MEN'S HEALTH MATTERSBasal cell carcinoma, also known as rodent ulcer, doesn't spread around the body like other cancers, writes Thomas Lynch
Q My husband has been told by his doctor that a growth on his cheek is a skin cancer, which he called a rodent ulcer. How did he get this, what is the best treatment for it, and is it dangerous?
A A rodent ulcer or basal cell carcinoma (BCC) is the most common type of cancer in Ireland. As it doesn't spread around the body like other cancers it is very rarely a threat to life. However, if left to fester and isn't treated it can cause problems. A BCC typically affects adults, particularly those who have a fair complexion and get a lot of sun exposure. It is not only the sun that you get on holidays or by the beach, but it is also the daily small exposure to the sun you get when you are out and about gardening, golfing, working etc.
Although BCCs can affect anywhere on the body they are usually found on the face where they typically grow slowly over months or years and can vary in size. The commonest type is a small translucent growth, sometimes with rolled edges and small blood vessels on the surface. They may become an open sore (hence the word rodent ulcer), bleed, and never quite heal up. They can also be brown like a little mole, or be skin coloured and look a bit like a waxy scar.
There are many different types of treatment for a BCC. This usually depends on the type and size of the tumour, where it is situated, the number of tumours to be treated, but also the expertise and preference of the doctor. Dermatologists or plastic surgeons usually treat these.
Treatments include: burning and scraping the tumours; cutting them out and stitching the skin up; cryosurgery where they are freeze-burned; and X-ray treatment.
There are some newer treatments, which can give good cosmetic results, such as photodynamic therapy or imiquimod cream. These two types of treatment are useful for very thin early tumours only. Because BCCs can be a bit like icebergs - more under the surface than what one sees on the surface - there is a form of surgery called Mohs micrographic surgery, where a dermatological surgeon traces the roots of the tumour out.
It is used where the tumour occurs in high-risk areas in the middle of the face, or if it is one of the more aggressive forms of BCC. Whatever the chosen treatment, basal cell carcinomas nearly always can be cured, though occasionally they can recur at the same site. If this happens they can be treated again.
If you have one BCC diagnosed, you are at an increased risk of developing others. It is important that your husband protects his skin from the sun, by wearing covering clothing (long sleeves, a broad-brimmed hat and apply a broad spectrum sun screen to any exposed skin during the summer months.) It is also a good idea to check your own skin from time to time and any persisting or growing lumps should be checked out by your GP or dermatologist.
Q My husband who is 67 years of age is to have coronary bypass surgery in the near future. What exactly does this entail?
A Coronary artery bypass surgery is where the coronary arteries are bypassed due to an obstruction in the native coronary arteries. The arteries are blocked by atheromatous plaques (cholesterol laden deposits). The cause of this process is multifactorial, involving hereditary factors, smoking, cholesterol levels, sedentary lifestyle and stress.
This is a major open operation where the sternum (chest bone) is split and separated to allow the surgeon access to the heart.
The blocked arteries are bypassed using veins or other arteries from other places within your body. Commonly veins are taken from the leg and arteries are taken from the back of the chest wall or arm. These vessels are then attached (grafted) beyond the obstruction in the native coronary arteries. The number of bypasses performed depends on the number of vessels blocked, ie single, double or triple bypass graft or more.
Following the operation the patient will return to intensive care and generally will be woken up four to six hours later. The stay in ICU usually lasts about 24 hours, after which the patient will return to the ward before going home about a week later. During this time the patient will be given adequate analgesia (pain killers) and all your questions will be answered.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St Jamess Hospital, Dublin with contributions from Dr Patrick Ormond, consultant dermat- ologist and dermatological surgeon, St James's Hospital, Dublin and Michael Tolan, consultant cardiothoracic surgeon, St James's and St Vincent's University Hospital, Dublin.