Work-up and Diagnosis of Basal Cell Carcinoma of the Skin (BCC)

  • Workup begins with a history and physical examination:
    • For patients with a suspicious lesion
  • At the time of diagnosis, patients with BCC:
    • Should be given a full-body skin examination:
      • Because these individuals often have additional, concurrent cancers at other locations
    • A shave, punch, or excisional skin biopsy:
      • May be used for diagnosis of any suspicious lesion:
        • The biopsy should include deep reticular dermis:
          • Because infiltrative histology will often be present only at the deeper, advancing margins of a tumor
      • A punch biopsy:
        • Ranges in size from 2 to 8 mm and involves removing a cylinder of tissue to the level of the subcutaneous fat
      • A shave biopsy:
        • Involves injecting local anesthesia into the epidermis and upper dermis and performing a tangential sample at the base of the wheal
      • Excisional biopsy:
        • Involves removal of the entire lesion with a margin of clinically clear tissue
  • Imaging studies:
    • Should be performed when extensive disease:
      • Such as bone involvement, perineural invasion, or deep soft tissue involvement, is suspected
Figure 3
Magnetic resonance image of a patient with locally advanced basal cell carcinoma of the back
  • Location, independent of size, may constitute high risk, and these areas are defined as L, M, and H
Table 1
#Arrangoiz #CancerSurgeon #SurgicalOncologist #HeadandNeckSurgeon #MountSinaiMedicalCenter #MSMC #Miami #Mexico

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