Basal cell carcinoma (BCC) clinically presents as a pearly white/pink papulo-nodule or firm plaque.
Patient usually has prominent solar damage or a history of considerable ultraviolet (UV) radiation exposure.
Can be locally aggressive, but rarely metastasises.
Diagnosis of a cancer is histological. Findings are of dermal masses of varying sizes and shapes composed of basophilic cells with large oval rather uniform nuclei and scant cytoplasm. These masses exhibit a peripheral cell layer demonstrating a palisading pattern of nuclei.
Most BCCs are successfully treated with surgery, with low recurrence rates.
Basal cell carcinoma (BCC) of the skin is a common neoplasm, related to exposure to sunlight. BCC can be locally aggressive, but rarely metastasises. While certain factors can result in higher-grade behaviour, in most cases early detection and treatment have made extensive local invasion and destruction from this neoplasm a thing of the past.
History and exam
Key diagnostic factors
- presence of risk factors
- papules with associated telangiectasias
- plaques, nodules, and tumours with rolled borders
- small crusts and non-healing wounds
- non-healing scabs
- pearly papules and/or plaques
Other diagnostic factors
- metastases associated with large or neglected BCC
- local destruction with advanced lesion
- Ultraviolet (UV) radiation
- sun exposure
- x-ray exposure
- arsenic exposure
- aberrant hedgehog signalling pathway
- xeroderma pigmentosum
- nevoid basal cell carcinoma (Gorlin-Goltz) syndrome
- history of non-melanona skin cancer
- childhood cancer survivors
- transplant patients
1st investigations to order
- biopsy for dermatohistopathology
- in vivo multiphoton microscopy
nevoid basal cell carcinoma (Gorlin-Goltz) syndrome
low-risk subtype in non-cosmetically challenging location
low-risk subtype in cosmetically challenging location
positive margins on initial procedure
complicated BCC recurrences and/or site not accessible to surgical and topical therapies
Robert A. Schwartz, MD, MPH, FAAD, FRCP (Edin)
Professor & Head
Rutgers University New Jersey Medical School
China Medical University
Sree Balaji Medical College
RAS declares that he has no competing interests. RAS is an author of a number of references cited in this topic.
Professor Robert A. Schwartz would like to gratefully acknowledge Dr James R. DeBloom and Dr Drazen Jukic, the previous contributors to this topic.
JRD and DJ declare that they have no competing interests.
Richard Bull, BMBCh
Homerton University Hospital NHS Foundation Trust
RB declares that he has no competing interests.
David Cassarino, MD, PhD
Department of Pathology and Laboratory Medicine
University of California
DC declares that he has no competing interests.
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