Skin cancer ---> Non melanoma skin cancer ---> Basal cell carcinoma
Basal cell carcinoma (rodent ulcer) is a slow-growing, locally invasive tumor with virtually no capacity to metastasize.
Epidemiology
Basal cell carcinoma is the most common type of skin cancer, approximately 4 times more common than squamous cell carcinoma.
Pathology
The most significant etiological factor is chronic excess ultraviolet radiation exposure. As a result, exposed areas such as the head and neck are most commonly involved. Other risk factors include increasing age, male gender, and skin phototypes I and II. Histologically there is a proliferation of atypical basal keratinocytes.
Clinical features
The clinical appearances and morphology are diverse and include nodular, morphoeic, superficial multifocal, keratotic and pigmented varieties.
The nodular basal cell carcinoma tends to arise on the forehead, nose or adjacent to the inner canthus of the eye as a skin-colored or pigmented, translucent nodule with surface telangiectasia. Gradual enlargement leads to central ulceration (ulcerated basal cell carcinoma) with a peripheral, 'rolled' pearly edge. There may also be cystic change (cystic or nodulocystic basal cell carcinoma). The morphoeic (sclerosing) basal cell carcinoma presents as a firm, indurated, skin-colored, scar-like plaque with ill-defined edges, commonly on the nasolabial fold or forehead. Superficial multifocal basal cell carcinomas tend to arise on extra-facial sites as red, scaly plaques and have no relation to sun exposure. Pigmented basal cell carcinomas may be brown, blue or black with a smooth glistening surface. Keratotic basal cell carcinomas have evidence of keratinization on histology.
Initial investigations
Skin biopsy
A skin biopsy confirms the diagnosis and determines the histological subtype. Alternatively, cytology can be performed on skin scrapings.
Initial management
Multidisciplinary team approach
Depending on the size and site of the basal cell carcinoma, dermatologists, clinical oncologists and plastic surgeons may all be involved in the management. Therefore, a multidisciplinary approach is favored.
Surgical management
Curettage and cautery
Curettage and cautery is a suitable option for patients with low-risk lesions (small, well-defined, primary lesion) and can achieve 5-year cure rates of up to 97%. Patients with recurrent morphoeic tumors in high-risk sites such as the nose, nasolabial folds and around the eyes should undergo formal surgical excision.
Cryotherapy
Cryotherapy can be used on low-risk lesions with non-aggressive histology that are not recurrent lesions.
Surgical excision
The main aim of surgery is complete excision with a clear surgical margin.
Medical management
Radiotherapy
Radiotherapy is useful for treatment of basal cell carcinoma in locations where disfigurement results from surgical excision (although atrophy telangiectasia may develop in the long term and affect the cosmetic results). The 5-year cure is approximately 90%. Patients with recurrent lesions after radiotherapy should undergo surgical excision.
Topical 5-fluorouracil
Topical 5-fluorouracil is usually the treatment of choice for multiple superficial basal cell carcinomas on the trunk and lower limbs.
Palliative management options
Aggressive treatment can be inappropriate in elderly debilitated patients, especially for asymptomatic low-risk lesions. Palliative treatment such as debulking the tumor or radiotherapy may be more appropriate.
RECENT ADVANCES
Intralesional interferon and photodynamic therapy are still under investigation with some early promising results.
Prognosis
Metastasis is extremely rare and the morbidity is related to local tissue invasion and destruction. Patients with a single tumor are at a significant increased risk of developing subsequent basal cell carcinomas.
Wednesday, December 12, 2007
Tuesday, December 11, 2007
Wednesday, December 5, 2007
Understanding Basal Cell Carcinoma (Skin Cancer #4)
Skin cancer awareness ---> skin cancer videos---> basal cell carcinoma
Basal cell carcinoma is the most common form of all cancers. Learn more about BCC.
Basal cell carcinoma is the most common form of all cancers. Learn more about BCC.
Basal Cell Carcinoma: BCC
Skin cancer ---> Non melanoma skin cancer ---> Basal cell carcinoma
BCC is the most common form of skin cancer. These epithelial- derived tumors can be divided into various subtypes according to clinical appearance, histologic pattern, and biologic behavior. Although BCCs rarely metastasize, they are characterized by slow but relentless and destructive local invasion that results in high morbidity without treatment. The subclinical local invasion may be deep, extensive, and asymmetric, with finger like extensions several centimeters beyond the clinical borders.
The most common subtype of BCC is the well-circumscribed nodular variety. These tumors often present as pearly papules or nodules with telangiectases. They may be pruritic and bleed occasionally. With time, the center ulcerates to create peripheral rolled borders; such ulcerating BCCs are called rodent ulcers. Occasionally, the lesions are deeply pigmented and nodular and can be confused with melanoma. This variant has been called a pigmented BCC. The histologic features of these tumors demonstrate isolated areas of basaloid tumor islands arising from the epidermis with peripheral palisading of nuclei and stromal retraction. In some cases, the BCC has histologic features of squamous metaplasia with keratinization. These tumors have basosquamous differentiation and can become more aggressive and develop regional lymphatic spread.
The most locally aggressive type of BCC is characterized by a diagnostic histopathologic aggressive growth pattern, known as morpheaform, sclerosing, or fibrosing BCC. Clinically, these tumors may be more subclinical, are flat, and appear to be scar like. They have a significant incidence of recurrence because of the isolated, finger like fronds of basal cell tumor cells that may deeply invade the surrounding structures well beyond the clinical margins of the lesion. These small, finger like islands are often missed with standard histologic margin control.
Clinically, superficial BCCs are scaly pink to red lesions. Frequently, they are confused with psoriasis or other eczematous, scaly dermatoses. Although these tumors are usually relatively superficial, extensive superficial subclinical involvement is common. Numerous risk factors are associated with possible extensive subclinical invasion and increased rates of local recurrence for BCC after standard treatment, including surgical excision
BCC is the most common form of skin cancer. These epithelial- derived tumors can be divided into various subtypes according to clinical appearance, histologic pattern, and biologic behavior. Although BCCs rarely metastasize, they are characterized by slow but relentless and destructive local invasion that results in high morbidity without treatment. The subclinical local invasion may be deep, extensive, and asymmetric, with finger like extensions several centimeters beyond the clinical borders.
The most common subtype of BCC is the well-circumscribed nodular variety. These tumors often present as pearly papules or nodules with telangiectases. They may be pruritic and bleed occasionally. With time, the center ulcerates to create peripheral rolled borders; such ulcerating BCCs are called rodent ulcers. Occasionally, the lesions are deeply pigmented and nodular and can be confused with melanoma. This variant has been called a pigmented BCC. The histologic features of these tumors demonstrate isolated areas of basaloid tumor islands arising from the epidermis with peripheral palisading of nuclei and stromal retraction. In some cases, the BCC has histologic features of squamous metaplasia with keratinization. These tumors have basosquamous differentiation and can become more aggressive and develop regional lymphatic spread.
The most locally aggressive type of BCC is characterized by a diagnostic histopathologic aggressive growth pattern, known as morpheaform, sclerosing, or fibrosing BCC. Clinically, these tumors may be more subclinical, are flat, and appear to be scar like. They have a significant incidence of recurrence because of the isolated, finger like fronds of basal cell tumor cells that may deeply invade the surrounding structures well beyond the clinical margins of the lesion. These small, finger like islands are often missed with standard histologic margin control.
Clinically, superficial BCCs are scaly pink to red lesions. Frequently, they are confused with psoriasis or other eczematous, scaly dermatoses. Although these tumors are usually relatively superficial, extensive superficial subclinical involvement is common. Numerous risk factors are associated with possible extensive subclinical invasion and increased rates of local recurrence for BCC after standard treatment, including surgical excision
Causes of BCC and SCC
Non melanoma skin cancer ---> Causes of Non melanoma skin cancer
Both BCC and SCC are most commonly induced by significant exposure to ultraviolet light from the sun or tanning booths. These cancers are the predominant neoplasms on the head, neck, trunk, lower legs, and extensor arms and hands where sun exposure is common. Skin cancer is a significant occupational hazard for people who work outdoors. The phenotype at increased risk is one with fair skin who sunburns and freckles easily, blue eyes, and red or blonde hair. Melanin pigment in the skin appears to be the protective factor.
A number of genetic syndromes are associated with an increased risk of developing NMSC, including Gorlin syndrome, xeroderma pigmentosa, and albinism. Gorlin syndrome is an autosomal dominant disorder associated with multiple BCCs, palmoplantar pits, jaw cysts, frontal bossing, and hypertelorism. Albinism is a disorder characterized by a partial or complete deficiency in melanin production and, thus, loss of protective pigment. Another factor associated with NMSC, primarily SCC, is chronic exposure to chemicals such as arsenic and hydrocarbons (found in coal tars, soot, and asphalt). Cigarette smoking has been associated with SCC of the lip and mouth. Human papillomavirus has been associated with cutaneous SCC in the genital and acral/periungual areas. Radiation has been associated with both SCC and BCC.
Both BCC and SCC are most commonly induced by significant exposure to ultraviolet light from the sun or tanning booths. These cancers are the predominant neoplasms on the head, neck, trunk, lower legs, and extensor arms and hands where sun exposure is common. Skin cancer is a significant occupational hazard for people who work outdoors. The phenotype at increased risk is one with fair skin who sunburns and freckles easily, blue eyes, and red or blonde hair. Melanin pigment in the skin appears to be the protective factor.
A number of genetic syndromes are associated with an increased risk of developing NMSC, including Gorlin syndrome, xeroderma pigmentosa, and albinism. Gorlin syndrome is an autosomal dominant disorder associated with multiple BCCs, palmoplantar pits, jaw cysts, frontal bossing, and hypertelorism. Albinism is a disorder characterized by a partial or complete deficiency in melanin production and, thus, loss of protective pigment. Another factor associated with NMSC, primarily SCC, is chronic exposure to chemicals such as arsenic and hydrocarbons (found in coal tars, soot, and asphalt). Cigarette smoking has been associated with SCC of the lip and mouth. Human papillomavirus has been associated with cutaneous SCC in the genital and acral/periungual areas. Radiation has been associated with both SCC and BCC.
Subscribe to:
Posts (Atom)