Basal cell carcinoma

Question 1

definition of basal cell carcinoma

Answer 1

commonest form of skin malignancy

also known as rodent ulcer

Question 2

aetiology of basal cell carcinoma

Answer 2

prolongued sun exposure or UV radiation

associated with abnormalitues of the patched/hedgehog intracellular signalling cascade - seen in Gorlin’s syndrome (naevoid basal call ca syndrome)

Question 3

RF for BCC

Answer 3

photosensitising pitch

tar

arsenic

Question 4

pathology of BCC

Answer 4

small dark blue staining basal cells growing in well defined aggregates invading the dermis with the outer layer of cells arranged in palasides

numerous mitotic and apoptotic bodies are seen

growth rate usually slow, but steady and insidious

does not met

has potential to invade and destroy local tissues

Question 5

epidemiology of BCC

Answer 5

common in those with fair skin and areas of high sunlight exposure

common in elderly

rare before age of 40yrs

lifetime risk in caucasians is 1:3

Question 6

sx of BCC

Answer 6

a chronic slowly progressive skin lesion

usually on face but also scalp, ears or trunk

Question 7

different types of BCC

Answer 7

nodulo-ulcerative (most common)

morphoeic

superficial

pigmented

Question 8

signs of nodulo-ulcerative BCC

Answer 8

small glistening translucent skin over a coloured papule that slowly enlarges (early) or a central ulcer (rodent ulcer) with raised pearly edges

fine telangiectatic bessels often run over the tumour surface

cystic change may be seen in larger more protuberant lesions

Question 9

signs of morphoeic BCC

Answer 9

expanding

yellow/white waxy plaque with an ill-defined edge

more aggresive

Question 10

signs of superficial BCC

Answer 10

most often on trunk/shoulders

multiple pink/brown scaly plaques with a fine whipcord edge expanding slowly

raised smooth edge

can grow to more than 10cm in diameter

Question 11

signs of pigmented BCC

Answer 11

specks of brown or black pigment may present in ant type of BCC

Question 12

Ix for BCC

Answer 12

biopsy rarely necessary - dx based mainly on clinical suspicion

Question 13

mx of basal cell ca

Answer 13

surgical removal- excision / mohs
curettage - small, well defined nodular / superficial
cryotherapy - superficial bcc
photodynamic therapy - superficiall bcc
topical cream: imiquimod, fluorouracil
radiotherapy

Question 14

mx of contact dermatitis

Answer 14

1. avoidance
2. short course topical steroids
3. emollients
4. severe - systemic steroids
5. occasionally phototherapy, immunosuppressive eg methotrexate