Basal Cell Carcinoma (11)

Question 1

What is Basal Cell Carcinoma (BCC)?
How does it look?

Answer 1

Skin cancer
Pearly papule with a central ulcer, with granulation tissue on base and with rolled in (inverted) edges with surrounding telangiectasia

Question 2

What is the most probable diagnosis for the lesion?

Answer 2

Basal Cell Carcinoma

Question 3

What is the natural history of BCC?

Answer 3

Indolent with slow progression, locally destructive but limited potential to metastasize

Question 4

What are the differential diagnoses for BCC?

Answer 4

SCC, TB, Actinic keratosis, Seborrheic keratosis, Verruca vulgaris

Question 5

What is the concern in the pathology report for BCC?

Answer 5

Deep margin involvement

Question 5

How does lymph node spread occur in BCC?

Answer 5

Permeation, embolization

Question 6

How do you manage a patient with deep margin involvement in BCC?

Answer 6

Re-excision

Question 7

What are the causes for graft failure in a skin graft placed for a patient with BCC?

Answer 7

• Infection
• Trauma
• Lack of wound bed/graft apposition (avascular bed)
• Haematoma or Seroma formation under the graft
• Technical error

Question 7

What are the treatment options for BCC?

Answer 7

• Surgical: Curettage and Electrodessication, Excision with primary closure, Cryotherapy (with liquid nitrogen), Mohs micrographic surgery
• Radiotherapy
• Topical: Topical photodynamic therapy, Topical fluorouracil 5%, Topical imiquimod 5%

Question 8

How can recurrence of deep margin involvement be prevented during re-operation?

Answer 8

If recurrent, go for Mohs micrographic surgery (frozen section)

Question 9

How would you manage a patient with MRSA wound infection?

Answer 9

• If abscess, I&D
• Outpatient: Oral antibiotics as clindamycin, amoxicillin plus tetracycline or tmp/smx, linezolid
• Inpatient: Vancomycin Dose to target trough level 7-14 days, Linezolid 600 mg twice daily, PO or IV 7-14, Daptomycin 4 mg/kg once daily 7-14, Telavancin 10 mg/kg once daily 7-14, Clindamycin 600 mg IV or 300 mg PO 3 times daily
• Decolonization with mupirocin nasal or chlorhexidine for body decolonization
• Infection control of MRSA

Question 10

After excision, the patient developed regional lymphadenopathy. What is the interpretation of FNAC results?

Answer 10

Reed-Sternberg cells: (owl eye appearance) → Hodgkin’s lymphoma

Question 11

How does lymphatic spread occur in malignant tumors?

Answer 11

Malignant tumors release growth factors such as VEGF-C to induce lymphatic vessel expansion (lymph angiogenesis) in primary tumors and in draining sentinel LNs, thereby promoting LN metastasis.

Question 12

Describe infection control measures for MRSA

Answer 12

Measures apply to all patients, regardless of MRSA status:
- High standards of hand decontamination required
- Hands should be decontaminated before and after every patient contact
- Use liquid soap and water for handwashing; alcohol hand rub may be used as an alternative
- Maintain high standards of aseptic technique and ward cleanliness
- Handle all linen and waste in accordance with Trust policies

Additional precautions for all MRSA positive patients:
- Place patient in a single room or ward bay
- Wear gloves and disposable plastic aprons when handling the patient or having contact with their immediate environment
- Dispose of waste and linen in accordance with Trust policies
- Gowns may be required where extensive contact with the patient is anticipated

Question 13

What organising most commonly infects skin grafts resulting in them failing?

Answer 13

Common organism: S. aureus

Need to be aware for MRSA (Methicillin-resistant Staphylococcus aureus)