Basal Cell Carcinoma

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Commonest form of skin cancer
Slow growing tumour affecting the basal cells of the skin
Can locally invade but rarely metastasises
Can sometimes be referred to by laymen as "rodent ulcer"

Epidemiology[edit]

  • Accounts for 80% of non-melanoma skin cancers
  • 80% of cases occur in the head and neck [1]
  • Marked geographical variation (commonest in Europe, Australia and USA)
  • Much more common in fair-skinned individuals with a family history
  • Up to 30% of caucasians will develop BCCs in their lifetime [1]
  • Incidence increases in those >50 years old
  • Multiple BCCs in younger patients is suggestive of nevoid basal-cell carcinoma syndrome (Gorlin-Goltz Syndrome)
  • ♀ > ♂

Clinical Features[edit]

  • Most commonly affects sun exposed areas
  • Different subtypes exist which tend to occur at different anatomical locations (see below for main types)
  • Pigmented subtype also exists (~7% of cases)[2]
Clinical subtypes
Type Image Clinical Notes
Nodular Basal cell carcinoma.jpg

Nodular
Pearly white or pink
Telangiectasia
Ulceration
Cystic is a variant of nodular BCC

  • Appears as a smooth, round cystic mass
Most common form
Morphoeic (Sclerosing) Source = DermNet

Usually found in mid-facial sites
Waxy, scar-like plaque with indistinct borders
Wide and deep subclinical extension
May infiltrate cutaneous nerves (perineural spread)

The most important clinical subtype
5% of all BCCs
More aggressive and ill-defined
∴ complete excision is more difficult
Can be very large and pose reconstructive issues

Superficial Source = DermNet

Slightly scaly, irregular plaque
Thin, translucent rolled border
Multiple microerosions

Most common type in younger adults
Most common type on upper trunk and shoulders

Differential Diagnosis[edit]

  • Squamous Cell Carcinoma
  • Malignant melanoma (pigmented basal cell carcinoma)
  • Melanocytic naevi (pigmented basal cell carcinoma)
  • Bowen's disease (especially superficial basal cell carcinoma)
  • Psoriasis (superficial)
  • Eczema (superficial)
  • Sebaceous hyperplasia
  • Molluscum contagiosum
  • Appendygeal tumours

Aetiology and Pathogenesis[edit]

Investigations[edit]

Diagnosis is usually clinical
In cases where there is uncertainty an incisional or punch biopsy may be performed

Imaging[edit]

CT or MRI imaging may be used for extensive lesions to delineate any involvement in adjacent structures

Management[edit]

  • Management

Prognosis and Complications[edit]

  • Prognosis and Complications

References[edit]