 基底細胞癌
影響老年人鼻子皮膚的潰瘍性病變通常被診斷為基底細胞癌 (Basal cell carcinoma)。鼻子是這類皮膚癌的常見發生部位。
基底細胞癌 (Basal cell carcinoma) 可能會出現不規則的邊界和潰瘍。
基底細胞癌 (Basal cell carcinoma) 可能會被誤認為疣。
References
Basal cell carcinoma (BCC) 是最常見的皮膚癌類型。陽光照射是主要原因。幾乎所有 BCC 病例在分子分析中都顯示出過度活躍的 Hedgehog 訊號傳導。根據復發風險、組織保存的重要性、患者偏好和疾病程度，可以選擇不同的治療方法。
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 歲及以上皮膚白皙的成年人中最常見的皮膚癌類型。它們的數量在世界範圍內不斷增加，主要是由於暴露在陽光下。某些遺傳條件會使人們在年輕時容易患上這些癌症。 Basal cell carcinomas 嚴重程度各不相同，從容易治療的淺表或結節性病變到需要專業醫療團隊討論的更廣泛的病變。預後取決於癌症復發的可能性或其損害附近組織的能力。手術是大多數病例的標準治療方法，可確保精確切除並降低復發機會。侵入性較小的方法可以有效治療表淺病變。
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 的主要治療方法是手術。對於高風險或復發性基底細胞癌，特別是在關鍵部位，建議進行顯微控製手術。低風險表淺性基底細胞癌患者可能會考慮局部治療或破壞性方法。光動力療法對於淺層和低風險結節性基底細胞癌效果很好。對於局部晚期或轉移性 BCC，建議使用 Hedgehog 抑制劑 (vismodegib or sonidegib) 。如果疾病進展或對 Hedgehog 抑制劑不耐受，可以考慮使用 anti-PD1 antibody (cemiplimab) 進行免疫治療。對於無法進行手術的患者，尤其是老年患者，放射治療是一個不錯的選擇。如果無法選擇手術或放射治療，可以考慮電化學療法。
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.
危險因子包括暴露於紫外線、放射治療、長期暴露於砷和免疫系統功能不良（例如器官移植）。兒童時期暴露於紫外線尤其有害。
經過活檢診斷後，通常會透過手術切除進行治療。如果癌症很小，可以透過簡單的切除來實現；如果癌腫不小，一般建議莫氏手術。
基底細胞癌至少佔全球所有癌症的 32%。在除黑色素瘤以外的皮膚癌中，約 80% 是基底細胞癌。在美國，大約 35% 的白人男性和 25% 的白人女性在一生中的某個階段受到基底細胞癌的影響。
○ 診斷與治療
#Dermoscopy
#Skin biopsy
#Mohs surgery