basal cell carcinoma

Basal Cell Carcinoma Omar Abdullah

Epidemiology
Most common human cancer(~80-90%)600,000 to 800,000 cases per year in U.S.Male:Female 2-3:180% arise in head and neckAge✔Likelihood increases with age✔ BCCa over 40 years oldRace✔Most often in light-skinned, rare in dark-skinned races

Etiology

Ultraviolet radiation ethnicity ionizing radiation exposure chemical exposure - arsenic burns, scarring immunosuppression

Basics of BCC

Typically slow-growing Rarely metastasizes (<0.1%) Typically sporadic No cellular anaplasia (a true carcinoma?) Very low mortality Significant morbidity with direct invasion of adjacent tissues, especially when on face or near an eye

Classic presentation of basal cell

Classic superficial basal cell

Variants of Basal Cell Carcinoma

Superficial Nodular Micronodular Infiltrating (5%) Sclerosing/ morpheaform (5%) Metatypical Infundibulocystic
Nodulocystic Adenoid Clear cell Follicular Sebaceous Perineurally invasive

Types of BCC

Nodular
Basosquamous
Superficial
Pigmented
Morphoeic

Basal Cell Carcinoma - Subtypes

Superficial Single or multiple patches Trunk Indurated scaly D/D- eczema, psoriasis tinea.

Basal Cell Carcinoma - Subtypes

Nodular Ulcerative Most common Usually on the face Small, slow growing Firm Telangectasias Ulceration

Basal Cell Carcinoma - Subtypes

Sclerosing (Morpheaform) Yellow white plaques Ill defined boarders Most aggressive Most likely to recur Central sclerosis & scarring

Basal Cell Carcinoma - Subtypes

Pigmented Similar to nodular type Deep brown pigmentation Differential- malignant melanoma

Basal Cell Carcinoma - Subtypes

FIBROEPITHELIOMA PINKUS TUMOUR Raised Moderately firm Erythematous and smooth Lower trunk (lumbosacral area)_

BCC - Syndromes

BASAL CELL NEVUS (GORLIN’S) SYNDROMEAD, no sex linkage, low penetrance? Mutated tumour suppressor at Ch 9q23.1-q31Childhood onsetBCC (average age 20y)Pitting of palms and soles odontogenic keratocysts (epithelial jawline cysts) CNS calcifications (dura), MR

Other Associated Syndromes

XERODERMA PIGMENTOSUM Incomplete sex-linked recessive Deficiency of endonuclease Childhood onset Extreme sun sensitivity BCC,SCC,Melanoma

Other Associated Syndromes

ALBINISM Genetic abnormality of the pigment system.

Basal Cell Carcinoma - Histopathology

Resemble normal basal cells Hyperchromatic nuclei, scant cytoplasm Clustered separate from stroma Peripheral palisading Desmoplastic reaction Nests or in continuity

Clinical course

Nodulo-ulcerarive type begins as a flesh coloured waxy nodule with telangectasia→ enlarges → central ulceration → deepens → rolled out, beaded edges → destroys structures locally as deep as bone/ cartilage → aptly named rodent ulcerRare metastasis, but recurrence known after inadequate treatment


DIFFERENTIAL DIAGNOSIS
Cyst Infected spot Sebaceous hyperplasia Naevus Molluscum contagiosum Wart
Bowens disease Tinea Eczema/psoriasis Malignant melanoma Seborrhoeic keratosis Erosions and leg ulcers

Treatment Options

Electrodessication and curettage Curettage alone Surgical excision Mohs micrographically controlled surgery Cryosurgery Ionizing radiation Surgical excision plus radiation Imiquimod cream

Factors Considered in Treatment Planning

Pt preference to keep eyePt ageSurgical excision-considered definitive tx“Careful frozen section controlled excision of periocular BCCs yields cure rates comparable to Mohs micrographic surgery at 5-year follow-up”5 year recurrence of 2.2% in one studyTherefore, avoiding exenteration was considered a good possibility