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

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