Basal Cell Carcinoma

Question 1

Definition

Answer 1

· COMMONEST form of skin malignancy, also known as a rodent ulcer

Question 2

Aetiology/Risk factors

Answer 2

Caused by damage and subsequent DNA changes to the basal cells in the outermost layer of skin

· MAIN RISK FACTOR: prolonged sun exposure or UV radiation

· Seen in Gorlin’s syndrome

· Other risk factors:
o Photosensitising pitch
o Tar
o Arsenic

Question 3

Epidemiology

Answer 3

· COMMON in those with FAIR SKIN
· Common in areas of high sunlight exposure
· Common in the elderly
· Rare before the age of 40 yrs
· Lifetime risk in Caucasians = 1 in 3

Question 4

Presenting symptoms

Answer 4

· A chronic slowly progressive skin lesion

· Usually found on the:
o FACE
o Scalp
o Ears
o Trunk

Question 5

Signs on physical examination

Answer 5

· Nodulo-ulcerative (MOST COMMON)
o Small glistening translucent skin over a coloured papule
o Slowly enlarges
o Central ulcer with raised pearly edges
o Fine telangiectasia over the tumour surface
o Cystic change in larger lesions

· Morphoeic
o Expanding
o Yellow/white waxy plaque with an ill-defined edge
o More aggressive than nodulo-ulcerative

· Superficial
o Most often on trunk
o Multiple pink/brown scaly plaques with a fine edge expanding slowly

· Pigmented
o Specks of brown or black pigment may be present in any BCC

Question 6

Investigations

Answer 6

· Biopsy is RARELY necessary

· Diagnosis is mainly on clinical suspicion