Basal Cell Carcinoma Flashcards
Define basal cell carcinoma
Cancer of the keratinocytes in the stratum basale of the epidermis
Slow growth rate with local invasion and does not tend to metastasise
What are the main types of basal cell carcinoma
Nodular (most common)
Superficial
Morpheic
Pigmented
Risk factors for basal cell carcinoma
UV light (repetitive and frequent)
Family history
Lighter skin
Arsenic exposure
Tar
Xeroderma pigmentosum
Gorlin syndrome
Epidemiology of basal cell carcinoma
Most common form of skin malignancy in fair skinned adults
Incidence increasing
Increases with age
Symptoms of basal cell carcinoma
Slowly progressive skin lesion found on the face, but also on scalp, ears or trunk
Small crusts and non-healing wounds or scabs
Symptoms of metastases to lung or bone (UNCOMMON)
Signs of nodular basal cell carcinoma
Nodule
Pearly/shiny edges
Rolled edges
Central “rodent” ulcer
Central fine telangiectasia
Signs of superficial basal cell carcinoma
Found on trunk
Flat
Pink/brown scaly plaques
“whipcord edge” that expands
Signs of morphemic basal cell carcinoma
Yellow/white waxy plaque
Ill-defined edge
Scar-like
Signs of pigmented basal cell carcinoma
Specks of brown or black pigment
Investigations for basal cell carcinoma
Clinical diagnosis
Skin biopsy (shave or punch):
Neoplasm composed of basophilic (blue) hyperchromatic cells, with high nuclear-cytoplasmic ratio
Management for Basal Cell Carcinoma
Consider routine referral OR suspected cancer pathway referral (2ww) if there is particular concern that a delay may have a significant impact, because of factors such as lesion site or size
Conventional surgery: excision (with 3mm surgical margin for lesions < 2cm | 2% recurrence )
Curettage +/- electrodessication and biopsy
Radiotherapy (if surgery not appropriate, lower recurrence rates)
Cryotherapy or non-surgical topical therapies (imiquimod, fluorouracil, phototherapy)
Moh’s surgery (1% recurrence): Excision of lesion and tissue borders are progressively excised until specimens are microscopically free from tumour
If metastatic → Visomedegib (hedgehog pathway inhibitors)
If basal cell naevus syndrome → Treat BCCs | Visomodegib
Complications of treatment for basal cell carcinoma
Moh’s surgery: wound dehiscence, excessive scarring, and infections.
- Most of the adverse effects are relatively minor and can be addressed by medication
Radiotherapy: permanent hair loss, radiation burn and increased risk of secondary cancers
