Basal Cell Carcinoma

BCC: What is the pathophysiolgy?

• Originates from basal keratinocytes

• DNA damage due to UV radiation

• Most common skin cancer

BCC: What is the classification?

• Nodular→ most common, shiny pink nodule

• Sclerosing→ firm, scar-like plaque

• Superficial→ scaly red patches (mistaken for eczema or psoriasis)

BCC: What are the symptoms?

• Very slow growing

• Local destruction can occur

• Usually painless and ulcerates

• Flesh coloured nodules with central depression, pearly surface, rolled edge, and telangiectasia

• They can can necrose and ulcerate in the centre ('rodent ulcer)

BCC: What are the investigations?

• Excision biopsy with 4mm margin

• If lesion is 2cm diameter or on ear/lip/face/genitals/hand/feet etc or patient is immunocompromised or had BCC before→ excision biopsy with 6mm margin

BCC: What is the treatment?

• Almost always treated surgically with excision using a 4mm margin (6mm for high-risk lesions)

• Micrographic surgery for poorly-defined areas

• Radiotherapy

• Other options: curettage and cautery, topical 5-fluorouracil, topical imiquimod, cryotherapy for low-risk lesions