Basal Cell Carcinoma

Question 1

Epidemiology

Answer 1

Caucasians, increased risk with age, r/t frequent sun exposure early in life and prior sunburns

Question 2

Pathogenesis of BCC

Answer 2

UV radiation causes mutations in cells and the p53 gene on sun exposed sites or any site with pilosebaceous glands.

Question 3

Most common site for BCC

Answer 3

Face

Question 4

Nodular BCC

Answer 4

Most common, pearly papule with rolled borders and telangiectasias. Can ulcerate. Head, ears, scalp, hear bearing areas

Question 5

Superficial BCC

Answer 5

erythematous macule or patch or plaque with thin rolled borders. Trunk and extremities.

Question 6

Morpheaform BCC

Answer 6

Elevated or depressed area of induration, light or white in color, ill defined borders, telang.

Question 7

Fibroepithelial BCC

Answer 7

pedunculated smooth nodule, flesh colored or pink, low back most commonly

Question 8

Pigmented BCC

Answer 8

Nodular features but with brown pigment

Question 9

Basosquamous BCC

Answer 9

BCC and SCC, 1% of all non melanoma skin cancers

Question 10

Curettage with Electrodessication

Answer 10

97-98 percent effective

Question 11

Excision margins needed

Answer 11

4mm, effective in 98% of cases

Question 12

Radiation tx for BCC

Answer 12

When surgery is not an option, pts > 60 years, higher recurrence rates

Question 13

MOHS

Answer 13

99% effective to remove entire tumor, frozen sections guide the excision, especially superior to facial lesions

Question 14

Tx: Intralesional interferon alpha 2b

Answer 14

3 injections weekly for 3 weeks - for those who arent surgical/radiation candidates

Question 15

Imiquimod tx for BCC

Answer 15

50-75% effective for superficial BCC

Question 16

Vismodegib (Erivedge)

Answer 16

metastatic, aggressive or recurrent BCC, interacts with hedgehog pathway, 150mg daily until clear. s/e: alopecia, n/v/d, decreased appetite, muscle spasms, amenorrhea. teratogenic, no donating blood until 7mo post therapy