Basal Cell Carcinoma (BCC)

Question 1

What is the aetiology and epidemiology of BCC?

Answer 1

Most common type of cancer in humans.
Very rarely a threat to life.
Typically affect adults in fair complexion (refer Fitzpatrick scale) with a lot of sun exposure/episodes of sunburn
More common in elderly, 50s, may present under 40s in sun-loving individuals
Tendency to develop may be inherited

Question 2

What are the presenting features of BCC?

Answer 2

1. Nodular BCC (often in the face)
   - dome-shaped
   - smooth, rolled-edges
   - pearly
   - telangiectasia
   - papule
   - old tumours may present as ulcerated noduels (rodent ulcer)
2. Superficial BCC (often multiple, most often on upper trunk/shoulders-may resemble discoid eczema etc)
   - scaly erythematous plaques
   - well-defined ?raised pearly edges
3. Pigmented
4. Morphoeic (sclerosing)
   - ill-defined borders
   - waxy indurated plaque
   - may resemble a scar

Question 3

What are the treatments for BCC?

Answer 3

1. Surgical excision (gold standard)
   - most appropriate for nodular, infiltrative, morphoeic BCC
2. Curretage, shave & cautery
   - many small, well-defined nodular/superficial BCC, removing top layer of skin
3. Moh’s micrographically controlled excision
   - high risk areas of face, ill-defined, morphoeic and recurrent BCC-layer by layer
4. Photodynamic therapy
5. Imiquimoid cream
6. Cryotherapy
   - small superficial BCC, leaves white mark