Updated: 6/22/2021

Basal Cell Carcinoma

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  • summary
    • Basal Cell Carcinoma is the most common skin malignancy that rarely, if ever, metastasizes.
    • The condition most commonly occurs in patients with significant sun exposure, who present with a pink, pearly-white, dome-shaped nodule.
    • Diagnosis is made with a biopsy showing basophilic palisading cells.
    • Treatment is usually wide surgical resection. 
  • Epidemiology
    • Risk factors
      • sun exposure
      • prior ionizing radiation
      • xeroderma pigmentosum
      • common in fair-skinned individuals
    • Anatomic location
      • commonly affects upper lip (squamous cell carcinoma typically affects lower lip)
  • Presentation
    • Symptoms
      • typically asymptomatic, but may be tender if ulcerated
      • slow-growing
    • Physical exam
      • pink, pearly-white, almost translucent dome-shaped nodule or papule
      • overlying telangiectasias
      • commonly develop raised or rolled border
      • commonly ulcerate, bleed, and crust in the center (a non-healing ulcer)
      • frequently on sun-exposed areas
  • Evaluation
    • Diagnosis by skin biopsy
      • basophilic palisading cells on histology
      • nests of basaloid cells in dermis
  • Differential
    • Squamous cell carcinoma
    • Actinic keratosis
  • Treatment
    • Prevention
      • use sunscreen
      • avoid sun exposure
    • Surgical
      • electrodesiccation and curettage
        • indications
          • typically for non-facial tumors that are small or superficial – not used for aggressive tumors
          • best technique determined by
            • size
            • location
            • histology
            • cosmetic considerations
        • outcomes
          • cure rate up to 92%
      • Mohs micrographic surgery
        • indications
          • especially if on face or if recurrence
        • outcomes
          • cure rate up to 99%
      • wide local surgical excision
        • outcomes
          • cure rate up to 90%
  • Prognosis
    • If treated, typically very good
    • Risk of developing another basal cell carcinoma is 5-8% per year

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