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
- Microcystic adnexal carcinoma
- Merkel cell carcinoma
- NCCN clinical practice guidelines in oncology: basal cell skin cancer
- Guidelines for the management of basal cell carcinoma
Staying safe in the sun
Basal cell carcinomaMore Patient leaflets
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