Basal Cell Carcinoma Flashcards
1
Q
What is Basal Cell Carcinoma?
A
- A slow-growing locally invasive malignant tumour of the epidermal keratinocytes
- Most common malignant skin tumour
2
Q
What are some of the Risk Factors for BCC?
A
- UV exposure
- Frequent repeated sunburn in childhood
- Fitzpatrick Skin Type 1 ( always burns and never tans)
- Increasing Age and Male
- Previous History of Cancer
- Immunosuppression
- Genetic Predisposition
- Gorlin-Goltz Syndrome
3
Q
What are the Different Types of BCC?
A
- Nodular (most common)
- Superficial (slightly scaly, irregular plaque, thin + translucent rolled border)
- Cystic
- Morphoeic (waxy, scar-like plaque with indistinct borders, infiltrate cutaneous nerves)
- Keratotic
- Pigmented
4
Q
What are the classical features of BCC?
A
- T (Telengiectasia)
- U (Ulceration)
- R ( Rolled Edges)
- P ( Pearly Edges)
5
Q
What is Gorlin- Goltz Syndrome?
A
- Nevoid Basal Cell Carcinoma Syndrome
- A genetic condition which greatly increases the risk of developing BCC’s
- Rare Autosomal Dominant Condition: PTCH1 gene mutation
6
Q
What are other clinical features of Gorlin-Goltz Syndrome?
A
- Broad Nasal Root
- Hypertolerism (wide-spaced eyes)
- Bifid Ribs
- Odontogenic Keratocysts
- Palmar and Plantar Pits in the hands
- Calcification of the Faux Celebri
7
Q
How would you describe the presentation of a Nodular BCC?:
A
- Red/ Flesh-coloured/ well defined borders with overlying telangiectasias
8
Q
How would you describe Superficial BCC?
A
- Erythematous plaque, dry/ crusted or a slight bluish tinge
9
Q
How would you describe Morphoeic BCC?
A
- Scar-like lesion or identation, commonly occur on the upper trunk or face
- whitish, compact, poorly-defined plaque or scar
- Deeply invasive
10
Q
How would you describe a Pigmented BCC ?
A
- Difficult to distinguish from Melanoma
11
Q
What is the Management for a BCC?
A
- Surgical and Non-Surgical
12
Q
What is the Surgical Treatment for BCC?
A
- Surgical Excision - Treatment of choice as it allows histological examination of the tumour and margins OR wide-local excision
- Moh’s Micrographic Surgery ( excision of the lesion and tissue borders are progressively excised until specimens are microscopically free of tumour - high risk recurrent tumours)
13
Q
What is the non-surgical treatment for BCC?
A
- Topical Immunotherapy (Imiquimod) - immune response modifier, applied 3/5 each week for 6/16 week
- 5- Fluorouracil - topical agent, twice daily for 6/12 weeks
- Radiotherapy
- Cryotherapy
- Curettage
- Cautery
- Photodynamic Therapy
14
Q
How can you differentiate between a High Risk and Low Risk lesion?
A
- Size >2cm
- Site (around eyes, nose, lips and ears)
- Poorly-defined margins
- Histological sub-type
- Histological features
- Previous treatment failure
- Immunosuppression
15
Q
What are the Surgical Excision Margins for a Low-risk lesion?
A
- small <2 cm = 4/5mm margins
