BASAL CELL CARCINOMA: UPDATES AND PERSPECTIVES ON TREATMENT OPTIONS

• DOI: https://doi.org/10.22533/at.ed.15941012402125

• Palavras-chave: Basal Cell Carcinoma, Epidemiology, Surgical Treatment, Skin Cancer Prevention, UV Exposure

• Keywords: Basal Cell Carcinoma, Epidemiology, Surgical Treatment, Skin Cancer Prevention, UV Exposure

• Abstract:

  INTRODUCTION: Basal cell carcinoma (BCC) is the most common skin cancer, originating in the basal cells of the epidermis. Its incidence has been increasing, with estimates of 2.7 to 4.3 million annual cases in the USA. The main cause is chronic exposure to ultraviolet (UV) radiation, especially UVB, which damages the DNA of the basal cells, causing genetic mutations. Factors such as immunosuppression, exposure to chemical substances and genetic predisposition also increase the risk. BCC can manifest itself in subtypes such as nodular, ulcerative, superficial and scleroderma, with distinct clinical characteristics. Understanding these factors is essential for prevention, early diagnosis and effective treatment. OBJECTIVES: This integrative review evaluates different therapeutic approaches for the treatment of Basal Cell Carcinoma (BCC), such as Mohs Surgery, Surgical Excision, Curettage, Cryotherapy, Topical Treatments, Photodynamic Therapy and Radiotherapy, considering efficacy, precision, aesthetic and functional preservation. The aim is also to highlight the importance of early diagnosis, prevention, self-examination, the use of sunscreen and regular dermatological follow-up, in order to reduce recurrences, complications and improve prognosis. METHODOLOGY: The search was carried out on the PUBMED, VHL and MEDLINE databases, covering articles from 2018 to 2023, in English, using keywords such as "Basal Cell Carcinoma" and "Surgical Treatment". Initially, 643 articles were identified, of which 192 were selected for full reading. After evaluation, 45 studies were included in the final analysis, after excluding duplicates, irrelevant articles and those with insufficient methodology. RESULTS AND DISCUSSION: Biopsy is essential to confirm the diagnosis of Basal Cell Carcinoma (BCC), distinguishing it from other dermatological conditions. Early diagnosis is crucial, as it allows for more effective treatments, reducing complications and increasing the chances of a cure. Prevention is equally important, and can be achieved through measures such as using sunscreen and carrying out regular self-examinations. Treatment for Basal Cell Carcinoma varies depending on the characteristics of the tumor, and options include. Mohs surgery: A highly precise technique indicated for high-risk tumors or those located in delicate anatomical areas, such as the face. It has a high cure rate and significant aesthetic preservation, being one of the most effective options. Surgical excision: Used for smaller, localized tumours, this is an effective and affordable treatment. However, it can leave more visible scars and is less precise than Mohs surgery. Curettage and electrodissection: A less invasive technique, indicated for superficial tumors. Although effective, it has a higher risk of recurrence and lower precision compared to other approaches. Cryotherapy: A minimally invasive procedure that uses cold to destroy tumor cells and is recommended for small superficial tumors. Its effectiveness is limited in deeper lesions. Topical treatments (Imiquimod, Fluorouracil): Used on superficial and low-risk lesions, these treatments are applied directly to the skin. Although effective, they can cause skin irritation and have a higher chance of recurrence in some cases.Photodynamic Therapy (PDT): This consists of using light combined with photosensitizing agents to treat superficial lesions. It is a non-invasive and well-tolerated option, but is more suitable for early and less aggressive tumors. Radiotherapy: Indicated in cases where surgery is not feasible, such as in patients with tumors located in areas that are difficult to operate on or in patients with conditions that would contraindicate surgery. Radiotherapy is also useful in treating recurrences and can be an effective alternative for hard-to-reach tumors, with good local control rates. However, it can cause side effects such as skin changes and, in rare cases, the risk of developing another cancer in treated areas. Each approach should be chosen based on the characteristics of the tumor, location and general condition of the patient, always aiming for the best therapeutic and aesthetic result.  CONCLUSION: Basal cell carcinoma (BCC) is the most common skin cancer, with slow growth and low metastatic capacity, but it can cause local damage if left untreated. Early identification is essential to avoid complications. Therapeutic options, such as Mohs surgery, surgical excision, curettage, cryotherapy, topical treatments, PDT and radiotherapy, should be chosen based on the type, size and location of the tumor, as well as the patient's condition. Mohs surgery is highly precise, especially in sensitive areas. Prevention, such as the use of sunscreen, is also key to reducing the incidence and improving treatment results.