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 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.[3]
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
Risk factors
- 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 recipient
Diagnostic investigations
1st investigations to order
- biopsy for dermatohistopathology
Emerging tests
- in vivo multiphoton microscopy
Treatment algorithm
nevoid basal cell carcinoma (Gorlin-Goltz) syndrome
low-risk subtype in non-cosmetically 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.
Differentials
- Microcystic adnexal carcinoma
- Trichoepithelioma/trichoblastoma
- Merkel cell carcinoma
More DifferentialsGuidelines
- Suspected cancer: recognition and referral
- NCCN clinical practice guidelines in oncology: basal cell skin cancer
More GuidelinesPatient information
Staying safe in the sun
Basal cell carcinoma
More Patient information
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