Basal cell carcinoma Flashcards
What are the clinical features of the lesion?
- Shiny pearly nodule
- Surface crust
- Ulceration
- Surface telangiectasia
- Pigmented lesion
The lesion is a shiny pearly nodule with prominent blood vessels on the surface called telangiectasia.
What is the diagnosis?
- Squamous cell carcinoma
- Basal cell carcinoma
- Bowen’s disease
- Dermatofibroma
- Epidermoid cyst
This is a nodular basal cell carcinoma with a typical shiny, pearly appearance and surface telangiectasia. Ulceration may occur in larger lesions but is not seen here. Surface crust typically occurs on ulcerated lesions. This lesion is flesh coloured, not pigmented.
What is the optimal treatment?
- Surgical excision
- Radiotherapy
- Cryotherapy
- Curettage and cautery
Surgical excision with a 3-4 mm margin is the gold standard to clear the tumour.
Should the patient be instructed to stop his Aspirin 10 days prior to surgery?
Aspirin is routinely stopped prior to skin surgery unless there is a good reason not to in terms of thromboembolic risk.
What are the high risk areas for complication of basal cell carcinoma? (4)
- Around the eyes
- Lips
- Nasolabial folds
- Around the ear canal
- Posterior auricular sulcus
- Around the eyes
- Nasolabial folds
- Around the ear canal
- Posterior auricular sulcus
The central face and behind the ears are danger areas. BCC at embryological fusion lines may invade deeply making the risk of recurrence higher. Excision of tumour with clear margins is necessary in these areas.
This non-healing solitary lesion (image below) has been slowly expanding on the trunk of a 70-year-old man for 3 years. What is the diagnosis?
- Superficial BCC
- Psoriasis
- Tinea corporis
- Bowens disease
Superficial BCC
This type of BCC presents as a red scaly plaque. A rolled edge/ pearly border is sometimes discernible.
You might be worried about a melanoma within this lesion - although it could just be blood.
Define basal cell carcinoma.
Commonest form of skin malignancy, related to sun exposure.
BCC has also been known as basal cell epithelioma, reflecting the fact that this neoplasm infrequently metastasises. It can be locally aggressive, but rarely metastasises.
What is the aetiology of basal cell carcinoma?
Repetitive and frequent sun exposure, as ultraviolet (UV) radiation induces DNA damage in keratinocytes - particularly 290-320nm wavelength
Other RFs: photosensitizing pitch, tar and arsenic.
What is the pathophysiology of BCC?
- Basal cells grow in well-defines aggregates invading the dermis with the outer layer of cells arranges in palisades.
- Probably p53 gene mutation and aberrant activation of sonic hedgehog signalling cascade.
- Mitotic and apoptotic bodies seen
- Growth rate is slow, but steady and insidious
- Does not metastasize but has ability to invade and destroy local tissues.
What are the risk factors for BCC?
- UV radiation - mostly 290-320 nm wavelength UV (sunburn wavelength)
- sun exposure
- X-ray exposure
- arsenic exposure - in contaminated water
- xeroderma pigmentosum
- basal cell naevus syndrome (Gorlin-Goltz syndrome)- autosomal dominant inheritance
- transplant patients
What is xeroderma pigmentosum?
An inborn error of DNA-repair mechanisms predisposes patients who suffer from this genetic defect to develop early skin ageing, innumerable BCCs, SCCs, and sometimes a melanoma
What are the signs and symptoms of BCC?
- Papules associated with telangiectasias
- Plaques, nodules, tumours with rolled borders
- Small crusts and non-healing wounds
- Non-healing scabs
- Pearly papules or plaques
All characteristic of BCC.
How is BCC diagnosed?
Biopsy for dermatohistopathology - shave or punch biopsy. Or diagnosis and treatment at same time if lesion is small.
What are these?
TL - Bowen’s disease - early form of skin cancer that is easily treatable. Main sign is red, scaly, patch on the skin. Easy to miss.
BL - SCC
TR - epidermoid cyst - smelly, yellow keratin material would come out if squeezed
BR - dermatofibrome - common benign lesion, usually due to bite or trauma where there is overreaction of the immune system causing hyperpigmenttaion and dimpling if squeezed.
Can a GP remove a BCC?
Only if accredited and part of an MDT; only if below the neck and if they do a certain number of removals a year.
What types of BCCs are these?
