Basal cell carcinoma

Question 1

What are the risk factors for BCC?

Answer 1

• UV exposure
• History of frequent or severe sunburn in childhood
• Skin type I
• Increasing age
• Male
• Immunosuppression
• Prev history of skin cancer
• Genetic predisposition

Question 2

On what areas of the skin do BCC typically occur?

Answer 2

• Areas of skin exposed to the sun
• Typically occurs above the line joining the earlobe and the corner of the mouth
• Forehead
• Eyelid
• Nose and nasolabial fold
• Upper lip
• Palms, soles of the feet, and mucous membranes are rarely affected

Question 3

What is the appearance of a BCC?

Answer 3

• Pearly nodules with superficial telangiectasia
• Rolled edges
• Non healing lesion with a necrotic or ulcerated centre (rodent ulcer)
• Scaling plaque (superficial BCC)
• Painless

Question 4

Describe the typical growth of a BCC.

Answer 4

• Slow growing (over months to years)
• Locally invasive
• Rarely metastasises

Question 5

What investigations should be done when a BCC is suspected?

Answer 5

• Dermoscopy
• Excisional biopsy (full or partial thickness) –> first-choice investigation
• Wedge biopsies (large lesions)

Question 6

What are the main differentials for a BCC?

Answer 6

• Trichoepithelioma
• Keratoacanthoma
• SCC

Question 7

What is the treatment for BCC?

Answer 7

• Surgical excision with a safety margin
• Radiotherapy (patient preference, large tumours, incomplete surgical removal)
• Other options include cryosurgery, laser ablation, topical chemotherapy with imiquimod or 5- fluorouracil

Question 8

What is the prognosis for BCC?

Answer 8

Excellent with surgical excision - low rate of metastasis