Basal Cell Carcinoma

Question 1

Skin cancer is one of the most common cancers. In general skin cancer can be divided into non-melanoma (BCC and SCC) and melanoma (malignant melanoma). Sun exposure is the single most preventable risk factor for skin cancer.

What is a basal cell carcinoma?

Answer 1

• Slow-growing
• Locally invasive
• Malignant tumour of epidermal keratinocytes normally in older individuals
• Only rarely metastasies
• Most common malignant skin tumour

Question 2

What are the risk factors for basal cell carcinoma?

Answer 2

• UV exposure
• Hx of frequent or severe sunburn in childhood
• Skin type I (always burns, never tans)
• Increasing age
• Male sex
• Immunosuppression
• Prev hx of skin cancer
• Genetic predisposition

Question 3

How does BCC present?

Answer 3

• Various morphological types → nodular (most common), superficial (plaque-like), cystic, morphoeic (sclerosing), keratotic and pigmented
• Nodular BCC is a small, skin-coloured papule or nodule w/ surface telangiectasia, and a pearly rolled edge; the lesion may have a necrotic or ulcerated centre (rodent ulcer)
• Most common over the head and neck

Question 4

Generally, if a BCC is suspected, a routine referral should be made. What is the management for BCC?

Answer 4

• Surgical excision → treatment of choice as it allows histological examination of tumour and margins
• Mohs micrographic surgery (ie. excision of lesion + tissue borders are progressively excised until specimens are microscopically free of tumour) → for high risk, recurrent tumours
• Radiotherapy → when surgery not appt
• Cryotherapy
• Curettage + Cautery
• Topical photodynamic therapy
• Topical treaments eg. imiquimod, fluorouracil

Question 5

What are complications of BCC?

Answer 5

Local tissue invasion and destruction

Question 6

What is the prognosis for BCC?

Answer 6

• Depends on tumour size, site, type, growth pattern/histological subtype, failure of prev treatment/recurrence, and immunosuppression
• Most BCCs are cured by treatment. Cure is most likely if treatment is undertaken when the lesion is small.

About 50% of people with BCC develop a second one within 3 years of the first. They are also at increased risk of other skin cancers, especially melanoma. Regular self-skin examinations and long-term annual skin checks by an experienced health professional are recommended.

Question 7

How can basal cell carcinoma be prevented?

Answer 7

The most important way to prevent BCC is to avoid sunburn. This is especially important in childhood and early life. Fair skinned individuals and those with a personal or family history of BCC should protect their skin from sun exposure daily, year-round and lifelong.

• Stay indoors or under the shade in the middle of the day
• Wear covering clothing
• Apply high protection factor SPF50+ broad-spectrum sunscreens generously to exposed skin if outdoors
• Avoid indoor tanning (sun beds, solaria)