Basal cell carcinoma (BCC) is the most common type of skin cancer and the most common type of cancer overall with over 4 million cases each year in the United States. These locally invasive lesions appear as slowly growing nodules or plaques that are pink or skin-colored and can bleed or ulcerate.
When recognized and accurately diagnosed at an early stage, BCC can usually be successfully treated with surgical excision. Therefore, patient education and careful monitoring of the skin are crucial to help address these slow-growing tumors before they become more invasive.
Functional medicine offers a personalized approach to treatment for BCC that can complement traditional therapies and support the whole person and her health. Holistic strategies like optimizing the diet, practicing safe sun exposure, exercise, stress management, and integrative therapies help to address BCC and prevent future lesions.
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What is Basal Cell Carcinoma (BCC)?
Basal cell carcinoma (BCC) is the most common type of skin cancer around the world. It appears as a slow-growing pink or skin-colored nodule or plaque that often bleeds or ulcerates and often appears in areas that have chronic sun exposure like the face, scalp, nose, eyelids, legs, ears, and arms.
Basal cells reside in the outer layer of your skin (epidermis) where they make new skin cells by dividing and copying themselves. When there are spontaneous, inherited, or UV-induced DNA mutations in the patched (PTCH) tumor suppressor gene that is part of the sonic hedgehog (Shh) signaling system, these cells can proliferate and grow out of control forming a tumor.
The most common subtype of BCC on the face is nodular which appears as a shiny or pearly nodule with a smooth surface with visible blood vessels. These lesions often have a central depression or ulceration with rolled edges. In younger adults, the superficial subtype of BCC is most common and often appears on the upper trunk and shoulders as a red slightly scaly, irregular plaque with a thin, translucent rolled border.
The risk of BCC is greatest in those with fair skin color, red and blond hair, high susceptibility to sunburn, and chronic UV damage from the sun or tanning lamps. BCC is also more common in people with certain genetics and inherited syndromes like Gorlin syndrome and xeroderma pigmentosum and those with exposure to ionizing radiation or arsenic, immunosuppression, and medications such as hydrochlorothiazide.
This nonmelanoma skin cancer (NMSC) can usually be treated with surgical excision but can result in significant morbidity, metastasis to local lymph nodes, and difficult removal if diagnosis and treatment are delayed. Early detection is crucial to allow for the largest chance of cure.
The Functional Medicine Perspective on Cancer Care
The functional medicine perspective on cancer emphasizes prevention, addressing root causes, and supporting the body's innate healing capacity. This approach empowers patients to become partners in their care. This type of partnership between providers and patients has been shown to enhance outcomes and quality of life.
Functional medicine provides an individualized root cause medicine approach to cancer care that aims to prevent future disease, improve treatment outcomes, decrease side effects, and increase the quality of life. In this integrative and empowering approach to cancer care, there is a focus on prevention and root causes being identified and addressed.
The cellular environment in which tumors like BCC develop is referred to as the tumor microenvironment. These surrounding cells include blood vessels, immune cells, nerve cells, fibroblasts, and the cancer cells themselves. For example, when a basal cell carcinoma is developing, cancer-associated fibroblasts become activated due to chronic UV exposure and signaling from the tumor and begin to secrete inflammatory cytokines and other chemicals that promote the growth and survival of the tumor.
Since around 50% of people develop a second BCC within 3 years, prevention and awareness is crucial. Regular self-skin examinations and professional check-ups are important for early recognition of BCCs in addition to integrating the lifestyle and integrative therapies discussed below to help support the body’s innate healing capacity and create an internal environment less conducive to cancer growth.
Conventional Treatments for BCC
The conventional approach to BCC diagnosis and treatment involves a complete history and physical exam. A skin biopsy is usually done to confirm the diagnosis by examining the affected skin under a microscope. While BCC rarely spreads beyond the skin, imaging studies like MRI or CT scans can be used when needed to assess any metastatic spread.
Even though BCC usually progresses slowly and rarely metastasizes due to its downregulated vascularization, it can display locally destructive growth. The standard BCC treatments usually center around surgical excision of established tumors. This can be done using various modalities depending on the type, size, location, and depth of the tumor.
Most commonly, BCC is removed with surgical excision of the tumor plus 3 to 5 mm margins of normal skin around the tumor. Mohs surgery offers a more precise surgical option that helps to ensure the entire cancer is removed while preserving healthy tissue. Layer-by-layer excision of the lesion is carried out with repeated microscopic examination of the edges of the surgical field to ensure complete removal. Laser surgery may also be used.
Small superficial tumors may be removed using superficial skin surgery such as electrodessication and curettage where cancer cells are scraped off with a curette and then burned with a special electric needle to destroy any remaining cells or cryosurgery where the cancer is frozen with liquid nitrogen to remove it.
Another technique for treating small low-risk BCC is photodynamic therapy. This involves applying a photosensitizing chemical to the skin followed by blue light a few hours later to induce an inflammatory reaction. Similarly, topical therapies like imiquimod cream can be used with small superficial BCCs to induce an immune response and inflammatory reaction. Although it requires repeated application over a 6-12 week course, 5-Fluorouracil cream is an alternative topical cytotoxic agent that is used to treat small superficial BCCs and also to treat large areas that have many small lesions or precursor lesions.
In cases where surgery is not suitable or the margins cannot be completely cleared, radiotherapy may be used to induce an inflammatory response. It usually involves repeated treatments over several weeks.
Emerging therapies for advanced BCC target the Shh pathway involved with DNA mutations underlying BCC tumor initiation. Shh pathway inhibitors (vismodegib or sonidegib) are used to trigger the immune system to target tumor cells with tumor-infiltrating CD8+ T cells that help to stimulate an anti-tumoral response within the tumor microenvironment.
Lifestyle Modifications for BCC Prevention and Management
The skin is the largest organ in the body and is influenced by various factors. Functional medicine incorporates several lifestyle modifications that can support skin health and reduce the risk of BCC. These include practicing safer sun exposure and implementing sun protection strategies, meaningful stress management, and sleep optimization.
Stress can be a major contributing factor to skin conditions and cancers. Chronic stress suppresses the immune system including suppressing skin cell-mediated immunity. Therefore, it is important to integrate practices like breathwork, yoga, meditation, prayer, or other mind-body practices for meaningful stress management into your life.
Another way to support immune and skin health is to ensure that you get adequate restorative sleep. Getting at least 7-9 hours of sleep each night helps maintain skin health by managing stress and balancing inflammation.
Regular exercise also helps the body maintain balanced inflammation levels and supports a well-functioning immune system.
Since UV damage contributes to the risk of skin cancers including BCC, it is important to practice safe sun exposure. Reduce your time spent in the sun’s strongest rays between 10 a.m. and 4 p.m. when there is the most harmful UVB radiation, and opt for sun-protective clothing and a wide-brimmed hat to protect the delicate skin of the face and lips that are prone to developing BCC
Nutritional Interventions and Supplementation
Nutritional interventions and supplementation can help you optimize nutrition for skin health and prevent the development of BCC. Ensuring balanced and adequate nutrients nourishes and protects the skin from within.
Reactive oxygen species are created by metabolic processes and insults like UV radiation. These create free radicals that can damage DNA, cellular proteins, and lipids and increase the risk of cancer and skin damage. Studies suggest that people with BCC have greater levels of oxidative stress and lower levels of dietary antioxidants in their blood.
Skin health is supported by consuming an anti-inflammatory diet with a variety of colorful fruits and vegetables. This way of eating supplies plenty of antioxidants like beta-carotene and vitamins C, E, and A that help combat free radicals and prevent UV damage to the skin.
Carotenoids are polyphenols that give rich color to foods like carrots, squash, and sweet potatoes. They are powerful antioxidants that help to scavenge free radicals and improve skin health by protecting the skin from the damaging effects of UV radiation and reducing skin inflammation.
Vitamin C is a water-soluble vitamin that is abundant in strawberries, bell peppers, and broccoli. It is important for the formation of collagen in the skin as well as activating it as an intracellular antioxidant.
Vitamin E is another antioxidant that helps reduce UVB-associated epidermal damage in the skin. This fat-soluble vitamin is found in soybeans and wheat germ
Incorporating wild fatty fish like salmon and walnuts supplies omega-3 fatty acids to keep skin healthy and mitigate free radical damage caused by too much exposure to UV radiation.
Nicotinamide helps mitigate the impacts of UV damage by reducing oxidative stress and supporting DNA repair. This form of vitamin B3 can be used topically or taken orally at a dose of 500 mg twice daily has been shown to reduce the number and severity of BCCs and can be used for prevention of additional lesions or in high-risk individuals.
Environmental and Toxin Exposure Reduction
In addition to optimizing nutrition with diet and targeted supplementation, minimizing exposure to environmental toxins and carcinogens can help reduce the risk of BCC. Environmental toxins like alcohol and arsenic are carcinogens that can contribute to the development of skin cancers like BCC.
While damage from UV radiation from chronic sun or tanning lamp exposure is a major contributor to skin cancers like BCC, exposure to various environmental chemicals also plays a role. These include substances like alcohol and arsenic as well as polycyclic aromatic hydrocarbons (PAH) that are created through combustion. Other sources of radiation like x-rays and occupational exposures can also play a role. These exposures contribute to cancer formation in the skin by directly damaging DNA, causing increased oxidative stress, and other cellular impacts.
In addition to increasing consumption of whole foods that provide a variety of nutrients and antioxidants, a diet that avoids processed foods, simple sugars, and chemical additives can help reduce inflammation and improve skin health. Avoiding alcohol can also decrease the risk of skin cancers like BCC.
Metals like arsenic contribute to BCC risk. The most common source of exposure to arsenic is via contaminated drinking water. Use a high-quality water filter to reduce your exposure.
Other chemicals including insecticides, herbicides, and fungicides have also been linked to a higher risk of skin cancers.
Integrating Functional and Conventional Approaches
Integrating approaches from functional medicine with conventional BCC treatments offers holistic patient care that optimizes outcomes and quality of life. A multidisciplinary team including dermatologists, oncologists, nutritionists, and functional medicine practitioners provides personalized holistic patient care for BCC.
This type of integrative and multidisciplinary approach helps to empower patients to care for their health, recognize early signs of disease, and take steps to prevent future skin cancers. While factors like genetics cannot be changed there are modifiable lifestyle and environmental risk factors that can be altered to reduce risk. These include incorporating sun-protective behaviors, dietary interventions, and steps to reduce environmental exposures.
Incorporating a range of knowledge and approaches to skin cancer prevention also offers greater possibilities for prevention and care. A comprehensive, collaborative approach provides personalized treatment and prevention strategies for each individual.
For example, emerging research suggests that the skin microbiome may help protect against the development of skin cancers like BCC. Your skin is home to microbes including bacteria, fungi, viruses, and mites that compose your skin microbiome.
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Key Takeaways
A functional medicine approach offers many benefits in the prevention, management, and treatment of basal cell carcinoma. This holistic approach combines integrative strategies for the prevention and treatment of skin cancer like BCC with conventional treatments to address the whole person.
Comprehensive strategies like smart sun exposure, mind-body practices, and adequate sleep to manage stress, regular exercise, and optimized nutrition with plenty of antioxidants improve skin health and reduce the risk of BCC. Approaching BCC with this holistic focus not only treats and prevents cancer but also helps to enhance overall health and well-being.
Educating patients and healthcare providers about the evolving understanding of why and how BCC develops and how to incorporate effective integrative strategies to target pathophysiologic contributors like oxidative stress and microbiome imbalances offers the most effective approach.
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