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Page 1: basal cell carcinoma
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Basal cell carcinoma

Bhavishya Valder

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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

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Etiology

Ultraviolet radiationethnicityionizing radiation exposurechemical exposure - arsenicburns, scarringimmunosuppression

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Basics of BCCTypically slow-growingRarely metastasizes (<0.1%)Typically sporadicNo cellular anaplasia (a true carcinoma?)•Very low mortality•Significant morbidity with direct invasion of adjacent tissues, especially when on face or near an eye

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Classic presentation of basal cell

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Classic superficial basal cell

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Variants of Basal Cell Carcinoma

• Superficial• Nodular• Micronodular• Infiltrating (5%)• Sclerosing/

morpheaform (5%)• Metatypical• Infundibulocystic

• Nodulocystic • Adenoid• Clear cell• Follicular

• Sebaceous• Perineurally

invasive

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Types of BCC

Nodular

Basosquamous

© Schofield JK and Kneebone R (2006) Skin lesions: a practical guide to diagnosis management and minor surgery.

Superficial

PigmentedMorphoeic

©dermNetNZ.org (http://dermnetnz.org)

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Basal Cell Carcinoma - Subtypes

SuperficialSingle or multiple patchesTrunkIndurated scalyD/D- eczema, psoriasis or tinea.

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Basal Cell Carcinoma - SubtypesNodular UlcerativeMost commonUsually on the faceSmall, slow growingFirmTelangectasiasUlceration

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Basal Cell Carcinoma - SubtypesSclerosing (Morpheaform)Yellow white plaquesIll defined boardersMost aggressiveMost likely to recurCentral sclerosis & scarring

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Basal Cell Carcinoma - Subtypes

PigmentedSimilar to nodular typeDeep brown pigmentationDifferential- malignant melanoma

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Basal Cell Carcinoma - Subtypes

FIBROEPITHELIOMAPINKUS TUMOURRaisedModerately firmErythematous and smoothLower trunk (lumbosacral area)_

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BCC - SyndromesBASAL 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

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Other Associated Syndromes

XERODERMA PIGMENTOSUMIncomplete sex-linked recessiveDeficiency of endonucleaseChildhood onsetExtreme sun sensitivityBCC,SCC,Melanoma

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Other Associated Syndromes

ALBINISM Genetic abnormality of the pigment system.

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Basal Cell Carcinoma - Histopathology

Resemble normal basal cellsHyperchromatic nuclei, scant cytoplasmClustered separate from stromaPeripheral palisadingDesmoplastic reactionNests or in continuity

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Clinical courseNodulo-ulcerarive type begins as a flesh coloured waxy nodule with telangectasia→ enlarges → central ulceration → deepens → roled out, beaded edges → destroys structures locally as deep as bone/ cartilage → aptly named rodent ulcer

Rare metastasis, but recurrence known after inadequate treatment

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DIFFERENTIAL DIAGNOSIS

• Cyst

• Infected spot

• Sebaceous hyperplasia

• Naevus

• Molluscum contagiosum

• Wart

• Bowens disease

• Tinea

• Eczema/psoriasis

• Malignant melanoma

• Seborrhoeic keratosis

• Erosions and leg ulcers

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Treatment Options

• Electrodessication and curettage• Curettage alone

• Surgical excision• Mohs micrographically controlled surgery• Cryosurgery• Ionizing radiation• Surgical excision plus radiation

• Exenteration

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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

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