Carcinoma Basocelular: O Câncer de Pele mais comum

O carcinoma basocelular (CBC) é o tipo mais comum de câncer da pele, sendo que os cânceres da pele correspondem a 33% de todos os cânceres no Brasil. A sua incidência vem aumentando nos últimos anos. A letalidade é baixa, porém, sua incidência é elevada, gerando um ônus significativo ao sistema de saúde, se tornando um problema de saúde pública.

Fatores de Risco

O seu aparecimento está relacionado a exposição solar. Outros fatores de risco são:

-Pele clara

-Idade avançada

-Histórico familiar de carcinomas de pele

-Olhos e cabelos claros

-Sardas na infância

-Imunossupressão por tratamento de outras doenças ou por transplantes

-Aspectos comportamentais, como exercício profissional ou recreativo com exposição solar e queimaduras solares na juventude.

Geralmente acomete mais a face, especialmente o nariz, orelhas, ombros e costas, mas pode surgir em qualquer área exposta ao sol e mais raramente em áreas não expostas

Causas

O CBC é causado pelo crescimento anormal e descontrolado das células que compõem a camada basal da pele. Apresenta-se geralmente como uma lesão na pele de aparência elevada e brilhante, translúcida, pode ser cor da pele, as vezes avermelhada e até acastanhada, lembrando uma pinta, que pode sangrar com facilidade. Seu crescimento geralmente é lento, podendo ulcerar, dando origem a uma ferida que não cicatriza.

Diagnóstico

O diagnóstico é muitas vezes através do exame clínico. Atualmente os dermatologistas usam aparelhos como o dermatoscópio que é uma lente de aumento acoplada a uma luz especial, que auxilia no exame da lesão, com maior detalhe, observando sua arquitetura. Outro equipamento útil, porém disponível apenas em alguns centros de referência de diagnóstico e tratamento do câncer da pele é o microscópio confocal, que permite a avaliação do tipo de células da lesão, evitando muitas vezes a necessidade da realização de biópsia para o diagnóstico.

Na maioria dos casos a biópsia da pele é necessária para diagnóstico do CBC, diferenciação dos outros tumores da pele e também para indicar a melhor forma de tratamento. O dermatologista orientará qual a melhor forma de examinar a lesão para propor o melhor tratamento para cada tipo de CBC.

O importante em todo o tipo de câncer é o diagnóstico e o tratamento precoces. O CBC é um tipo de câncer que cresce lentamente, porém sua incidência maior é na face e pode acometer áreas nobres como nariz, pálpebra, orelhas que são áreas mais delicadas para reconstrução cirúrgica após a retirada do tumor. Se, após a retirada do tumor, a ferida cirúrgica for grande, poderá ser necessário o uso de um retalho ou mesmo um enxerto de pele. Quanto menor for a lesão no momento do seu diagnóstico e tratamento, mais fácil será a reconstrução. Os CBCs grandes e infiltrativos podem provocar lesões mutilantes ou desfigurantes, causando sofrimento aos pacientes. Raramente o CBC pode causar metástase.

Tratamento

Há várias formas de tratamento para o CBC. A modalidade varia conforme o subtipo do CBC, localização, extensão, idade e doenças associadas.

O tratamento mais comum é a cirurgia, considerada a primeira opção devido a sua alta eficácia. Na maioria das vezes o procedimento pode ser feito em ambiente ambulatorial. A retirada deverá ser realizada com uma margem de segurança.

A cirurgia com controle microscópico das margens, como a cirurgia de Mohs (nome do seu criador), técnica de Munique entre outras, apresenta os maiores índices de cura e está indicada para algumas áreas mais delicadas e consideradas “nobres” como a face, subtipos mais agressivos de CBC e também tumores já recidivados. É a melhor forma de se avaliar se as margens estão livres no ato da cirurgia, antes de se fechar a lesão através do exame de congelação. Esse tipo de exame dá mais segurança para o médico e para o paciente de que não há mais células do tumor na pele, diminuindo as chances de recidiva. Para realização desse tipo de cirurgia há necessidade de uma equipe capacitada.

Alguns tumores muito pequenos e em áreas consideradas menos complexas pode se realizar curetagem e eletrocoagulação. O calor do bisturi elétrico é utilizado para destruir as células cancerígenas. Da mesma forma, a criocirurgia, através do uso de nitrogênio líquido, congela o tumor, causando a sua destruição.

A radioterapia é reservada para tratamento do CBC quando a cirurgia pode não ser a melhor escolha de tratamento devido as características do CBC ou por condições do paciente

A terapia fotodinâmica utiliza uma droga para tratamento da lesão que é aplicada topicamente no tumor, permanece na pele por algum tempo para que possa ser absorvida. Então, a pele é exposta a uma luz especial para tratar a lesão. Sua indicação é mais restrita para alguns tipos de tumores onde a cirurgia ou outras formas de tratamento não pode ser realizada.

Outra forma de tratamento é a aplicação de um medicamento tópico como o imiquimode ou o 5-fluorouracil. O tratamento pode ser feito em casa pelo próprio paciente que aplica o creme na lesão com o objetivo de se destruir o tumor. Essa modalidade também possui indicações bem específicas e não está indicada para todos os tumores.

Há medicamentos orais chamados de droga alvo, como o vismodegib. Essas drogas são reservadas para tratamento de tumores inoperáveis e/ou metastáticos. A incidência de meta´stases de CBC e´ extremamente rara.

O mais importante é que o CBC deve ser tratado adequadamente após o seu diagnóstico. A primeira opção sempre é a cirurgia, de preferência, com o controle microscópico de suas margens quando indicado. O tumor recidivado apresenta pior prognóstico que o tumor inicial. O dermatologista indicará qual é a melhor opção de tratamento para cada tipo de CBC.

O paciente que apresentou um CBC deve fazer seguimento com o dermatologista com o objetivo de se avaliar recidivas do tratamento e aparecimento de outros CBCs e também outros tipos de câncer da pele. O indivíduo que apresentou um CBC está sujeito a ter outros CBCs e outros cânceres da pele.

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