BASAL CELL CARCINOMA (RODENT ULCER)

the most common skin cancer (and the most common of all cancers)

a locally invasive, slowly spreading primary epithelial malignancy

Origin: arises from the basal cell layer of the skin and its appendages

85% are found on the skin of the head and neck

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Clinical Featuresa disease of adult whites

some lesions are detected as early as the second decade of life, particularly in patients with red hair and blue eyes.

nodular (noduloulcerative)BCC: The most common form

clinicopathologic varieties

Pigmented BCC

Sclerosing (morpheaform) BCC

superficial BCC

associated with the nevoid basal cell carcinoma syndrome

begins as a firm, painless papule that slowly enlarges and gradually develops a central depression

One or more telangiectatic blood vessels ………..over the rolled border surrounding the central depression

Expanding ulceration often develops in the central depressed area

nodular (noduloulcerative)BCC

Pigmented BCCThe melanin production imparts a tan, brown, black, or even bluish color to the lesion

an insidious lesion that often mimics scar tissue

Sclerosing (morpheaform) basal cell carcinoma

pale and atrophic overlying skin

the lesion is firm to palpation

poorly demarcated borders

superficial BCC may be mistaken clinically for psoriasis

occurs primarily on the skin of the trunk

Often, lesions are multiple

well-demarcated, erythematous, scaly patches

A fine, elevated, "threadlike" border is seen at the margins.

usually do not produce a significant degree of tissue destruction.

BCC associated with the nevoid basal cell carcinoma syndrome

in both sun-exposed and protected areas of the skin

may number in the hundreds on a single patient

Histopathologic Features

The noduloulcerative, pigmented, and syndrome-related BCCs are comprised of:

uniform ovoid, darkstaining basaloid cells with moderate-sized nuclei and relatively little cytoplasm

Solid tumor Nested tumor

well-demarcated islands and strands

appear to arise from the basal cell layer of the overlying epidermis and invade into the underlying dermal connective tissue

well-demarcated islands and strands

Epithelial islands typically demonstrate palisading of the peripheral cells

frequently, a clear zone of artifactual retraction is seen between the epithelial islands and the connective tissue.

Although most of these neoplasms show no differentiation,some exhibit areas of keratin production, sebaceous differentiation, or interlacing strands of lesional cells that resemble duct formation ("adenoid")

interlacing strands of lesional cells that resemble duct formation ("adenoid")

Necrosis of epithelial islands may produce a cystic appearance.

Basal cell carcinoma + an independent primary squamous cell carcinoma of the skin.

Some authorities consider the basosquamous carcinoma to be a simple basal cell carcinoma with abundant squamous metaplasia.

Basosquamous carcinoma"collision" tumor

Treatment and Prognosis

Radical surgical excision radiation therapy

size site of the lesiondepends on

Small lesions (< 1 cm)………

•routine surgical excision•laser ablation•electrodesiccation •curettage

with 5 mm margins

a cure rate of 95% to 98%

for large or aggressive lesions

For sclerosing type lesionsrecurrent lesionslesions situated near embryonic planes of fusion

Mohs micrographic surgery(with frozen-section evaluation)

Recurrence …………… uncommon

Metastasis …………..exceptionally rare

death ……………..in patients with uncontrollable disease………… local invasion into . . vital structures.

chance of a second lesion …………..30%............3 years of the treatment of the initial tumor.