Basal Cell Carcinoma
last authored: Sept 2009, David LaPierre
last reviewed:
Introduction
Basal cell carcinoma: most common human malignant disease! Ulcerative lesion w rolled
borders and telangiectasias. Grows by local invasion (“rodent ulcer”), not by LN or
distant mets.
The Case of...
Causes and Risk Factors
Fasting growing group is women under 40.
Pathophysiology
Subtypes include:
Types (from most common:
- noduloulcerative
- superficial (almost like eczema)
- pigmented
- scar-like
- morpheoform (sclerosing)
Signs and Symptoms
- history
- physical exam
History
Physical Exam
start up as papules-nodules-ulcerative
pearly/shiny
growing
Rolled-up borders
telangiectasias
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
squamous cell carcinoma
actinic keratosis
melanoma (pigmented BCC can be confused with it)
Treatments
Excisional surgery is standard.
Electrodessication and curretage may be done, but with poor opportunity for patholgy diagnosis.
Radiation
Chemotherapy or immiquimod (T Cell modulator) can be applied topically, especially for superficial BCC.
5- fluorouracil (5-FU) used topically, destroys tumour cells by interfering
- pain, itching, burning, hyperpigmentation
Imiquimod is an immunomodulator that induces cytokines with antiviral and anti-tumoural effects
- expensive
- less local side effects, but can cause systemic flu-like symptoms
Ingenol
- directly induces tumour cell necrosis via intracellular calcium spike
- plant derivative
- very quick course
- expensive
Rx: elecrodessic’n & curettage (derm), local excision (can use narrow
margins for most BCC), cryotherapy (liquid N), topical chemo, superficial RT or
tumours (e.g. morpheaform/sclerosing or neurotropic BCC).
Consequences and Course
Metastasis is exceedingly rare, except in immunosuppressed patients, who even still have very rare rates of metastasis.
Resources and References
Topic Development
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