Basal Cell Carcinoma

8/04/2020

Basal Cell Carcinoma

Basal Cell Carcinoma (BCC) is a slow-growing locally invasive malignant tumour (malignant skin ulcer) arising from basal epidermis and hair follicles – hence affecting the pilosebaceous skin!

90% of the lesions are found on the face above a line from the lobe of the ear to the corner of the mouth.

It rarely metastasize.

EPIDEMIOLOGY

• White people are almost exclusively affected
• Middle-aged and elderly people (40-80 years)
• More in men

RISK FACTORS FOR

• UV light (But 33% arises in parts of the body not exposed to sun)
• Arsenic
• Coal tar
• Aromatic hydrocarbons
• Ionising radiation
• Genetic skin cancer syndromes (Gorlin’s syndrome, Xeroderma pigmentosum)
• Immunosuppression (AIDS)
• Premalignant lesions (Naevus of Jadassohn)

CLASSIFICATION OF BASAL CELL CARCINOMA

BY APPEARANCE

• LOCALIZED
  • Nodular
  • Nodulocystic
  • Cystic
  • Pigmented
  • Naevoid
• GENERALIZED
  • Superficial
  • Infiltrative (morphoeic)

BY PROGNOSIS

• HIGH RISK (The risk of recurrence is high)
  • Located at specific sites – periorbital, nose, perioral, nasolabial folds, pre/post auricular
  • Ill defined margins
  • Histology – morphoeic or infiltrative
  • Those occurring in immunosuppressed
• LOW RISK
  • The types other than the above-mentioned ones

MANAGEMENT OF BASAL CELL CARCINOMA

SURGICAL MANAGEMENT

• Mohs’ Micrographic surgery
• Standard Excisional surgery

NON-SURGICAL MANAGEMENT

• Radiotherapy (for elderly patients)
• Topical chemotherapy (with 5-FU)
• Cryotherapy
• Photodynamic therapy (application of photosensitising agents to the skin that are preferably absorbed by tumour cells