Basalioma | Specialists and information

Leading Medicine Guide Editors
Leading Medicine Guide Editors
Basalioma, also known as basal cell carcinoma, is the most common form of skin cancer worldwide. Here, the tumour arises from the cells of the basal layer of the skin or the root sheaths of the hair follicles. The skin tumour is rarely pigmented and is therefore also colloquially known as white skin cancer.

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ICD codes for this diseases: C44

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Brief overview:

  • What is basal cell carcinoma? The most common form of skin cancer worldwide, also known as white or light skin cancer. It is only life-threatening in rare cases. It mainly affects areas of the body that are frequently exposed to the sun, especially the face. 
  • Causes: Long-term exposure to UV rays is the cause of basal cell carcinoma. People with fair skin are particularly at risk.
  • Symptoms: Basaliomas can be very different in appearance. In the early stages, they are rather inconspicuous and show up as small pimples, scaly patches of skin or scarring changes. Any skin lesion that does not heal after three weeks should be medically examined.
  • Diagnosis: Dermatologists can usually recognise a basal cell carcinoma with the naked eye. The examination of a tissue sample confirms the diagnosis. Advanced stages can be examined more closely with CT or MRI.
  • Treatment: Surgical removal of the tumour is the best treatment option. Other therapies can be applied in addition, such as photodynamic treatment, radiation treatment and others.
  • Prognosis: Basaliomas rarely spread destructively and can therefore usually be removed without problems.

Article overview

In contrast to malignant melanoma of the skin, basal cell carcinoma metastasises only very rarely and is only life-threatening in exceptional cases. It is therefore also classified as a semi-malignant cancer. In Germany, around 180,000 people are diagnosed with basal cell carcinoma every year. This corresponds to a disease rate of 20 to 30 cases per 100,000 inhabitants. Men and women are equally affected by the disease, the average age is 60 years, although younger people are also increasingly affected.

Basaliom infraorbital rechts

What are the causes of basal cell carcinoma?

The biggest risk factor for the development of basal cell carcinoma, as with other skin cancers, is long-term exposure to UV radiation from sunlight. This is why basal cell carcinomas preferentially develop on areas of the body that are frequently exposed to the sun. In addition to the cheeks, nose and lips, this also includes the neck or the head if it does not have (much) hair.

Long-wave UVA light in particular plays a role in tumour formation. It penetrates into the deeper layers of the skin and leads to genetic changes in the skin cells. People with fair skin who get sunburned quickly and are sensitive to UV radiation are particularly at risk. A genetic predisposition can also favour the development of the disease. For example, hereditary skin diseases such as oculocutaneous albinism or Gorlin-Goltz syndrome lead to an increased incidence of basal cell carcinoma. In addition, there is a higher risk in people who take drugs to suppress the immune system.

A special case is the so-called trunk skin basal cell carcinoma, which does not occur on a skin area exposed to sunlight, but on the trunk of the body. People with this form of basal cell carcinoma were usually exposed to arsenic for many years. In the past, the substance was mainly used as a plant protection agent, but today arsenic is still produced when ore is mined.

What are the symptoms of basal cell carcinoma?

The clinical picture of basal cell carcinoma is very varied, which is why the skin tumour is also known as "skin cancer with a thousand faces". Especially at the beginning of the disease, the tumour is rather inconspicuous. Thus, skin cancer initially appears as a small pimple, nodule or scaly patch of skin. Often a yellowish-reddish nodule develops, which is surrounded by a pearl cord-like fringe. Small blood vessels may show through on the surface of the skin appearance.

Scarring changes can also be an indication of basal cell carcinoma. The special form of pigmented basal cell carcinoma, on the other hand, can easily be confused with malignant melanoma. For a long time, the tumour only spreads horizontally. In later stages, however, the cancer grows in an infiltrative way and can destroy bone and cartilage. Basically: Every pimple, every skin change and every wound that does not heal within three weeks should be examined by a dermatologist, as a basal cell carcinoma may be hidden behind it.

How is basal cell carcinoma diagnosed?

Dermatologists can often recognise a basal cell carcinoma with the naked eye through their experience. In addition, they can use a dermatoscope to differentiate the skin manifestation from other types of cancer. However, for a reliable diagnosis, they must take a tissue sample and then have it examined in the laboratory histologically. If the basal cell carcinoma is already growing into other tissue structures, a computer tomography or magnetic resonance imaging can be performed to assess the spread.

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How is basal cell carcinoma treated?

The treatment of first choice is the complete surgical removal of the tumour. Different surgical methods can be used:

  • a removal with a small safety distance (especially for aesthetic reasons in the case of tumours on the face)
  • Operations with a safety distance adapted to the tumour (for medium-sized and larger basal cell carcinomas)
  • a horizontal excision for superficial and small tumours

Surface-destructive treatment methods such as photodynamic therapy are also used. This involves the targeted destruction of degenerated skin cells, while the healthy cells are largely spared. Radiotherapy and curettage which involves scraping out the tumour cells, also belong to these superficially destructive treatment methods. Likewise, the tumour can be iced in cryotherapy treatment or treated with a laser. Compared to full surgery, these non-surgical procedures have an increased risk of recurrence.

Since the beginning of the 2000s, a fairly new treatment method for superficial basal cell carcinoma has been approved. A cream with the active ingredient imiquimod, which belongs to the group of antivirals, is applied to the affected skin area by the patient over several weeks. The substance activates the body's own immune system and thus contributes to the destruction of the tumour. If the basal cell carcinoma cannot be treated with the above-mentioned procedures, drugs with the active substance vismodegib can be helpful. Since these drugs from the group of so-called hedgehog inhibitors, which influence cell growth and proliferation, have numerous side effects, they should only be used after detailed consideration of the risks and benefits.

What is the prognosis for basal cell carcinoma?

The prognosis of basal cell carcinoma is generally good because it does not metastasise and only grows destructively in advanced stages. Since some patients develop further tumours in the course of their lives even after the basal cell carcinoma has been surgically removed, regular follow-up examinations by a dermatologist are recommended.

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