Basal cell carcinoma PDF

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Basal cell carcinoma  

Common, locally invasive, keratinocyte cancer (NON-MELANOMA). Most common form of skin cancer

EPIDEMIOLOGY  173.5-265.4 per 100,000 UK RISK FACTORS  Increasing age (elderly males)  Previous history of BCC/ other skin cancers  Chronic sun exposure/damage (photoaging, actinic keratosis – precancerous condition)  Repeated epsiodes of sunburn  Skin type: fair skin, blond, burns easily  Previous cutaneous damage e.g. thermal burns, skin conditions (cutaneous lupus, sebaceous nevus)  Inherited conditions: basal cell naevus syndrome (gorlin Sebaceous naevus syndrome), xeroderma pigmentosum, rombo syndrome, oley syndrome  Others: ionising radiation, arsenic exposure, immune suppression CAUSES  Multifactorial  Mutations in PTCH (patched tumour suppressor gene) part of the hedgehog signalling pathway  UV exposure CLINICAL FEATURES  SLOW growing plague or nodule  Skin coloured, pink/brown/pigmented  Varies in size  Spontaneous bleeding or ulceration (telangiectasia seen on dermascope) TYPES BCC  Nodular BCC - Most common facial type - Shiny/pearly nodule with a smooth surface. Can have central depression/ulceration Nodular BCC - Blood vessels across the surface - Can have variants: cystic, micro-nodular, micro-cystic and infiltrative. (potentially aggressive)  Superficial BCC - Most common in younger adults on Upper trunk/shoulders - Slightly scaly, irregular plaque - Thin, translucent rolled border Superficial BCC - Multiple microerosions

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Morphoeic BCC - Mid facial sites - Waxy, scar like plaque with indistinct borders - May infiltrate cutaneous nerves Basosquamous BCC - Mixed basal and squamous cell carcinoma - Infiltrative growth pattern - Potentially more aggressive than other forms

Morphoeic BCC

COMPLICATIONS  Recurrence due to incomplete excision, location on head and Basosquamous BCC neck and morpheoic, micronodular and infiltrative types.  Advanced BCC are often neglected tumours that are several cm in diameter. Infiltrate tissues and are difficult to treat  Metastatic BCC are rare. Happens if primary lesion is big and neglected. May have had multiple prior treatments. DIAGNOSIS  Clinically: slow growing skin lesion with typical appearance.  Biopsy TREATMENT  depends on size, type and location  Excision biopsy: lesion cut out and skin stitched up. - Most common treatment for nodular, infiltrative, morphoeic BCCs. - Include 3-5mm margin of normal skin. - Large lesions require skin grafts - Pathologist will report deep and lateral margins  Mohs micographically controlled excision: reviewed each layer of skin until complete excision. Used in high risk areas e.g. eyes, lips, nose.  Superficial skin surgery: shave, cottage, electrocautery. Rapid. Uses local anaesthetic. - Small well defined nodules or superficial lesions - Trunk/limbs  Cryotherapy: freezing lesion off. Results in blister that heals after a couple of weeks  Photodynamic therapy: uses photosensitive chemical which is exposed to light - Aminolevulinic acid lotion and methyl aminolevulinate cream - Low risk, small, superifical BCC - Repeated 7 days after treatment - Excellent cosmetic results  Imiquimod cream: immune response modifier - Superficial BCC...