Page 1 of 2: tumors

gongu · Credits: 4772 My Scrapbook

true about basal cell carcinoma is all except -1. most common site is face 2. can penetrate deep to the fascia 3. frequently spread through lymphatics 4.radiotherapy is a good treatment. plz help.

determineddoc · Credits: 3359 My Scrapbook My Reading List 2 Books

bcc doesnt metastatise!! i guess ans is 3!!

cingulate_gyrus2006 · Credits: 22760 My Scrapbook

Can rarly metastise.. but radiotheraply is not much of use...surgury is the treatment i think..

determineddoc · Credits: 3359 My Scrapbook My Reading List 2 Books

surgical Care: The goal of surgical treatment of BCC is to destroy or remove the tumor so that no malignant tissue is allowed to proliferate further. Factors to consider in choosing therapy include the histologic subtype of BCC, the location and size of tumors, the age of the patient, the patient's ability to tolerate surgery, and the expense. Recurrent tumors are generally more aggressive than primary lesions, and subclinical extension also tends to be increased. Tumors that are aggressive and those occurring near vital or cosmetically sensitive structures are best treated with methods that allow for an examination of the tissue margins.

The most common surgical methods are curettage, excision with margin examination, Mohs micrographic surgery, and radiotherapy. Cryotherapy is sometimes used to treat these tumors (see Image 9).

* Curettage (usually with electrodesiccation)

o A looped blade (curette) is used to vigorously scrape tumor away from adjacent normal skin. One may start with a larger curette to debulk the tumor and then follow with a smaller curette to better remove smaller fragments of tumor from surrounding stroma. This technique works best in nodular or superficial BCC because these tumors tend to be friable and do not tend to be embedded in fibrous stroma. The instrument is applied firmly and used in multiple directions over the tumor and immediately adjacent skin. Curetting is most often followed by electrodesiccation, and the entire process may be repeated 1-2 more times. If electrodesiccation is not performed, vigorous and firm scraping in several directions is especially important. Many recurrences after curettage are believed to be due to insufficient aggressiveness on the part of the surgeon. The overall cure rate exceeds 90% for low-risk BCCs. The method is quick, simple and less expensive than most other methods.

o Curettage is a blind technique in which the specimen cannot be examined for margin control. This lack of microscopic margin control limits the usefulness of curettage in high-risk areas, such as the face and ears. Furthermore, the aggressive subtypes of BCC, such as morpheaform, infiltrating, micronodular, and recurrent tumors, are usually not friable and therefore unlikely to be removed by using the curette. The success of this treatment, even in nonaggressive tumors in low-risk sites, highly depends on the operator's experience and technique. Finally, healing by second intention (granulation) often leads to atrophic, white scars that may not be satisfactory in aesthetically important areas.

* Surgical excision

o One may surgically excise the clinically apparent tumor and a margin of clinically normal-appearing skin. This method can usually be performed in an ambulatory setting and provides the pathologist with a specimen to examine the tissue margins. Healing time is generally shorter with sutured closure than with granulation, and cosmesis compares favorably with that of curettage.

o Surgical excision is more time-consuming and costly than curettage. In addition, this method requires sacrifice of normal tissue to obtain acceptable cure rates. (Margins of at least 4 mm are needed, even the least aggressive BCCs to achieve 95% cure rates.) If standard bread-loaf tissue sectioning is used, areas of margin involvement may be missed under microscopy because only a small sampling of the specimen is evaluated.

* Mohs micrographic surgery

o Mohs surgery involves removal of the clinically apparent tumor and a thin rim of normal-appearing skin around the defect created. This saucer-shaped tissue specimen represents tissue adjacent to the tumor or the margin surrounding the tumor. This margin specimen is sectioned and marked so that the entirety of the undersurface and outer edges of the tumor are examined microscopically to minimize sampling error. Use of the frozen-section technique allows for an examination of tissue while the patient is in the office. Tissue is mapped microscopically so if any foci of tumor persist, further excision can be directed to only those areas to spare the normal tissue.

o With the Mohs technique, almost 100% of the tissue margins are examined compared with standard vertical (bread-loaf) sectioning in which less than 1% of the outer margins are examined. Because relatively thin layers are taken only in areas of proven tumor, this technique is tissue sparing. Excision and repair can usually be performed on the same day. Of most importance, Mohs micrographic surgical excision has the best long-term cure rates of any treatment modality for BCC. Cure rates for primary BCC are [snip]-99% with Mohs excision and 94-96% for recurrent BCC.

o Chief disadvantages of Mohs surgery are its increased expense and time requirement compared with curettage. Mohs excision compares favorably to standard surgical excision when one factors in the savings of treating fewer recurrences with this technique.

* Radiation therapy

o Radiation therapy is effective as primary treatment for a variety of BCCs. For most BCCs, cure rates approach 90%. It is especially useful for patients cannot easily tolerate surgery, such as elderly or debilitated individuals. Irradiation can also be a useful adjunct when patients have aggressive tumors that were treated surgically or when surgery has failed to clear the margins of the tumor. Radiation is also an excellent option in patients who refuse surgery because of the size of a lesion or its proximity to vital structures.

o Initial cosmetic results tend to be good, and this therapy can be less disfiguring than surgical excision. However, long-term results after several years can be deforming. Another disadvantage of this technique is that surgical margins cannot be examined. Tumors recurring in previously radiated sites tend to be aggressive and difficult to treat and reconstruct. Radiation therapy remains an important, feasible option in selected patients with BCC.

* Cryotherapy

o Cryotherapy is also an effective treatment for most nonaggressive BCCs, with cure rates near 90%. However, successful treatment is highly dependent on the experience of the operator. Optimal cure rates are obtained when the depth, duration, and temperature of treatment are measured with special instrumentation, such as cryoprobes.

o Patients must be willing to endure the immediate posttreatment swelling, resultant necrosis of treated areas, and unpredictable scarring that can occur with this approach.

o This method is not commonly used for the treatment of BCC, except by a few experienced cryosurgeons

determineddoc · Credits: 3359 My Scrapbook My Reading List 2 Books

radiotherapy the most imp it states!!

bully · Credits: 2673 My Scrapbook

BCC rarely metastises through the lymphatics

surgery is the mainstay treatment
radiotherapy is also used in BCC

i would go for option 3

cingulate_gyrus2006 · Credits: 22760 My Scrapbook

Ok, Ok,,
agree with u
-1 for me..
radiotheraphy is a god treatment for BCC.

Note some new points in relation to it

A new immune enhancement agent (topical imiquimod, "Aldara")

is effective for the treatment of superficial skin cancers (basal cell and squamous cell cancer, and even malignant melanoma in-situ). It is also used pre-operatively to shrink nodular basal cell cancers, thus allowing a smaller surgical excision.

There is also a new treatment using Euphorbia peplus a common garden weed. [2]

reference = wikepidia

determineddoc · Credits: 3359 My Scrapbook My Reading List 2 Books

thanx for the info cingulate!!

adsad21 · Credits: 220 My Scrapbook

think its option 3

CHHUTTKU · Credits: 142 My Scrapbook

answer is 3

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