Skin & Soft Tissue: Basal Cell Carcinoma (BCC)

Basal Cell Carcinoma (BCC)

Basics

  • Tumor from Epidermal Basal Epithelial Cells
  • Most Common Skin Cancer (Over 4x Incidence of SCC)
  • Most Common Malignancy in US

Risk Factors

  • Cumulative Sun Exposure
  • Fair Skinned
  • Elderly
  • Norther European Ancestry
  • Basal Cell Carcinoma Syndrome (Gorlin Syndrome)
    • PTCH1 Mutation
    • Develops Dozens-Hundreds of BCC’s
    • Also Associated with Bony Cysts, Medulloblastoma & Craniofacial Abnormalities

Presentation

  • Appearance: Pearly & Rolled Borders
  • Most Common Site: H&N
  • Path: Peripheral Palisading Nuclei & Stromal Retraction

Types

  • Nodular (80%)
    • Most Common Type
    • Most Common on Face
    • Produces Pigment
  • Superficial (15%)
    • Most Common on Trunk
    • Produces Pigment
  • Morpheaform (5-10%)
    • Flesh-Colored – Does Not Produce Pigment
    • Produces Collagenase
    • Most Aggressive
  • Other Subtypes:
    • Nonaggressive
      • Keratotic
      • Infundibulocystic
    • Aggressive
      • Micronodular
      • Infiltrative
      • Sclerosing
      • Desmoplastic
      • Basosquamous

Basal Cell Carcinoma 1

Basal Cell Carcinoma 2

Prognosis

  • Generally Slow Growing
  • Metastases are Rare

High-Risk Factors for Local Recurrence

  • ≥ 2 cm on Trunk or Extremities
  • ≥ 1 cm on Cheeks, Forehead, Scalp, Neck or Pretibial
  • Any Size on Face, Genitalia, Hands or Feet
  • Poorly Defined Borders
  • Recurrence
  • Immunosuppressed
  • Site of Prior XRT
  • Pathology:
    • Aggressive Growth Pattern (Not Nodular or Superficial)
    • Perineural Invasion

Treatment

  • Tx: Excision (0.4 cm Margins)
    • Consider Mohs Micrographic Surgery if High-Risk
    • Positive Margins: Repeat Excision (With Wider Margins) or Mohs Micrographic Surgery
  • Nodal or Distant Mets:
    • Resection if Able
    • Consider XRT
    • Consider Hedgehog Pathway Inhibitors (Vismodegib or Sonidegib)

References

  1. Hendrix J. Wikimedia Commons. (License: Public Domain)
  2. National Cancer Institute. Wikimedia Commons. (License: Public Domain)