Updated: 4/11/2017

Basal Cell Carcinoma

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Introduction
  • Most common skin malignancy that rarely, if ever, metastasizes
  • Epidemiology
    • risk factors
      • sun exposure
      • prior ionizing radiation
      • xeroderma pigmentosum
    • common in fair-skinned individuals
  • Commonly affects upper lip (squamous cell carcinoma typically affects lower lip)
  • Prognosis
    • if treated, typically very good
    • risk of developing another basal cell carcinoma is 5-8% per year
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%
 

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