Basal cell carcinoma : BCC

Skin cancer ---> Non melanoma skin cancer ---> Basal cell carcinoma

Basal cell carcinoma (rodent ulcer) is a slow-growing, locally invasive tumor with virtually no capacity to metastasize.
Epidemiology
Basal cell carcinoma is the most common type of skin cancer, approximately 4 times more common than squamous cell carcinoma.
Pathology
The most significant etiological factor is chronic excess ultraviolet radiation exposure. As a result, exposed areas such as the head and neck are most commonly involved. Other risk factors include increasing age, male gender, and skin phototypes I and II. Histologically there is a proliferation of atypical basal keratinocytes.
Clinical features
The clinical appearances and morphology are diverse and include nodular, morphoeic, superficial multifocal, keratotic and pigmented varieties.
The nodular basal cell carcinoma tends to arise on the forehead, nose or adjacent to the inner canthus of the eye as a skin-colored or pigmented, translucent nodule with surface telangiectasia. Gradual enlargement leads to central ulceration (ulcerated basal cell carcinoma) with a peripheral, 'rolled' pearly edge. There may also be cystic change (cystic or nodulocystic basal cell carcinoma). The morphoeic (sclerosing) basal cell carcinoma presents as a firm, indurated, skin-colored, scar-like plaque with ill-defined edges, commonly on the nasolabial fold or forehead. Superficial multifocal basal cell carcinomas tend to arise on extra-facial sites as red, scaly plaques and have no relation to sun exposure. Pigmented basal cell carcinomas may be brown, blue or black with a smooth glistening surface. Keratotic basal cell carcinomas have evidence of keratinization on histology.
Initial investigations
Skin biopsy
A skin biopsy confirms the diagnosis and determines the histological subtype. Alternatively, cytology can be performed on skin scrapings.
Initial management
Multidisciplinary team approach
Depending on the size and site of the basal cell carcinoma, dermatologists, clinical oncologists and plastic surgeons may all be involved in the management. Therefore, a multidisciplinary approach is favored.
Surgical management
Curettage and cautery
Curettage and cautery is a suitable option for patients with low-risk lesions (small, well-defined, primary lesion) and can achieve 5-year cure rates of up to 97%. Patients with recurrent morphoeic tumors in high-risk sites such as the nose, nasolabial folds and around the eyes should undergo formal surgical excision.
Cryotherapy
Cryotherapy can be used on low-risk lesions with non-aggressive histology that are not recurrent lesions.
Surgical excision
The main aim of surgery is complete excision with a clear surgical margin.
Medical management
Radiotherapy
Radiotherapy is useful for treatment of basal cell carcinoma in locations where disfigurement results from surgical excision (although atrophy telangiectasia may develop in the long term and affect the cosmetic results). The 5-year cure is approximately 90%. Patients with recurrent lesions after radiotherapy should undergo surgical excision.
Topical 5-fluorouracil
Topical 5-fluorouracil is usually the treatment of choice for multiple superficial basal cell carcinomas on the trunk and lower limbs.
Palliative management options
Aggressive treatment can be inappropriate in elderly debilitated patients, especially for asymptomatic low-risk lesions. Palliative treatment such as debulking the tumor or radiotherapy may be more appropriate.
RECENT ADVANCES
Intralesional interferon and photodynamic therapy are still under investigation with some early promising results.
Prognosis
Metastasis is extremely rare and the morbidity is related to local tissue invasion and destruction. Patients with a single tumor are at a significant increased risk of developing subsequent basal cell carcinomas.

Basal Cell Carcinoma photos

skin cancer pictures ---> basal cell carcinoma ---> basal cell carcinoma photos.

Understanding Basal Cell Carcinoma (Skin Cancer #4)

Skin cancer awareness ---> skin cancer videos---> basal cell carcinoma

Basal cell carcinoma is the most common form of all cancers. Learn more about BCC.

Basal Cell Carcinoma: BCC

Skin cancer ---> Non melanoma skin cancer ---> Basal cell carcinoma

BCC is the most common form of skin cancer. These epithelial- derived tumors can be divided into various subtypes according to clinical appearance, histologic pattern, and biologic behavior. Although BCCs rarely metastasize, they are characterized by slow but relentless and destructive local invasion that results in high morbidity without treatment. The subclinical local invasion may be deep, extensive, and asymmetric, with finger like extensions several centimeters beyond the clinical borders.
The most common subtype of BCC is the well-circumscribed nodular variety. These tumors often present as pearly papules or nodules with telangiectases. They may be pruritic and bleed occasionally. With time, the center ulcerates to create peripheral rolled borders; such ulcerating BCCs are called rodent ulcers. Occasionally, the lesions are deeply pigmented and nodular and can be confused with melanoma. This variant has been called a pigmented BCC. The histologic features of these tumors demonstrate isolated areas of basaloid tumor islands arising from the epidermis with peripheral palisading of nuclei and stromal retraction. In some cases, the BCC has histologic features of squamous metaplasia with keratinization. These tumors have basosquamous differentiation and can become more aggressive and develop regional lymphatic spread.
The most locally aggressive type of BCC is characterized by a diagnostic histopathologic aggressive growth pattern, known as morpheaform, sclerosing, or fibrosing BCC. Clinically, these tumors may be more subclinical, are flat, and appear to be scar like. They have a significant incidence of recurrence because of the isolated, finger like fronds of basal cell tumor cells that may deeply invade the surrounding structures well beyond the clinical margins of the lesion. These small, finger like islands are often missed with standard histologic margin control.
Clinically, superficial BCCs are scaly pink to red lesions. Frequently, they are confused with psoriasis or other eczematous, scaly dermatoses. Although these tumors are usually relatively superficial, extensive superficial subclinical involvement is common. Numerous risk factors are associated with possible extensive subclinical invasion and increased rates of local recurrence for BCC after standard treatment, including surgical excision

Causes of BCC and SCC

Non melanoma skin cancer ---> Causes of Non melanoma skin cancer

Both BCC and SCC are most commonly induced by significant exposure to ultraviolet light from the sun or tanning booths. These cancers are the predominant neoplasms on the head, neck, trunk, lower legs, and extensor arms and hands where sun exposure is common. Skin cancer is a significant occupational hazard for people who work outdoors. The phenotype at increased risk is one with fair skin who sunburns and freckles easily, blue eyes, and red or blonde hair. Melanin pigment in the skin appears to be the protective factor.
A number of genetic syndromes are associated with an increased risk of developing NMSC, including Gorlin syndrome, xeroderma pigmentosa, and albinism. Gorlin syndrome is an autosomal dominant disorder associated with multiple BCCs, palmoplantar pits, jaw cysts, frontal bossing, and hypertelorism. Albinism is a disorder characterized by a partial or complete deficiency in melanin production and, thus, loss of protective pigment. Another factor associated with NMSC, primarily SCC, is chronic exposure to chemicals such as arsenic and hydrocarbons (found in coal tars, soot, and asphalt). Cigarette smoking has been associated with SCC of the lip and mouth. Human papillomavirus has been associated with cutaneous SCC in the genital and acral/periungual areas. Radiation has been associated with both SCC and BCC.

Basal Cell Carcnoma Higher Risk Factors

Non melanoma skin cancer ---> Basal cell carcinoma ---> metastatic risk

These include the following factors:
Recurrent tumor

Anatomic location
High risk: central face, eyelid, eyebrow, periorbital, nose, lip, chin, mandible, temple, ear, in front or behind the ear, genitalia, hand and foot
Medium risk: cheeks, forehead, scalp, and neck
Low risk: trunk, extremity (excluding hand/foot)

Size
Lesions +6 mm on high-risk area
Lesions +10 mm on medium-risk area
Lesions +20 mm on low-risk area

Histologic subtype pattern
Aggressive growth (morpheaform, fibrosing, sclerosing, infiltrating)
Micronodular

Ill-defined clinical borders
Perineural invasion
Development in sites of prior radiation
Immunosuppression

How to Identify Skin Cancer Signs : Signs of Basal Cell Carcinoma Skin Cancer

Skin cancer awareness ---> skin cancer videos ---> Basal Cell Carcinoma ---> skin cancer detection ---> Signs of Basal Cell Carcinoma

Learn how to identify the signs of basal cell carcinoma skin cancer with expert tips from a doctor on skin health.

Adjuvant and Primary Radiation Therapy for nonmelanoma cancers

Non melanoma skin cancer ---> treatment of Non melanoma skin cancer ---> Radiation therapy

Radiation therapy may be useful for primary treatment of low-risk non melanoma skin cancers. In experienced hands, primary radiation therapy may also be useful for higher risk tumors with high cure rates. For cutaneous SCC with many high-risk factors and for those with extensive neurotropism, adjuvant prophylactic radiation therapy to the primary site and the primary draining lymph nodes may decrease the risks of local recurrence and regional nodal metastasis. Prophylactic adjuvant radiation therapy should also be considered for highly aggressive, deeply invasive BCCs that exhibit extensive neurotropism.

Treating BCC and SCC (Skin Cancer #6)

Skin cancer awareness ---> skin cancer videos ---> Non melanoma skin cancer ---> treatment of Non melanoma skin cancer

Basal cell carcinoma and squamous cell carcinoma are the two types of non-melanoma skin cancers. Luckily, there are many options for treating them.

Surgical Treatment of Nonmelanoma Skin Cancers

Non melanoma skin cancer ---> treatment of Non melanoma skin cancer ---> Non melanoma skin cancer Surgery

A skin biopsy for diagnosis is important before treatment of any skin cancer. Fortunately, most non melanoma skin cancers are small, low-risk lesions that respond with 90% to 95% cure rates to standard treatment techniques, including curettage and electrodesiccation, cryosurgery, radiation therapy, and surgical resection. Many skin cancers can be removed with elliptical excisions. Margins for low-risk SCC range from 0.5 to 1 cm. Margins for low-risk BCC range from 0.3 to 0.5 cm. Mohs surgery should be considered for BCCs and SCCs that exhibit the higher-risk factors. If Mohs surgery is not available, excision with careful frozen-section control (with permanent section confirmation) is indicated. The fundamental oncologic principle of tumor clearance first, reconstruction second should be followed.

Understanding Basal Cell Carcinoma (Skin Cancer #4)

Skin cancer awareness ---> skin cancer videos ---> Non melanoma skin cancer ---> Basal Cell Carcinoma

Basal cell carcinoma is the most common form of all cancers. Learn more about BCC.

Mohs Surgery

Non melanoma skin cancer ---> treatment of Non melanoma skin cancer ---> Non melanoma skin cancer Surgery ---> Mohs Surgery

Mohs surgery was developed by Frederick E. Mohs, a general surgeon from the University of Wisconsin, in the 1940s. Initially, a chemical fixative paste was applied to the skin to fix the tissue in situ; hence, the now outdated term Mohs chemosurgery. The fresh tissue technique, which omitted the chemical paste, was developed and refined in the 1970s. Mohs micrographic surgery is most useful for the treatment of higher risk NMSC. Mohs surgery is usually performed under local anesthesia in an outpatient Mohs surgical unit. After removal of all gross tumor, the surgeon excises a thin layer of tissue with 2- to 3-mm margins. The tissue is mapped, color-coded for orientation, and sent to the technician for frozen-section processing. The specimen is flexible and flattened, with the beveled peripheral skin edge placed in the same horizontal plane with the deep margin. In this plane, both the deep and peripheral margins are examined in one horizontal cut by frozen-section analysis with total (theoretically 100%) margin control. Good-quality frozen sections may be achieved only by a skilled and experienced Mohs histotechnician. The Mohs surgeon functions as both surgeon and pathologist. After histologic interpretation of the frozen-section specimens, the precise anatomic location of any residual tumor can be identified and re-excised until all margins are tumor free. The Mohs surgeon's ability microscopically to track subclinical tumor extensions results in the highest cure rate with maximal preservation of normal tissue. Soft tissue reconstruction can then be performed on the same day, after completion of Mohs surgical excision of the tumor. A multidisciplinary approach involving Mohs, plastic, head and neck, and oculo-plastic surgeons and radiation oncologists may be needed for extensive tumors. Mastering the Mohs technique is based on a steep learning curve. The American College of Mohs Micrographic Surgery and Cutaneous Oncology requires 1 to 2 years of fellowship training with a minimum of 500 to 600 cases before certification.