Introduction:
Basal and squamous cell carcinoma are types of cancers that occur on the skin. They are commonly called non-melanoma skin cancer or NMSC. They are the most common malignant neoplasm, but these non-melanoma skin cancers are rarely fatal. Squamous cell carcinoma is more aggressive than basal cell carcinoma. Most non-melanoma skin cancer can be treated successfully by surgical procedures like cryotherapy, curettage, or simple surgical excision.
What Is Basal Cell Carcinoma?
Basal cell carcinoma is a cancer seen in the skin's basal layer. It usually appears as a transparent bump on the skin. It is found in areas more exposed to the sun, for example, the face, neck, head, etc. They are caused by ultraviolet radiation and sunburns.
What Is Squamous Cell Carcinoma?
Squamous cell carcinoma is found on the middle and outer layers of the skin. It is aggressive cancer, but it can be treated easily. If left untreated, it can spread to other body parts, causing more complications. Like basal cell carcinoma, squamous cell carcinoma is also caused due to exposure to ultraviolet radiation and sunburns. It can be seen as a firm red nodule with raised margin.
How Are Squamous Cell Carcinoma and Basal Cell Carcinoma Diagnosed?
The Diagnostic method for confirming basal cell carcinoma and squamous cell carcinoma in load -
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Biopsy - Removal of a tissue sample and examining it under a microscope to know any abnormal cell changes and confirm carcinoma.
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Sentinel Lymph Node Biopsy - The sentinel lymph node is the first to have cancer involvement. Sentinel lymph node biopsy is done to identify cancer metastasis to the lymph node by removing cells from the lymph node and examining it under a microscope. A positive sentinel lymph node biopsy shows that it has metastasized to adjacent lymph nodes and organs.
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Imaging Techniques - Magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography are some imaging techniques used in diagnosing carcinomas.
What Are the Treatment Options for Advanced Basal Cell Carcinoma and Squamous Cell Carcinoma?
The treatment for advanced basal cell carcinoma and squamous cell carcinoma includes -
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Surgical Therapy - Surgical removal of the tumor is called tumor resection. Surgery can differ based on the position, extent, and type of cancer.
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Immunotherapy - Immunotherapy uses our immune system to fight against cancer cells.
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Radiation Therapy - Radiation therapy uses large doses to kill cancer cells and prevent cancer growth. There are two types of radiation therapy- external beam radiation therapy and internal beam radiation therapy. In external beam radiation therapy, a machine is placed outside the body to deliver the radiation. In internal beam radiation therapy, radiation seeds are placed in the body, which delivers the radiation to the targeted site.
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Chemotherapy - High drug dosages are used to kill the tumor cells. Chemotherapy can be administered orally and intravenously.
What Are the Types of Immunotherapy Used to Treat Cancer?
There are mainly five types of immunotherapy that are used to treat cancer. They are -
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Immune Checkpoint Inhibitors - Immune checkpoints are proteins in the immune system that help in giving responses. Immune checkpoint inhibitors block this protein allowing immune cells to respond and fight against the cancer cells.
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T-Cell Transfer Therapy - This therapy is used to increase the ability of T-cells (immune cells) to fight against cancer.
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Monoclonal Antibodies - Monoclonal antibodies are a protein used to bind to specific sites on the cancer cells to fight against carcinoma.
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Treatment Vaccines - Treatment vaccines will boost the response to the cancer cell by increasing the immune system.
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Immune System Modulators - Immune system modulators affect specific body parts to enhance the immune system for fighting against cancer.
How Does Immunotherapy Help in Advanced Basal Cell Carcinoma and Squamous Cell Carcinoma?
The immune system present in the body generally protects from germs and provides resistance to infections or any toxins present in the body. Immunotherapy is a biological treatment used for cancer treatment by fighting against the cancer cell with the help of our immune system. Immunotherapy uses medicines to activate the immune system, effectively identifying and killing cancerous cells. Immunotherapy is used to treat most cancer. It can be used to treat advanced basal cell carcinoma and squamous cell carcinoma. Commonly used immunotherapy drugs are Cemiplimab and Pembrolizumab. They are PD-1 inhibitors (checkpoint proteins present in T-cells). Immunotherapy drugs are administered intravenously. Cemiplimab is given once every three weeks, and Pembrolizumab is given once every six weeks. In advanced squamous cell carcinoma, Cemiplimab or Pembrolizumab can be used as an immunotherapy drug. In advanced basal cell carcinoma, Cemiplimab is used as an immunotherapy drug.
What Are the Side Effects of Immunotherapy Drugs Used to Treat Advanced Basal Cell Carcinoma and Squamous Cell Carcinoma?
The common side effects associated with immunotherapy drugs for the treatment of advanced basal cell carcinoma and squamous cell carcinoma include -
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Fatigue or weakness.
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Diarrhea or constipation.
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Nausea and vomiting.
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Skin rashes.
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Reduced appetite.
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Joint pain.
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Infusion reactions or allergic reactions.
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Autoimmune reactions can be seen in the lungs, liver, kidneys, or other organs.
What Are the Surgical Therapies Used in Advanced Basal Cell Carcinoma and Squamous Cell Carcinoma?
Based on the location, extent, and type of cancer, surgical therapy can be of different types. They include -
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Mohs Surgery - Mohs surgery is used to treat different types of skin cancer, which involves cutting thin layers of skin and examining for the presence of cancer. The surgery is stopped when a layer has no signs of cancer involvement. Mohs surgery does not involve the surrounding normal tissues; only the cancerous tissues are removed in this method. This method prevents cancer recurrence as all the cancer is removed during the surgery.
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Excisional Surgery - In excisional surgery, the tumor, along with adjacent normal healthy tissue, is removed to prevent any leftover cells of cancer to avoid recurrences.
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Cryosurgery - Cryosurgery uses extreme cold to kill cancer cells. In the case of advanced basal cell carcinoma and squamous cell carcinoma, liquid nitrogen is used to freeze the growth of the tumor, and it kills the abnormal cancer cells present. Cryosurgery is usually painless, but sometimes swelling can be seen in the area where the cryosurgery has been performed.
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Electrosurgery - Curettage is the scraping of the tumor with the help of a spoon-shaped tool called a curette. In electrosurgery, the tissue will be burned by using an electric current, which is done with the help of a metal needle. These are indicated in the early stages of basal cell and squamous cell carcinoma.
Conclusion:
Basal cell carcinoma and squamous cell carcinoma are types of skin cancer that are most common and aggressive. They can be easily treated if found in the early stages. Surgical resection of the carcinoma is the treatment of choice for these cancers. In rare cases, these cancers can spread to different body parts. In such cases, chemotherapy, radiation therapy, and immunotherapy are used.
