Basalioma refers to malignant skin neoplasms. In fact, it is a type of skin cancer. Its formation occurs due to the cells of the basal layer of the epidermis, and only of them, respectively, therefore, the basal cell is located exclusively on the skin. Moreover, although it can grow on any part of the body, most often this neoplasm is placed on the head - on the nose, cheeks, eyelids, upper lip, ears, scalp.
Among all malignant tumors, basal cell carcinoma has the most favorable prognosis for those affected in terms of treatment effectiveness and survival. The main thing that is required of the patient is to consult a doctor in a timely manner, who, having completed all the necessary examinations and analyzes, will determine the method of getting rid of the tumor, for example, will prescribe basal cell cryodestruction.
What is basal cell carcinoma, why it develops in humans, what is dangerous
Basal cell carcinoma of the skin, carcinoid, or corroding skin ulcer are synonyms for basal cell carcinoma. This tumor is formed from atypically altered cells of the basal layer of the skin.
The prevalence of the disease is almost independent of the type of skin. Basically, a tumor affects people over the age of 50. Of all varieties of skin cancer, basal cell carcinoma occurs in approximately 70-80% of diagnosed cases.
Interestingly, the disease more often affects men than women - the risk of getting sick for a man older than 50 is about 35%, for women of a similar age - 20-25%.
Tumor disease has its own specifics - it develops only on the skin, and most often occurs on the face and scalp - in about 90% of all cases. The remaining 10% implies the location of the formation on the trunk, upper or lower extremities.
A characteristic feature of the tumor is its malignancy. The neoplasm develops without any shell, it does not grow in the capsule, but simply penetrates into the tissues, disrupting their normal structure. At the same time, basal cell growth not only in depth, but also tends to expand the lesion area, thus affecting significant amounts of nearby tissues. Going deeper into the lower layers of the skin, it can reach subcutaneous fat. Usually, the depth of damage to the skin can be judged by the area of external damage, since they are directly proportional to each other.
Due to the fact that the tumor usually progresses at a speed of no more than 5 millimeters per year, it can be effectively treated with cryodestruction.
The main difference between basal cell carcinoma and other malignant tumors on the skin is that it does not provoke the development of metastases in nearby tissues.
To date, medicine has not established the exact causes of the development of basal cell carcinomas. Among the likely catalysts for the process of atypical cell growth:
- frequent exposure to UV radiation;
- light skin type with a tendency to burns and freckles;
- the effect of arsenic on the body, for example, due to prolonged use of water with its admixture;
- frequent prolonged contact with carcinogens, ionizing radiation;
- disturbances in the immune system;
- pigmented keroderma;
- Gorling-Holtz syndrome;
- burns, ulcers and scars on the skin.
The danger of the disease lies in the fact that, despite its slow growth, basal cell can eventually destroy the deeper layers of tissues, especially on the head, affecting nearby organs - the eyes, the ear, the bones of the skull and the lining of the brain, which can lead to death .
Cryodestruction: what is the essence of the method
The properties of low temperatures to reduce pain and slow inflammatory processes have been known to doctors since ancient times. For the first time, the technique of tissue cryodestruction in medicine began to be used as early as 1890, and to rid patients of tumors and neoplasms in the 1920s. Starting from the 1920s, medicine began to receive a sufficient amount of liquid nitrogen necessary for the procedure, which made it possible to carry out cryodestruction of various tumors everywhere.
From 1950 to the present, liquid nitrogen has been the main cooling agent used during the procedure.
Cryodestruction is a technique for treating skin formations in which their cells are exposed to very low temperatures, which is why they are destroyed. The contact of the cryogenic substance - liquid nitrogen - with the surface of the basal cell causes instant freezing of its external and internal tissues. In fact, the internal component of the tumor turns into ice. Due to the fact that extracellular fluid freezes first, high pressure is created in the tumor cells, which leads to their instant death.
Ice crystals formed during freezing rotate in a circle around the center of crystallization, destroying cell membranes. Oxygen and nutrients cease to flow into the body of the basal cell carcinoma, biochemical processes stop in it. This leads to the fact that cells that did not die under the influence of low temperature die off due to oxygen starvation.
The degree of success of the procedure is affected, firstly, by its duration, and secondly, by the temperature of the liquid nitrogen used. For one and a half minutes of freezing at a temperature of -180 degrees Celsius, cryodestruction gives the most effective destruction of tumor cells.
It should be noted that after the course of radiation therapy, the treatment of basal cell carcinoma through cryodestruction is significantly more difficult, since the cells that received the radiation dose become more prone to further mutations, which significantly increases the likelihood of a relapse of the disease.
Indications and contraindications for the method
Exposure to liquid nitrogen is recommended in such cases:
- in the presence of multiple basal cell carcinomas;
- if a neglected tumor of large sizes is detected;
- with deep tumors with germination in the bones of the skull;
- patients with a tendency to form keloid scars;
- patients with established pacemaker.
This method is especially indicated for those affected over the age of 65, since chemotherapy in this case can also provoke the appearance of other neoplasms.
In what cases is cryodestruction not prescribed to a patient? Doctors call such contraindications to the method:
- the presence of acute inflammatory diseases of internal organs;
- pathology of the development of body tissues;
- diagnosed endometriosis and fibroids;
- infectious diseases in the acute stage;
- cold intolerance;
- some somatic diseases in the stage of decompensation.
Advantages and disadvantages of cryodestruction in comparison with other methods of treatment of basal cell carcinoma
One of the main advantages of this tumor removal technique is called by doctors a low probability of relapse - usually not more than in 7.5% of cases, that is, less than after radiation therapy or laser removal.
In addition, the procedure gives a good cosmetic result, especially if the patient carefully complies with all the requirements for wound care.
The treatment is carried out on an outpatient basis, so the patient does not need to go to the hospital for this period. Only in rare cases does it become necessary to open a sick leave.
Through cryodestruction, a tumor of any area and depth can be destroyed, and for this there is no need to enter the patient into a state of drug sleep - local anesthesia is enough.
There is no risk of developing blood loss in the process of destruction by liquid nitrogen. At the same time, the probability of infection of the tissues during the removal of the tumor is minimal. After the operation, practically no complications arise.
Among the drawbacks of the technique, only one is significant - during the freezing, a physician cannot fully and 100% accurately control its depth, due to which there is a chance to hurt healthy tissues. In addition, a scar remains, although not significant, at the site of the destroyed basal cell carcinoma.
In rare cases, a course of procedures consisting of two to three sessions may be required.
How is basal cell removal using liquid nitrogen
Usually, as part of the preparatory measures before the destruction, the doctor conducts an external examination of the tumor, and removes a sample of its tissue for histological examination.
An hour before the start of the procedure, the patient is given an anesthetic drug, for example, Lidocaine or Ketonal.
Liquid nitrogen is applied using a special spray can with a spray nozzle. The tip of the nozzle is located 1 centimeter from the center of the tumor. The entire processing area in the process turns into a icy circle. Processing with nitrogen itself usually takes no more than a minute.
When using nitrogen temperature of -196 degrees Celsius, the surface temperature of the neoplasm reaches -180 degrees. At a depth of two millimeters in the tumor tissue, a temperature of -150 degrees Celsius is set.
If the neoplasm has a significant area and depth, the doctor can use the tactics of repeated freezing: it consists in the fact that the lesion is subjected to freezing several times in a row, alternating with thawing.
The procedure with a spray is not performed if the tumor has an irregular shape, or if it is localized in the eye area. In this case, it is recommended to use a cryoprobe.
With its help, it is possible to freeze the deeper layers of tissues, and at the same time prevent the cryogen from spreading.
Usually, for convenience, the doctor marks the affected area with a marker before starting the procedure, capturing 3 millimeters of healthy skin around the tumor. To protect healthy tissues from the cold, a special guide is used in the process, the walls of which freeze to the borders of the treated area.
After cryodestruction is completed, a sterile dressing is applied to the wound site, the doctor explains to the patient the rules for caring for the affected area, after which the patient can go home.
How to care for the wound surface after removal of basal cell carcinoma
After the destruction of the tumor, an open wound remains in its place. Around her, after a few hours, a pronounced red rash appears, similar to a urticaria. At the same time, edema will accumulate at the site of damaged tissues during the day. Where previously there was a basal cell carcinoma, a blister similar to a blister from a burn filled with fluid forms. It must not be punctured or damaged in any other way.
About a day after the appearance, the blister will burst by itself, exposing a weeping ulcer, into which the tumor site turns.
An ulcerative lesion must be treated with special antiseptic and healing agents that the doctor will prescribe.
In addition, the wound needs to be washed every day with baby soap. After washing, a medicine and a sterile gauze dressing are applied to it.
12-14 days after the procedure, a crust is formed on the site of the ulcer - a scab that protects the wound from infection, until it completely heals. The bandage must be worn until the crust falls off on its own; removing it mechanically is prohibited.
If initially the basal cell was larger than 1 centimeter in diameter, the skin after its removal can heal up to a month. If there is a wound after such a large neoplasm, the attending physician may prescribe vitamin preparations to speed up the healing process.
Until the end of the period of tissue repair at the site of the tumor, it is forbidden to use a solarium, sunbathe in the sun, visit a sauna, a bathhouse, a pool, or swim in open water.
Possible complications after the procedure: why cryodestruction of basal skin cancer is dangerous
According to medical research, based on the results of thousands of procedures for cryogenic destruction of malignant tumors, cryodestruction of basal cell carcinoma at the early stage of its development is not much inferior to surgical removal of the neoplasm in the issue of relapse.
However, the removal of more serious tumors that capture large volumes of closely spaced tissues through cryodestruction may not be practical. In some cases, the basal cell can spread the affected cells at such a distance and at such a depth that it is extremely difficult to “get” them under the influence of nitrogen, and even more so, to do this accurately and accurately.
As for the main consequences of the procedure, the first thing that the patient notices is an extensive edema, which develops already in the first week after cryodestruction. This factor is especially inconvenient if basal cell carcinoma was removed on the face.
The usual consequences of the operation are scar formation, especially if the cryogenic effect has reached the deep layers of the skin, as well as the loss of sensitivity in the area of the skin where the scar has formed.
There is also a risk of complications due to such interference with the integrity of the skin. Due to non-compliance with aseptic rules during cryodestruction, or in the future due to violation of the requirements for wound care, pathogenic microorganisms can get into it. As a result, the affected area can become inflamed, giving the person unpleasant sensations - pain, inflammation around the crust or at the very site of destruction, in some cases even fever and fever. If such symptoms appear, you should immediately consult a doctor who will prescribe antibiotic therapy, as well as the use of special antibacterial ointments.
Another consequence of the procedure is persistent baldness of the area with a scar. If this manifestation does not cause particular trouble on the body, then hair loss on the head, especially for women, can look really depressing.
In place of the scar, light pigment spots may form over time, which is especially noticeable in people with dark skin color. With age, they can pass, but most often remain for life.
In addition to numbness in the area of the skin that underwent cryodestruction, peeling and itching can occur - this indicates a violation of blood circulation, and requires a consultation with a doctor.
Basalioma is a type of skin cancer with the most optimistic prognosis for the patient. It does not allow metastases in nearby tissues, and also rarely recurs after removal. The neoplasm often affects men, and over the age of 50 years. However, women “over 50” are not immune from his appearance. Thanks to the invention and improvement of the method of cryodestruction, today the diagnosis of basal cell carcinoma in a patient is not at all a cause for panic. After the formation found on the skin has been studied and its malignant nature has been confirmed, it is treated with liquid nitrogen, due to which the atypical tumor cells are destroyed and it disappears. Subject to the rules for the care of the wound after the procedure, and to prevent infection in it, only a small, neat scar in the form of a fossa will remain at the site of the basal cell carcinoma after the operation.