As a principle in the treatment of skin cancers it is considered that healing is achieved by their radical removal and histological confirmation that the tumor was completely removed on healthy tissues.

Early attendance of the patient with the initiating tumor to the appropriate physician is best for immediate and radical treatment.

Dr Drimouras and colleagues, we take care of an oncological correct – “clean” excision of the skin lesion to safe surgical margins and in addition we pay special attention to the good aesthetic result of the reconstruction so that the patient will soon return to his daily life without stigmas and malformations.

The basal cell carcinoma is the most frequent malignant skin neoplasm. It causes topical tissue destructions, it increases in very slow rate and its course does not arrest easily. It may appear at any age but it usually appears after the age of 40.

Frequency of appearance of basal cell carcinoma is greater on men in comparison to women, although these last years a rise have been noted on the female population. Overall exposure of the patient to sun radiation during his life, ionize radiation from previous radiotherapies and exposure to arsenic are the most important risk factors.

Lesions are usually defected on the face (eyelid, inner canthal area, zygomatic area, cheeks, forehead, upper lip and nose) on the scalp, external ear and neck. Sometimes it is defected on the unprotected areas of the trunk and limbs.

There are various clinic types of basal cell carcinoma:

• Nodular basal cell carcinoma (also known as “classic basal-cell carcinoma”) which is the most common
• Rodent ulcer is a large skin lesion of nodular basal-cell carcinoma with central necrosis
• Cystic basal cell carcinoma
• Pigmented basal cell carcinoma
• Superficial basal cell carcinoma
• Cicatricial basal cell carcinoma (also known as “morpheaform basal cell carcinoma)
• Fibroepithelioma of Pinkus
• Gorlin syndrome
• Basal cell carcinoma associated with nevus sebaceous of Jadassohn
• Basosquamous carcinoma is a rare aggressive epithelial neoplasm with features of both basal cell carcinoma and squamous cell carcinoma

If not treated, basal cell carcinoma persists, infiltrates and destroys adjacent and deeper structures. When its treatment is inadequate, basal cell carcinoma can persist under the scar tissue formed by tumor destruction.

For those with a first carcinoma, the risk for second is estimated at 17% in the first year, 35% within three years and 50% within 5 years. Basal cell carcinoma rarely threatens the patient’s life. As a rule, basal cell carcinomas do not give rise to metastases. Depending on localization, local tissue damage can lead to significant disabilities.

For baseline basal cell carcinomas, the basic methods of treatment are cryotherapy, electrocauterization and the use of various agents (chemotherapeutics, immunostimulants). When the lesion is located in a “special” location (lips, nose, auricle, eyelids, scalp), as well as in larger or recurrent tumors, surgical removal is the method of choice.

The goal of surgical treatment is the complete removal of the tumor and the immediate surgical reconstruction of the anatomical structures both from a functional and aesthetic point of view. The following histological examination allows control of surgical margins to confirm that the malignant lesion has been removed. Removal of the tumor results in a deficit of some size, which must then be reconstructed using one of the techniques of Plastic Surgery, and specifically by direct closure, a partial or full thickness skin graft, a local flap or a regional flap.

These surgical procedures are mostly done with local anesthesia, are well tolerated by patients and do not affect their daily lives, especially when treatment is done on time.

Squamous cell carcinoma is the second most frequent malignant neoplasm of the skin. It is a primary, invasive tumor which appears in areas of the body exposed to the sun, most commonly in the head (nose, ears, chin, lower lip, forehead, temples, cheeks and scalp), neck and hands of the elderly patients.

Squamous cell carcinoma can develop in the presence of an actinic keratosis or other precancerous lesion or even skin area without pre-existing skin lesion (“de novo”). A person’s probability of developing squamous cell carcinoma at some point in his life is estimated to be between 4% and 14%.

The etiological factors involved in the pathogenesis of squamous cell carcinoma include solar radiation, X and gamma radiation, arsenic, polycyclic aromatic hydrocarbons, smoking, chronic inflammation (chronic osteomyelitis), chronic ulcerative scars (Marjolin ulcers), human papillomaviruses (HPV), immunological agents (immunosuppression, transplanted patients) and heredity.

Initially, the carcinoma penetrates the skin and infiltrates the topical tissues. When it reaches deeper layers of skin, the lateral extension of the tumor begins alongside the skin, following the minimal resistance path. Cancer cells can be transported to remote locations through the perivascular space of the large vessels and the perineural space of the nerves. Finally, the tumor may give metastases, usually through lymph vessels in the regional lymph nodes and later in distant organs.

Treatment of choice for primary squamous cell carcinomas is wide surgical excision and histological examination to confirm complete tumor removal with the right safety margins. The removal of the tumor creates a deficit of some size, which must then be reconstructed by one of the techniques of Plastic Surgery, namely direct closure, partial or full thickness skin graft, local flap or regional flap.

These surgical procedures are mostly done with local anesthesia, are well tolerated by patients and do not affect their daily lives, especially when treatment is done on time.

In all cases of invasive squamous cell carcinoma, regional lymph nodes must be checked. In squamous cell carcinomas that have an increased likelihood of metastasis, a sentinel lymph node biopsy (SLNB) may be performed. In the presence of clinically palpable and traceable lymph node metastases, lymphadenectomy of the regional lymph nodes must be performed.

When surgical removal of the lesion is not feasible, the patient may undergo radiotherapy.

After surgical removal of the tumor, careful monitoring of the patient is recommended at regular intervals. Patients should be trained to be able to examine the skin on their own, and if they find suspicious lesions, they should visit their physician.

The prognosis is generally better for squamous cell carcinomas grown in actinic keratosis as they almost never give metastases compared to those developed on healthy skin or other precancerous lesions (actinic cheilitis, post-traumatic ulcers and chronic actinic dermatitis) and show a possibility of metastasis 20-30%.

Generally, as a principle in the treatment of skin cancers it is believed that healing is achieved by their radical removal and histological confirmation that the tumor was completely removed on healthy tissues. Early attendance of the patient with the onset of cancer to the appropriate physician is best for immediate and radical treatment.