BCC

• Basal cell carcinoma:

  • Most common form of skin cancer
  • Slow growing lesions over months/years on sun exposed areas of body
  • 80% are on head and neck
  • Locally destructive
  • Rarely metastasize
  • Typically seen in middle aged/elderly
• Risk factors:

  • Typical patient is elderly male
  • Sun damage
  • Fitzpatrick skin types I+II
  • Previous skin cancer
  • Immunosuppression
  • Carcinogens e.g. ionizing radiation, arsenic
  • Some genetic conditions - basal cell nevus syndrome (Gorlin's syndrome)
• Clinical features:

  • Irregular pink/skin-coloured lesion commonly on face or neck
  • Telangiectasia
  • Ulceration
  • Rolled edges
  • Pearly edge - shiny
• Clinical subtypes of BCC:

  • Nodular: 60-80%
  • Superficial: 10-30%
  • Basosquamous: 5%
  • Morphoeic: <5%
• Nodular BCC:

  • Most common type of facial BCC
  • Pink/flesh coloured, well defined borders, telangiectasia, central ulceration
  • Commonly on face/forehead, temples, upper lip, rarely on mucosa
• Superficial BCC:

  • Commonly on trunk and limbs
  • Slow growing irregular erythematous plaque
  • Thin, translucent rolled borders
  • Multiple micro erosions
  • Sometimes pigmented
  • Can be difficult to distinguish from melanoma
• Basosquamous BCC:

  • Mixed BCC and SCC
  • Majority present in the head and neck region
  • Rare but aggressive
  • Increased risk of recurrence and even metastasis
• Morphoeic BCC:

  • Waxy, whitish, scar like plaque or indentation
  • Commonly on upper trunk or face
  • Often deeply invasive
• Referral:

  • Generally a routine referral to dermatology as so slow growing
  • Consider 2WW if concern that delay may have significant impact on patient e.g. large size lesion or difficult site as can be locally destructive - around eyes, nose, lips, ears
• Surgical treatment:

  • Most BCC are treated surgically
  • Excision - provides tissue diagnosis so generally used in high-risk lesions
  • Destructive - shave, curettage, cautery and cryotherapy - cannot get a tissue diagnosis from these methods
• Options for excision:

  • Wide local excision - remove the lesion and a margin of healthy skin around the edges
  • Mohs microsurgery - remove visible lesions and thin layer of surrounding tissue with aim to leave as much healthy skin as possible - remove more if histology suggests BCC still present
• Non-surgical management:

  • Photodynamic therapy
  • Imiquimod cream - immune response modulator
  • Fluorouracil cream - cytotoxic
  • Radiotherapy