Basaliomas

Basaliomas, more commonly called basal cell carcinomas (BCC), are the most frequent form of skin cancer. They originate from the basal cells of the epidermis and most often develop on sun-exposed areas such as the face, neck, and ears. Basaliomas grow slowly and rarely metastasize, but they can invade surrounding tissues and cause local destruction if not treated.

Risk factors include fair skin, light hair or eye color, history of prolonged sun exposure, previous basal cell carcinomas, advancing age, immunosuppression, and certain genetic conditions such as basal cell nevus syndrome (Gorlin-Goltz) or xeroderma pigmentosum. Additional factors include radiation exposure and immunosuppressive therapies.

Basaliomas are categorized into several subtypes, including nodular, superficial, infiltrative, morpheaform (sclerosing), and pigmented. Nodular BCCs typically present as pearly, flesh-colored or pink nodules with visible telangiectasias. Superficial BCC appears as red, scaly patches. Infiltrative and morpheaform forms are more likely to invade surrounding tissues and may be less well defined. The differential diagnosis includes actinic keratosis, squamous cell carcinoma, and melanoma.

Diagnosis is confirmed by biopsy with histopathological examination. Dermoscopy can assist in evaluation, but biopsy remains the standard. Staging is not routinely required; imaging is reserved for suspected deep invasion or involvement of critical structures.

Treatment choices depend on tumor size, location, subtype, and patient factors. Options include surgical excision with clear margins, Mohs micrographic surgery (especially for facial or high-risk lesions), curettage and electrodessication for small, low-risk tumors, cryotherapy, and radiation therapy in selected cases. Topical therapies (imiquimod or 5-fluorouracil) and photodynamic therapy may be used for superficial BCCs. Regular follow-up with skin examinations is advised due to the possibility of new lesions and recurrence. Prognosis is generally excellent when treated early, with metastasis being exceedingly rare.