Basal Cell Carcinoma (BCC)

• Basal cell carcinoma (BCC) is the most common type of skin cancer worldwide:
  • In the United States, BCC is diagnosed in greater than 2 million patients annually, and global incidence rates continue to rise.
• Risk factors for the development of BCC include:
  • Fair skin type
  • Exposure to ultraviolet radiation
  • Age
  • History of BCC
  • Genetic disorders:
    • Gorlin syndrome
    • Xeroderma pigmentosum
  • Immunosuppression.
• BCC tumors are generally slow growing and rarely metastasize (less than 0.05%):
  • The prognosis for patients who receive appropriate therapy is typically very good.
• For most BCCs:
  • Including small, well-defined tumors or intermediate-sized, low-risk tumors in low-risk areas:
    • The treatment of choice is surgical excision:
      • Whereas Mohs micrographic surgery is the preferred surgical technique for:
        • Higher-risk tumors
        • Recurrent tumors
        • Tumors in specific anatomic locations
        • Tumors with a wider diameter (Figure).
• Appropriate use criteria for Mohs micrographic surgery have been developed:
  • Mohs is appropriate for patients with:
    • Recurrent BCC of any size
    • BCC with an unexpected positive margin on recent excision
    • Primary aggressive, nodular, or superficial BCC of any size:
      • In an area of H (high risk):
        • Central face, eyelids, eyebrows, nose, lips, chin, ear, periauricular skin/sulci, temple, genitalia, hands, feet, nail units, ankles, and nipples/areola)
      • In an area of M (moderate risk):
        • Cheeks, forehead, scalp, neck, jawline, and pretibial surface,:
          • With the exception of primary superficial BCC in area M that is 0.5 cm in diameter in otherwise healthy patients:
            • For which the appropriateness of Mohs surgery is uncertain;
      • In an area of L (low risk):
        • Trunk and extremities:
          • Excluding pretibial surface, hands, feet, nail units, and ankles:
            • Mohs is considered appropriate for:
              • Aggressive or nodular BCC that is recurrent (of any size)
              • BCC that had unexpected positive margins 
              • Primary aggressive BCC equal or greater than 0.6 cm in diameter
              • Primary nodular BCC > 2 cm in diameter in healthy patients or equal or greater than 1.1 cm in diameter in immunocompromised patients.
      • Mohs is also considered appropriate for the treatment of primary BCC arising in:
        • Previously radiated skin
        • Traumatic scars
        • Areas of osteomyelitis
        • Areas of chronic inflammation / ulceration
        • Patients with genetic syndromes

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

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#SurgicalOncologist

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#CancerSurgeon

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#SkinCancer

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#Melanoma

#BasalCellCarcinoma

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