Malignant Skin Tumours: Non-Melanoma Skin Cancers

Question 1

BASAL CELL CARCINOMA

Subtypes

Answer 1

noduloulcerative (typical)
pigmented variant
superficial variant
sclerosing (morpheaform) variant

Question 2

BASAL CELL CARCINOMA

describe noduloulcerative

Answer 2

skin-coloured papule/nodule with rolled, translucent (“pearly”) telangiectatic border, and
depressed/eroded/ulcerated centre

Question 3

BASAL CELL CARCINOMA

pigmented variant

Answer 3

ecks of pigment in translucent lesion with surface telangiectasia
- may mimic malignant melanoma

Question 4

BASAL CELL CARCINOMA superficial variant

Answer 4

flat, tan to red-brown plaque, often with scaly, pearly border, and fine telangiectasia at margin
least aggressive subtype

Question 5

BASAL CELL CARCINOMA sclerosing (morpheaform) variant

Answer 5

flesh/yellowish-coloured, shiny papule/plaque with indistinct borders, indurated

Question 6

BASAL CELL CARCINOMA

Pathophysiology

Answer 6

malignant proliferation of basal keratinocytes of the epidermis

Question 7

BASAL CELL CARCINOMA. Grade of mallignancy and aggressivity

Answer 7

low grade cutaneous malignancy, locally aggressive (primarily tangential growth), rarely metastatic

Question 8

BASAL CELL CARCINOMA Cause and site

Answer 8

usually due to UVB light exposure, therefore >80% on face
may also occur in previous scars, radiation, trauma, arsenic exposure, or genetic predisposition
(Gorlin Syndrome)

Question 9

BASAL CELL CARCINOMA

Epidemiology. Prevalence,

Answer 9

most common malignancy in humans

• 75% of all malignant skin tumours >40 yr, increased prevalence in the elderly

Question 10

BASAL CELL CARCINOMA Risk Factors, gender.

Answer 10

• M>F, skin phototypes I and II, chronic cumulative sun exposure, ionizing radiation,
immunosuppression, arsenic exposure

Question 11

BASAL CELL CARCINOMA

Differential Diagnosis

Answer 11

benign: sebaceous hyperplasia, intradermal melanocytic nevus, dermatofibroma
• malignant: nodular malignant melanoma, SCC

Question 12

BASAL CELL CARCINOMA topical Management

Answer 12

imiquimod 5% cream (Aldara®) or cryotherapy is indicated for superficial BCCs on the trunk
• 5-fluorouracil and photodynamic therapy can also be used for superficial BCCs

Question 13

BASAL CELL CARCINOMA Qx Procedures

Answer 13

shave excision and electrodessication and curettage for most types of BCCs, not including
morpheaform
• Mohs surgery: microscopically controlled, minimally invasive, stepwise excision for lesions on the face
or in areas that are dificult to reconstruct

Question 14

BASAL CELL CARCINOMA radiotherapy

Answer 14

used in advanced cases of BCC

Question 15

BASAL CELL CARCINOMA vismodegib

Answer 15

is approved for metastatic BCC, also in syndromes characterized by multiple BCCs (Gorlin
Syndrome)

Question 16

BASAL CELL CARCINOMA Prognosis

Answer 16

95% cure rate if lesion <2 cm in diameter or if treated early

Question 17

Surgical Margins

Smaller lesions:

Answer 17

electrodessication and
curettage with 2-3 mm margin of normal
skin

Question 18

Deep infiltrative lesions:

Answer 18

surgical
excision with 3-5 mm margins beyond
visible and palpable tumour border,
which may require skin graft or flap; or
Mohs surgery, which conserves tissue
and does not require margin control