Basal cell carcinoma

Question 1

Define basal cell carcinoma.

Answer 1

Basal cell carcinoma (BCC) of the skin is a common neoplasm, related to exposure to sunlight. BCC has also been known as basal cell epithelioma, reflecting the fact that this neoplasm infrequently metastasises.

Nodular BCC - ROLLED PEARLY EDGES

Question 2

What is the aetiology of basal cell carcinoma?

Answer 2

UV radiation (290-320nm) causes DNA damage

Question 3

What are risk factors for basal cell carcinoma?

Answer 3

UV radiation (290-320nm)

Aberrant Hedgehog signalling pathway

Xeroderma pigmentosum

Nevoid basal cell carcinoma (Gorlin-Goltz) syndrome

Question 4

Summarise the epidemiology of BCC.

Answer 4

Most common skin malignancy in white adults

Common

>40 y/o mostly but younger cases are also rising

Question 5

What are signs and symptoms of BCC?

Answer 5

Papules with associated telangiectasias

Plaques, nodules, and tumours with rolled borders

Small crusts and non-healing wounds

Non-healing scabs

Pearly papules and/or plaques

Question 6

What investigations should be performed for BCC?

Answer 6

Skin biopsy

Question 7

What is the management for BCC?

Answer 7

Conventional surgery

Curettage and cautery and biopsy for low risk

Radiotherapy

Question 8

What are complications associated with basal cell carcinoma?

Answer 8

Lymph node spread of BCC

Distant metastasis of BCC

Local spread of BCC

Question 9

What is the prognosis of BCC?

Answer 9

Treatment is generally very effective with low recurrence rates

Question 10

What are signs of high risk BCC?

Answer 10

Tumour size 2 cm or larger

Tumour site (the central face)

Poorly defined clinical margins

High-risk histological sub-type

Histological features of aggression; perineural or perivascular involvement

Failure of previous treatment (the tumour is a recurrence)

Immunosuppression