Il basalioma noto anche come carcinoma o epitelioma basocellulare è il tumore della pelle più comune, ma anche la più frequente neoplasia in assoluto. Non solo melanoma dunque: i tumori della pelle sono diversi e per fortuna anche meno aggressivi. Il carcinoma basocellulare infatti raramente fa metastasi (ovvero si diffonde in altri organi del corpo) e cresce anche lentamente. Di fatto però è importante toglierlo, onde evitare che nel tempo distrugga i tessuti circostanti la parte superficiale della pelle, per scongiurare i rari casi di diffusione e per avere una diagnosi certa. Ma come si toglie? Di seguito tutte le terapie più utilizzate e le indicazioni.
La biopsia
La visita da uno specialista in dermatologia in questo caso comporta il controllo della cute e di lesioni anomale (che comunemente definiamo come controllo dei neì). Nel dubbio, per avere una diagnosi certa, occorre procedere con una biopsia, ovvero con l’esame istologico in laboratorio della porzione di pelle interessata, asportata chirurgicamente. Esistono diverse metodiche per farlo o anche per asportare il sospetto carcinoma basocellulare a prescindere dalla certezza diagnostica. La terapia utilizzata dipende da vari fattori (come la grandezza o il posto in cui questo tumore maligno si trova- anche per motivazioni estetiche), ma può essere effettuato quasi sempre a livello ambulatoriale e comunque in anestesia locale e senza necessità di ricovero. Raro il dolore post operatorio. Le varie tecniche rappresentano però anche statistiche diverse per la guarigione totale: per questi motivi il dialogo con lo specialista che deve intervenire, va fatto in modo chiaro ed approfondito. Ecco comunque cosa occorre sapere
Togliere il carcinoma con il curettage
Questa tecnica viene utilizzata solitamente per lesioni di piccole dimensioni. Il tumore viene raschiato via dalla pelle con una curette (uno strumento affilato a forma di cucchiaio) mentre la sede del tumore viene di fatto essiccata attraverso un ago elettrocauterizzante. Tale metodica garantisce un grado di cura di circa il 95% , può essere ripetuta due o più volte nella medesima seduta al fine di assicurare che tutte le cellule neoplastiche vengano rimosse. Non risulta però essere particolarmente utile nel trattamento di forme aggressive di carcinoma basocellulare, di forme localizzate in aree critiche o in sedi in cui potrebbero rimanere cicatrici non accettabili esteticamente. Di solito, nella sede dell’intervento rimane una cicatrice tondeggiante biancastra. Non permette inoltre l’esame istologico per la certezza diagnostica.
Chirurgia micrografica di Mohs
Il medico (con una specifica competenza per questo tipo di chirurgia) rimuove un sottile strato di tessuto tumorale che viene contestualmente analizzato al microscopio: se lo strato asportato è costituito interamente da tessuto neoplastico, il chirurgo ripete la procedura asportando strato dopo strato e controllandoli uno ad uno con il microscopio. La resezione viene ripetuta fino a quando la sede trattata non presenta più cellule tumorali. Questo metodo permette di preservare la maggior parte dei tessuti sani e presenta la più alta incidenza di guarigione (circa il 99%). La chirurgia micrografica di Mohs viene utilizzata frequentemente per il carcinoma baso-cellulare recidivante e per quelli localizzati in aree critiche come quella perioculare, il naso, le orecchie e le labbra.
Asportazione chirurgica del tumore
Il medico asporta con il bisturi l’intera lesione tumorale unitamente a parte del tessuto sano circostante quale “margine di sicurezza” (come si fa con altri tipi di tumore) . La cute intorno all’area asportata viene riparata con fili di sutura e il campione di tessuto rimosso viene inviato in laboratorio per l’esame istologico finalizzato ad accertare che tutto il tumore sia stato rimosso. La percentuale di guarigione con l’escissione chirurgica è di circa il 95%, comparabile con quella di procedure come il curettage e l’elettroessiccazione. Se il risultato dell’esame istologico rivela che il tumore non è stato escisso completamente (margini indenni), si dovrà intervenire con una nuova escissione.
Radioterapia vs basalioma
La radioterapia viene eseguita colpendo con i raggi X direttamente il tumore, non richiede anestesia nè incisione chirurgica. Generalmente la totale distruzione della neoplasia richiede una serie di trattamenti, con sedute ogni 7 giorni circa che si protraggono per alcune settimane. Tale metodica è preferibile nel caso di basalioma difficile da asportare chirurgicamente e nei pazienti anziani o in non buone condizioni di salute. La percentuale di guarigione si attesta intorno al 90 %, poichè questa procedura non permette di identificare e rimuovere con precisione le cellule tumorali presenti ai margini della lesione. Se il vantaggio della radioterapia è quello di limitare il danno ai tessuti adiacenti, gli svantaggi sono rappresentati dalla possibilità di comparsa di esiti antiestetici a lungo termine nonchè dai rischi legati all’esposizione alle radiazioni e dalla necessità di numerose sedute per effettuare il trattamento.
Congelare il tumore con azoto liquido
Con la criochirurgia (o crioterapia) il tumore viene distrutto attraverso il congelamento con azoto liquido. Questo viene posto a contatto con la lesione cancerosa senza necessità di anestesia o di incisione chirurgica ( tuttavia, potendo associarsi alla procedura un modesto dolore, si può far precedere il trattamento da una anestesia locale). Dopo il trattamento si forma una bolla o una crosta che cade nell’arco di alcune settimane. La procedura può essere ripetuta nella stessa seduta per assicurare la completa distruzione delle cellule del carcinoma. Un rossore e un gonfiore possono svilupparsi, ma passano da soli nell’arco di poco tempo. La crioterapia è efficace soprattutto nel trattamento delle forme superficiali di carcinoma basocellulare, ed è particolarmente utile nei pazienti affetti da disordini della coagulazione o allergici all’anestetico. Attualmente si ricorre sempre meno frequentemente alla criochirurgia, considerata la minore percentuale di guarigione rispetto a quella riportata con le altre tecniche chirurgiche (circa 85-90%, a seconda dell’abilità del medico operante).
Una crema da applicare localmente
Alcune creme, gel e soluzioni topiche sono usate per trattare forme specifiche e limitate di casalioma, ma hanno percentuali di guarigione più basse rispetto alle altre metodiche: tra l’80 e il 90%.
E’ importante sottolineare che, diversamente dalla chirurgia di Mohs e dalla escissione chirurgica, il curettage ed elettroessiccazione, la radioterapia, crioterapia, e terapia topica presentano tutte un significativo svantaggio: non permettono di determinare se il tumore è stato rimosso completamente e la diagnosi istologica precisa.
Carcinoma basocellulare in fase avanzata, nuove cure
Raramente questo tumore ha forme invasive o fa metastasi. Quando questo accade però si possono utilizzare altre terapie. In particolare il vismodegib rappresenta il primo farmaco in assoluto per forme avanzate di carcinoma basocellulare, approvato dalla FDA nel 2012. E’ indicato per i casi in cui non vi sono altre possibilità terapeutiche ed è controindicato in gravidanza o età fertile.
Leggi anche:
Epitelioma basocellulare, sintomi e cause
T
Fonte: Skincancer.org
Foto: Thinkstock
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