Introduction
Basal Cell Carcinoma (BCC) is a type of skin cancer, and its occurrence tends to be more frequent in elderly individuals. BCC, its connection to aging, its underlying causes, recognizable symptoms, and the various treatment options are available to tackle this condition effectively. For elderly people, the risk of developing BCC is notably higher due to a lifetime of sun exposure and a decrease in the skin's ability to repair itself.
What Is Basal Cell Carcinoma?
BCC is a typical form of skin cancer that develops in the basal cells of the skin's epidermis. The generation of new skin cells is carried out by these cells. BCC is typically slow-growing and rarely metastasizes (spreads to other body parts), but it can be locally invasive if left untreated. There are several subtypes of BCC, including nodular, superficial, infiltrative, morphea form (sclerosing), and pigmented. Each subtype has slightly different characteristics and appearances, but they all share a common origin in the skin's basal cells. Initial treatment is required to stop the damage to surrounding tissue.
What Are Symptoms of Basal Cell Carcinoma?
BCC often appears as small, pearly, or waxy-looking bumps on the skin. These bumps can be translucent and may have a shiny surface. Some BCCs may manifest as flat, reddish, or pinkish patches on the skin. These patches can resemble eczema or other benign skin conditions. BCCs can ulcerate or develop into open sores that do not heal or heal very slowly.
These sores may ooze or crust over. BCCs can have raised edges or borders that may be rolled, with a central depression or crater-like appearance. In some cases, BCCs may show tiny, visible blood vessels (telangiectasia) on their surface. It can develop scaly, dry, or crusty patches on the skin that can be mistaken for other skin conditions.
BCCs may bleed intermittently, especially when irritated or scratched. Some individuals with BCC may experience itching. BCC can also develop within an existing mole or skin lesion, causing changes in size, color, shape, or texture. Not all BCCs will exhibit all of these characteristics. It typically grows slowly and is unlikely to metastasize.
How Does Aging Impact the Development and Progression of Basal Cell Carcinoma?
The aging process significantly influences the development and progression of BCC. Skin undergoes natural changes that increase vulnerability to this type of skin cancer. Repeated exposure to UV (ultraviolet) radiation over a lifetime plays a pivotal role, leading to DNA (deoxyribonucleic acid) damage in the skin's basal cells. Moreover, the skin's ability to repair itself diminishes with age, making it less effective in combating the effects of UV radiation. These age-related factors and cumulative sun exposure create a favorable environment for developing BCC lesions. Consequently, aging individuals are at a higher risk of developing BCC, emphasizing the importance of sun protection, regular skin checks, and early intervention to manage this condition effectively.
What Factors Lead to Basal Cell Carcinoma?
1. UV Radiation Exposure:
Prolonged and cumulative exposure to UV radiation factors that cause BCC in elderly individuals. Over a lifetime, repeated sun exposure can lead to DNA damage in the skin's basal cells, ultimately resulting in cancerous growth. Sunburns, especially during childhood and adolescence, contribute to this risk.
2. Genetics:
UV exposure is the primary external factor; genetic predisposition also plays a role. Some individuals may have inherited genetic mutations that make them more susceptible to skin cancers, including BCC. A family history of skin cancer can indicate this genetic predisposition.
3. Fair Skin and Light Eye/Hair Color:
People with fair skin, light-colored eyes, and light-colored hair are at higher risk for BCC. These characteristics are associated with reduced melanin production, which protects against some radiation.
4. Occupational Exposures:
Certain occupations or recreational activities that involve prolonged outdoor exposure can increase the risk of BCC. This includes careers like farming, construction, and lifeguarding, where individuals are consistently exposed to the sun's harmful UV rays.
5. Immunosuppression:
Elderly individuals with compromised immune systems due to medical conditions or medications are at an increased risk of developing BCC. A weakened immune system may be less effective in detecting and eliminating cancerous cells.
6. Radiation Therapy, Chemical Exposure, and Previous Skin Cancers:
Past radiation therapy for other medical conditions or a history of previous skin cancers can increase the risk of developing BCC in the elderly. Exposure to certain chemicals, such as arsenic, may contribute to the development of BCC.
What Are the Options for Treating Basal Cell Carcinoma?
Excision is a procedure in which the BCC is surgically removed. The size and depth of excision depend on the characteristics of the tumor. Mohs Micrographic Surgery involves removing thin layers of the tumor and immediately determining it using a microscope. Repeated examination is essential until no cancer cells are present, ensuring minimal damage to surrounding healthy tissue. It is often used for large or recurrent BCCs or cosmetically sensitive areas.
In Cryotherapy, Liquid nitrogen is applied to the BCC lesion to freeze and destroy the cancer cells. This is typically used for small, superficial BCCs. High-energy X-rays are used in radiation therapy to target and destroy cancer cells. It is an option when surgery is not advisable due to the tumor's location or the patient's health status. For superficial BCCs or those in high-risk areas, topical creams or ointments containing drugs like imiquimod may be prescribed.
These medications stimulate the body's immune system to attack and eliminate the cancer cells. Electrodesiccation and Curettage (ED&C) is a procedure where the BCC is scraped off with a curette (a sharp instrument) and then burned or cauterized with an electric needle. ED&C is generally used for small, well-defined BCCs. Photodynamic Therapy (PDT) involves applying a photosensitizing agent to the BCC lesion, which is then exposed to a specific type of light. This activates the agent and destroys the cancer cells. PDT is suitable for superficial BCCs. Certain lasers ( laser therapy) can remove or destroy BCC lesions. Laser therapy is typically reserved for superficial BCCs on the skin's surface. In some advanced cases of BCC, targeted therapies like Hedgehog pathway inhibitors (vismodegib) or immunotherapies may be considered. These treatments target specific pathways involved in BCC growth.
Conclusion
Aging is a main factor, which is the primary cause of BCC and prolonged exposure to UV radiation. The type of treatment is determined by the tumor's size, depth, and location, as well as the patient's general condition. It is essential for individuals diagnosed with BCC to discuss their treatment options with a dermatologist or oncologist to determine the most appropriate approach. Effective therapy and early discovery are essential for controlling BCC. With advancements in medical science, numerous treatment options are available to address BCC in elderly individuals, ensuring a better quality of life and skin health in their later years.
