BASAL CELL CARCINOMA

  • BCC is the most common cancer in humans and the most common type of skin cancer
  • BCCs are believed to arise from:
    • Hair follicle cells:
      • And are therefore found almost exclusively on hair-bearing skin
  • Most lesions are found on sun-exposed mask areas of the head and neck:
    • But non–sun-exposed areas are also at risk
  • These tumors tend to grow slowly:
    • But when untreated can lead to invasion of local structures including:
      • Muscle, cartilage, and bone
    • Although the biologic behavior of BCC is characterized by:
      • Local and sometimes disfiguring invasiveness:
        • Metastasis is rare:
          • Occurring in less than 0.05% of cases
  • There are multiple histologic subtypes of BCC:
    • Subtype is predictive of its behavior
  • Less aggressive subtypes include:
    • Nodular BCC
    • Superficial BCC
    • Keratotic variant BCC
    • Infundibulocystic variant BCC
    • Fibroepithelioma of Pinkus
  • Higher-risk subtypes include:
    • Sclerosing BCC
    • Infiltrating BCC
    • Micronodular BCC
    • Morpheaform (or desmoplastic) BCC
    • Basosquamous carcinoma
  • The higher-risk subtypes:
    • Tend to have subclinical extension exceeding the visible borders of the lesion making treatment more difficult
  • Nodular BCC:
    • Is the classic lesion of this type of non-melanoma skin cancer (NMSC)
    • It appears as a pink translucent nodule with rolled edges and is often described as pearly
    • In dark-skinned individuals:
      • These tumors are often pigmented and can resemble melanoma
    • Overlying telangiectasias and ulceration are common:
      • They occur predominantly on the face
  • Superficial BCC:
    • Is a variant that is more common on the limbs and trunk, and on other areas with little or no sun exposure
    • It presents as a slow-growing, scaly pink plaque and can easily be confused with psoriasis, superficial SCC or SCC in situ (Bowen disease)
    • Gentle traction on the periphery of the lesion often demonstrates a shiny translucent surface characteristic of BCC which can assist with diagnosis
  • The sclerosing or morpheaform type:
    • Represents the rarest form of BCC and is often difficult to recognize
    • It presents as a poorly defined indurated or sclerotic plaque:
      • Which can be mistaken for a scar
    • In addition, this type of BCC frequently is found to be larger histopathologically than is clinically evident:
      • Therefore, both diagnosis and treatment remain a challenge
  • Basosquamous carcinomas:
    • Have histologic features of both BCC and SCC
    • Some of these lesions occur as a result of collision between adjacent BCC and SCC
    • These are aggressive tumors with potential to metastasize:
      • Though metastatic risk is determined by the degree of squamous component present

#Arrangoiz #CancerSurgeon #SurgicalOncologist #SkinCancer #Melanoma #BasalCellCarcinoma #CASO #CenterforAdvancedSurgicalOncology

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