Summary
Definition
BCC of the skin is a common neoplasm, related to exposure to sunlight.[1][2][Figure caption and citation for the preceding image starts]: Nodular basal cell carcinoma on the cheek, on background of diffuse solar damage with marked solar elastosisFrom the collection of Prof. Robert A. Schwartz [Citation ends].
BCC can be locally aggressive, but rarely metastasizes. While certain factors can result in higher-grade behavior, in most cases early detection and treatment have made extensive local invasion and destruction from this neoplasm a thing of the past.[3]
History and exam
Key diagnostic factors
- papules with associated telangiectasias
- plaques, nodules, and tumors with rolled borders
- small crusts and nonhealing wounds
- nonhealing scabs
- pearly papules and/or plaques
Other diagnostic factors
- metastases associated with large or neglected BCC
- local destruction with advanced lesion
Risk factors
- Ultraviolet (UV) radiation
- sun exposure
- x-ray exposure
- arsenic exposure
- aberrant hedgehog signaling pathway
- xeroderma pigmentosum
- nevoid basal cell carcinoma (Gorlin-Goltz) syndrome
- history of nonmelanona skin cancer
- childhood cancer survivors
- transplant recipient
Diagnostic tests
1st tests to order
- biopsy for dermatohistopathology
Emerging tests
- in vivo multiphoton microscopy
Treatment algorithm
nevoid basal cell carcinoma (Gorlin-Goltz) syndrome
low-risk subtype in noncosmetically challenging location
low-risk subtype in cosmetically challenging location
high-risk subtype
positive margins on initial procedure
complicated BCC recurrences and/or site not accessible to surgical and topical therapies
advanced disease
Contributors
Authors
Robert A. Schwartz, MD, MPH, DSc (Hon), MAE, FAAD, FRCP (Edin)
Professor & Head
Dermatology
Rutgers University New Jersey Medical School
Newark
NJ
Disclosures
RAS declares that he has no competing interests. RAS is an author of a number of references cited in this topic.
Acknowledgements
Professor Robert A. Schwartz would like to gratefully acknowledge Dr James R. DeBloom and Dr Drazen Jukic, the previous contributors to this topic.
Disclosures
JRD and DJ declare that they have no competing interests.
Peer reviewers
Richard Bull, BMBCh
Consultant Dermatologist
Homerton University Hospital NHS Foundation Trust
London
UK
Disclosures
RB declares that he has no competing interests.
David Cassarino, MD, PhD
Assistant Professor
Department of Pathology and Laboratory Medicine
University of California
Los Angeles
CA
Disclosures
DC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Nasr I, McGrath EJ, Harwood CA, et al; British Association of Dermatologists' Clinical Standards Unit. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol. 2021 Nov;185(5):899-920.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: basal cell skin cancer [internet publication].Full text
Kim JYS, Kozlow JH, Mittal B, et al; Work Group, Invited Reviewers. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018 Mar;78(3):540-59.Full text Abstract
Thomson J, Hogan S, Leonardi-Bee J, et al. Interventions for basal cell carcinoma of the skin. Cochrane Database Syst Rev. 2020 Nov 17;(11):CD003412.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Microcystic adnexal carcinoma
- Trichoepithelioma/trichoblastoma
- Merkel cell carcinoma
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: basal cell skin cancer
- Guidelines for the management of basal cell carcinoma
More GuidelinesPatient information
Staying safe in the sun
Basal cell carcinoma
More Patient information
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