Basal Cell Carcinoma

(BCC)

<Presentations>

<Index>

 

 

Definition

-  Malignancy of basal cell layer of epidermis (skin cancer)

 

Features

-  Most common malignancy in humans

-  Typically occur in areas of chronic sun exposure

-  Usually slow growing, rarely metastasises (<0.1%)

-  Common in whites, rare in dark skinned races

-  Increased likelihood for another BCC --> monitoring

-  40% chance on 5 years

 

Causes

-  UVB exposure: latency of 20-50 years

-  X-rays

-  Arsenic exposure

 

Associated S/S

-  Pigmented skin lesion

-  Non-healing sore of varying duration

-  Typically on face, scalp, ears, neck, upper trunk

-  50% lesions head & neck

-  30% upper trunk

-  Minor trauma may cause bleeding

 

Types

-  Nodular

-  Pigmented

-  Cystic

-  Superficial

-  Micronodular

-  Morpheaform

-  Infiltrating

 

Ix

-  Dermoscopy

-  Skin Bx: shave or punch

-  Histology

-  Dx & subtypes

-  Clear margins

 

Mx

-  Rx

-  Chemotherapy esp for small superficial BCCs

-  Imiquimob 5% cream

-  Superficial BCCs

-  5 x week for 6 weeks

-  70-200% cure rate

-  5-Fluorouracil 5% cream (Efudex)

-  Superficial BCCs

-  80% cure rate

-  BD for 3-6 weeks +

-  Imiquimod (Adara)

-  Imiquimod 5% cream topically Nocte 5 days/week for 6 weeks

-  Potent immunostimulant

-  Good cosmetic outcome

-  Less effective for nodular BCCs

-  Pre Rx Skin Bx recommended

-  Sx

-  Curettage & Cautery

-  Not suitable for high risk areas (face, ears) or aggressive tumours

-  Does not allow margin control

-  90% cure rate

-  Excision w margin examination

-  Down to fat w 3-4mm+ lateral margins

-  95% cure rate

-  Mohs micrographic surgery

-  100% margins examined

-   Histo clear margins confirmed prior to closure

-   Allows re-excision before closure

-  $ & timely

-  98-99% cure rate

-  Used for high risk of recurrence or where tissue conservance critical (eye..)

-  Cryotherapy

-  Non aggressive BCCs

-  Histo required first (Skin Bx)

-  90% cure rate

-  Unpredictable scarring

-  Not commonly used

-  +/- Radiotherapy

-  Elderly & debilitated who cannot tolerate Sx

-  90% cure rate

-  May be used as adjuvant

-  No examination of margins

 

 

 

Nodular

<BCC>

 

 

-  Most common

-  Head, neck, upper back

-  Waxy papules w central depression

-  Pearly, bleeding, erosion/ulcer, crusting

-  Transluncent, raised border (rolled)

-  Telangiectasia over surface

-  DDx Nodular Melanoma

 

BCC - Nodular 1

 

BCC - Nodular

 

 

 

Pigmented

<BCC>

 

 

-  Increased brown or black pigment

-  Most common in dark skinned people

-  Must DDx Melanoma

 

BCC - Pigmented

 

 

 

Cystic

<BCC>

 

 

-  Translucent blue-gray cystic nodules

 

 

 

Superficial

<BCC>

 

 

-  Scaly patches or papules

-  Red-brown to pink in color, central clearing

-  Common on trunk

-  No tendency to invade

-  Numerous may indicate arsenic exposure

 

BCC - Superficial

 

 

 

Micronodular

<BCC>

 

-  Aggres

-  sive

-  Yellowish-white when stretched

-  Firm to touch, not prone to ulceration

 

 

 

Morpheaform & Infiltrating

<BCC>

 

 

-  Aggressive

-  Scar-like plaques or papules

-  Ill-defined border

-  Ulceration, bleeding & crusting uncommon

 

BCC - Morpheaform

 

 

 

References

 

eTG: Bascal Cell Carcinoma (BCC); Feb 2009