FIRAS BCC

Basal cell carcinoma

Dr. firas kassab

FIRAS BCC

Basal cell carcinoma is a slow-growing form of skin cancer.

Skin cancer falls into two major groups: Nonmelanoma and melanoma.

Basal cell carcinoma is a type of nonmelanoma skin cancer

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Basics of BCC

Background Most common cutaneous malignancy (~80-90%) Typically slow-growing, rarely metastasizes Sun-exposed skin, mostly face and scalp, esp

nose, cheek, and periorbital regions (~80%)Frequency

900,000 Dx in US/year estimated lifetime risk of 33-39% for

men and 23-28% for womenSex

Men 2X over women

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Basics of BCC

Mortality/Morbidity <0.1% metastasize Very low mortality Significant morbidity with direct invasion of

adjacent tissues, especially when on face or near an eye

Age Likelihood increases with age Rare in <40 yo

Race Most often in light-skinned, rare in dark-skinned

races

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Classification

according to

AppearanceHistological

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Appearance

we can divide basal-cell carcinoma into 3 groups, based on location and difficulty of therapy:

1. . Superficial basal-cell carcinoma :is very responsive to topical chemotherapy such as .It is the only type that can be effectively treated with topical chemotherapy.

2. Infiltrative basal-cell carcinoma: which often encompasses morpheaform and micronodular basal-cell cance. More difficult to treat with conservative treatment methods such as electrodessiccation and curettage, or with curettage alone.

3. Nodular basal-cell carcinoma: which essentially includes most of the remaining categories of basal-cell cancer. It is not unusual to encounter morphologic features of several variants of basal-cell cancer in the same tumor.

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Histological

Basal-cell carcinomas may be divided into the following types: Nodular basal-cell carcinoma is a subtype of basal-cell carcinoma, most

commonly occurring on the sun-exposed areas of the head and neck.[

Cystic basal-cell carcinoma is characterized by dome-shaped, blue-gray cystic nodules.

Cicatricial basal-cell carcinoma is an aggressive variant with a distinct clinical and histologic appearance.

Infiltrative basal-cell carcinoma is an aggressive type of basal-cell carcinoma characterized by deep infiltration.

Micronodular basal-cell carcinoma is characterized by a micronodular growth pattern.

Superficial basal-cell carcinoma that occurs most commonly on the trunk and appears as an erythematous patch.

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Pigmented basal-cell carcinoma that exhibits increased melanization.About 80% of all basal cell carcinoma in chinese are pigmented while this subtype is uncommon in white people.

Rodent ulcer is a large skin lesionof nodular basal cell carcinoma with central necrosis

Fibroepithelioma of pinkus most commonly occurring on the lower back.

Polypoid basal-cell carcinoma is characterized by exophytic nodules (polyp-like structures) on the head and neck.

Pore-like basal-cell carcinoma is characterized by a basal-cell carcinoma that resembles an enlarged pore or stellate pit.

Aberrant basal-cell carcinoma is characterized by the formation of basal-cell carcinoma in the absence of any apparent carcinogenic factor, occurring in odd sites such as scrotum, vulva, perineum, nipple, and axilla.

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See also:Nevoid basal cell carcinoma syndromCystic basal-cell carcinomaMicronodular basal cell carcinomaSuperficial basal cell carcinomaMicrograph of a fibroepithelioma of Pinkus.

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Variants of Basal Cell Carcinoma

Superficial Nodular Micronodular Infiltrating (5%) Sclerosing/ morpheaform (5%) Metatypical Infundibulocystic Nodulocystic Adenoid Clear cell Follicular Sebaceous Perineurally invasive

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Nodular

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Superficial

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Morpheaform

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Pigmented

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Infiltrating

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Differential Diagnosis

Malignant melanomaSquamous cell carcinomaBasal cell carcinoma, infiltrativeInfectious

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Causes, incidence, and risk factors:

Basal cell carcinoma starts in the top layer of the skin called the epidermis. Most basal cell cancers occur on skin that is regularly exposed to sunlight or other ultraviolet radiation. This includes the top of your head, or scalp.

Basal cell skin cancer is most common in people over age 40. However, it occurs in younger people, too.

FIRAS BCC

You are more likely to get basal cell skin cancer if you have:Light-colored or freckled skinBlue, green, or grey eyesBlond or red hairOverexposure to x-rays or other forms of radiationMany molesClose relatives who have or had skin cancerMany severe sunburns early in lifeLong-term daily sun exposure (such as the sun exposure people who

work outside receive)

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Sings and Symptoms:

Basal cell skin cancer grows slowly and is usually painless. It may not look that different from normal skin.

patient may have a skin bump or growth that is:Pearly or waxyWhite or light pinkFlesh-colored or brownIn

some cases the skin may be just slightly raised or even flat.

FIRAS BCC

patient may have:A skin sore that bleeds easilyA sore that does not healOozing or crusting spots in a soreA scar-like sore without having injured the

areaIrregular blood vessels in or around the spotA sore with a depressed (sunken) area in the

middle

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Diagnosis:

doctor should check the skin and look at the size, shape, color, and texture of any suspicious areas.

If the patient might has skin cancer, a piece of skin will be removed and sent to a lab for examination under a microscope. This is called a skin biopsy. There are different types of skin biopsies.

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The most common method is a shave biopsy under locale anesthesia.

Most nodular basal-cell cancers can be diagnosed clinically; however, other variants can be very difficult to distinguish from benign lesions such as:

intradermal naevussebaceomasFibrous papulesearly acnes scarsand hypertrophing scarring.

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Treatment Options

Electrodessication and curettageCurettage aloneSurgical excisionMohs micrographically controlled surgeryCryosurgeryIonizing radiationSurgical excision plus radiationExenteration

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Treatment depends on the sizedepth location of the skin canceroverall health.

Treatment

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may involve:Excision: Cutting out the skin cancer and stitching the skin

togetherCurettage and electrodesiccation: Scraping away cancer cells

and using electricity to kill any that remainCryosurgery: Freezing the cancer cells, which kills themMedication: Skin creams containing imiquimod or 5-

fluorouracil for superficial (not very deep) basal cell cancer

Treatment

FIRAS BCC

Treatment

Mohs surgery: Removing a layer of skin and looking at it immediately under a microscope, then removing many layers of skin until there are no signs of the cancer; usually used for skin cancers on the nose, ears, and other areas of the face.

Photodynamic therapy: Treatment using light Radiation may be used if a basal cell cancer cannot be treated

with surgery

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Is excellent How well a patient does depends on many

things, including how quickly the cancer was diagnosed. Most of these cancers are cured when treated early.

Some basal cell cancers may return. Smaller ones are less likely to come back.

Basal cell carcinoma almost never spreads to other parts of the body ,Because basal-cell carcinoma rarely metastasis, it grows locally with invasion and destruction of local tissues

prognosis

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Complications

Basal cell skin cancer almost never spreads. But, if left untreated, it may grow into surrounding areas and nearby tissues and bone. This is most worrisome around the nose, eyes, and ears.

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Prevention

The best way to prevent skin cancer is to reduce exposure to sunlight.

Ultraviolet light is most intense between 10 a.m. and 4 p.m., so try to avoid sun exposure during these hours.

Protect the skin by wearing hats, long-sleeved shirts, long skirts, or pants.

Always use sunscreen

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Conclusion

Basal cell carcinomas are not always as innocent as we tend to believe

In formulating treatment course: Strong pt preference and

other pt factors Current research