infiltrating basal cell carcinoma

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Infiltrating Basal Cell Carcinoma. Maysoon ALGain Dermatology Demonstrator KAAU. Case Presentation. CC: growth on right side of nose HPI: 81 yo HF who first noted growth on right side of nose “last December”, progressively growing. PMH: arthritis SH: ½ ppd smoker X 25 years - PowerPoint PPT Presentation

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  • Infiltrating Basal Cell CarcinomaMaysoon ALGainDermatology DemonstratorKAAU

  • Case PresentationCC: growth on right side of noseHPI: 81 yo HF who first noted growth on right side of nose last December, progressively growing.PMH: arthritisSH: ppd smoker X 25 yearsROS: denies F/C, significant weight lossFH: non-contributory

  • Physical ExamGeneral: AAO, VSS and goodVA: 20/80 OD, 20/50 OSPupils: 3mm OU, no APDExternal: extensive ulcerative lesion from bridge of nose to RLL and R cheek, with almost complete destruction of RLL and nearly complete ptosis of RULIOP, CVF, DFE normal OS, unobtainable OD

  • Differential DiagnosisMalignant melanomaSquamous cell carcinomaBasal cell carcinoma, infiltrativeInfectious

  • Basics of BCCBackgroundMost common cutaneous malignancy (~80-90%)Typically slow-growing, rarely metastasizesSun-exposed skin, mostly face and scalp, esp nose, cheek, and periorbital regions (~80%)Frequency900,000 Dx in US/yearestimated lifetime risk of 33-39% for men and 23-28% for womenSexMen 2X over women

  • Basics of BCCMortality/Morbidity
  • Variants of Basal Cell CarcinomaSuperficialNodularMicronodularInfiltrating (5%)Sclerosing/ morpheaform (5%)MetatypicalInfundibulocysticNodulocystic AdenoidClear cellFollicularSebaceousPerineurally invasive

  • Perineural InvasionMay be seen in 3% of pts with infiltrating and morpheaform typesMost often infiltrating type, which has highest rate of local recurrenceRequires CT scan for full work-upCauses? inherently aggressive behavior vs inadequate early management?

  • Treatment OptionsElectrodessication and curettageCurettage aloneSurgical excisionMohs micrographically controlled surgeryCryosurgeryIonizing radiationSurgical excision plus radiationExenteration

  • Factors Considered in Treatment PlanningPt preference to keep eyePt ageSurgical excision-considered definitive txCareful frozen section controlled excision of periocular BCCs yields cure rates comparable to Mohs micrographic surgery at 5-year follow-up5 year recurrence of 2.2% in one studyWong, et al. Management of Periocular Basal Cell Carcinoma with Modified En Face Frozen Section Controlled Excision. Ophthalmic and Plastic Reconstructive Surgery. 2002. Vol 18 (6): 430-435.Therefore, avoiding exenteration was considered a good possibility

  • ConclusionBasal cell carcinomas are not always as innocent as we tend to believeIn formulating treatment course:Strong pt preference andother pt factorsCurrent research

    **Italicized considered aggressive histotypes, n most likely to lead to perineural invasion n/or recurrence. Overall 5 year recurrence is 5%, 1.2% c adequate exc, 12% c tumor in 1 HPF of margin, n 33% if at margin*

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