About Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common form of skin cancer arising from basal cells residing within the dermal-epidermal junction of the skin. This cancer is usually easily detectable as it forms plaques, nodules, or scabs on the surface of the skin. Basal Cell Carcinoma of the skin are the least aggressive skin cancers that we treat. These cancers only cause local tissue invasion and some destruction, and almost never metastasize. Basal Cell Carcinoma of the skin are very slow growing as a rule with some lesions taking many months to evolve.
Treatment of these cancers are numerous including curettage, simple excision, Moh’s surgery, and superficial radiotherapy. Other alternative treatments can include topical cancer treatment creams.
A lesion presenting as a non-healing skin lesion is biopsied. BCC can be diagnosed with a simple shave biopsy of the skin lesion. Punch and incisional biopsies can also be done. Diagnostic non-invasive techniques include Reflectance Confocal Microscopy (RCM). Most commonly used biopsy technique is a shave biopsy. Even very thin shave biopsy that leave no visible scars can diagnose BCC. In some cases incisional or punch biopsies may be necessary to adequately diagnose BCC, but that is uncommon. Incisional or punch biopsy provides much more material for microscopic evaluation if there is any doubt about the diagnosis. However, these techniques require a suture and may leave a visible scar. BCC are easily diagnosed under a microscope due to obvious staining of clusters of cancerous cells. Frequently dermatologists read their own biopsies in their office. Outside labs can also easily diagnose BCC with a 2 day turnaround time. RCM is noninvasive technique that leaves no scar, but requires 10-20 mins of scanning the patient’s lesion. This technique is reserved for special cases.
BCC classically presents as a pearly nodule. BCC can be a visually definable lesion. The exact extent of Basal Cell Carcinoma can frequently be determined by an experienced eye and good lighting. Visually defining the extent of the lesion helps with treatment planning. Another hallmark of BCC is its friability - fragility. The surface of BCC can rub off and bleed easily. This would appear as a a recurrent bleeding scab. Some BCC’s can be infiltrative. They present as a plaque within the skin that changes skin texture and appearance.
BCC is easily seen with frozen histopathology. Freshly biopsied tissue can be placed on a slide and stained for microscopy using a freezing technique. That is why Basal Cell Carcinoma can be treated with Moh’s Surgery which utilizes frozen section evaluation at the time of surgery.
More Complicated BCC
Rarely Basal Cell Carcinoma can be very aggressive infiltrating deeply into tissue. Some BCC’s can invade from skin into bone and cartilage. Some can even penetrate into vital structures such as ear canals and orbit. Although most BCC are visible to the skin, some can grow rapidly and extensively without showing much surface changes. Some rare BCC can be so deeply invasive and infiltrative that surgical treatment is no longer possible. We have had experiences with BCC’s invading cranial cavity, orbit, and maxilla. Some of these require radical soft tissue and bone resection or orbital exenteration. Some BCC’s are simply not treatable surgically.
An extraordinarily rare BCC presentation is lymphatic or distant metastases. This is so rare, that few dermatologists or oncologic surgeons will see them within their lifetime.
HISTORY 64-year-old woman presents with recurrence of left ear basal cell carcinoma. She has a history of sun lamp tanning and scuba diving with multiple sun burns. Basal cell carcinoma was first removed from left scapha and treated with a skin graft in July 2009. The area subsequently developed crusting and was treated with…Read More
HISTORY 57-year-old woman with 40-year history of growth on right mid back that has changed in color and size. This is a 2.2cm rough plaque with variable colors. Previous biopsy done 15-20 years ago was benign. Patient has a history of BCC and SCC. Biopsy was read as a squamous cell carcinoma by a dermatologist.…Read More
HISTORY 75-year-old man presents with a history of recurrent basal cell carcinoma of the nasal tip, previously treated with liquid nitrogen and excised 3-5 years ago. Mohs surgery was performed 7-10-2017 with a 3.2 x 3 cm defect extending from the nasal tip and ala to the mid dorsum. Reconstruction was performed with an extended…Read More
History 61-year-old woman underwent Mohs excision of left forehead basal cell carcinoma on 7/11/2017. Patient developed bleeding and pain post-op day 1. A subsequent polymicrobial wound infection was treated with antibiotics. Post-op hematoma is the likely contributing factor to skin flap necrosis. All ischemic tissue has self-debrided without surgical intervention. Patient is seeking reconstructive options.…Read More
HISTORY 71-year-old woman presents with a nasal tip lesion biopsied on 6/12/2017 showing basal cell carcinoma, superficial and micronodular type. There is a history of treatment with topical chemotherapy and Mohs excision of other sites. Patient is anxious about the possible extent of nasal carcinoma and the reconstruction required. DISCUSSION This case presents an excellent…Read More
HISTORY 68-year-old man presented with a recurrent right forehead basal cell carcinoma. The carcinoma was previously treated with Mohs excision in 2002 and 2009. The recurrence appeared initially as superficial and was treated successfully with topical imiquimod. Deep recurrence became evident many months later. Morphology of the basal cell carcinoma was infiltrative with metatypical features.…Read More
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