| What is basal cell carcinoma? | • Basal cell carcinoma (BCC) is a nonmelanocytic skin cancer (ie, an epithelial tumor) that arises from basal cells (ie, small, round cells found in the lower layer of the epidermis)
• The prognosis for patients with BCC is excellent, but if the disease is allowed to progress, it can cause significant morbidity |
| What are S&S of basal cell carcinoma? | BCC occurs mostly on the face, head (scalp included), neck, and hands.
Other characteristic features of BCC tumors include:
• Waxy papules with central depression
• Pearly appearance
• Erosion or ulceration: Often central and pigmented
• Bleeding: Especially when traumatized
• Oozing or crusted areas: In large BCCs
• Rolled (raised) border
• Translucency
• Telangiectasias over the surface
• Slow growing: 0.5 cm in 1-2 years
• Black-blue or brown areas |
| What are common areas for basal cell carcinoma? | Periocular tumors most commonly involve:
• Lower eyelid: 48.9-72.1%
• Medial canthus: 25-30%
• Upper eyelid: 15%
• Lateral canthus: 5% |
| What are the clinicopathologic types of basal cell carcinoma? | • Nodular: Cystic, pigmented, keratotic; the most common type of BCC; usually presents as a round, pearly, flesh-colored papule with telangiectases
• Infiltrative: Tumor infiltrates the dermis in thin strands between collagen fibers, making tumor margins less clinically apparent
• Micronodular: Not prone to ulceration; may appear yellow-white when stretched, is firm to the touch, and may have a seemingly well-defined border
• Morpheaform: Appears as a white or yellow, waxy, sclerotic plaque that rarely ulcerates; is flat or slightly depressed, fibrotic, and firm
• Superficial: Seen mostly on the upper trunk or shoulders; appears clinically as an erythematous, well-circumscribed patch or plaque, often with a whitish scale |
| How is dx of basal cell carcinoma? | Biopsy (• Types of skin biopsy that may be used to confirm the diagnosis and determine the histologic subtype of BCC include the following:
• Shave biopsy: Most often, the only biopsy that is required
• Punch biopsy: May be indicated in the case of a pigmented lesion if there is difficulty distinguishing between pigmented BCC and melanoma; ensures that the depth of the lesion can be determined if it proves to be a malignant melanoma) |
| How is histology of basal cell carcinoma? | • Undifferentiated BCC: when there is little or no differentiation, the carcinoma is referred to as solid BCC; this form includes pigmented BCC, superficial BCC, sclerosing BCC, and infiltrative BCC (a histologicsubtype)
• Differentiated BCC: often has slight differentiation toward hair (keratotic BCC), sebaceous glands (BCC with sebaceous differentiation), and tubular glands (adenoid BCC); nodulo-ulcerative (nodular) BCC is usually differentiated |
| How is tx of basal cell carcinoma? | In nearly all cases of BCC, surgery is the recommended treatment modality. Techniques used include :
• Electrodessication and curettage
• Excisional surgery
• Mohs micrographically controlled surgery
• Cryosurgery
• BCCs are usually radiosensitive; radiation therapy (RT) can be used in patients with advanced and extended lesions, as well as in those for whom surgery is not suitable
• Photodynamic therapy (PDT) as an adjunct is a reasonable choice in :
-Tumor recurrence with tissue atrophy and scar formation
-Elderly patients or patients with medical conditions preventing extensive oculoplastic reconstructive surgery
-Tumor with poorly defined borders based on clinical examination
-Tumor requiring difficult or extensive oculoplastic surgery |
| How is topical tx of basal cell carcinoma? | Topical agents used in the treatment of superficial BCC include the following :
• Topical 5-fluorouracil 5%: May be used to treat small, superficial BCCs in low-risk areas
• Imiquimod: Approved by the US Food and Drug Administration for the treatment of non facial superficial BCC
• Tazarotene: Can also be used to treat small, low-risk BCCs |
