Basal Cell Carcinoma

1. ACADEMIC REVIEWACADEMIC REVIEW
Dr. Shameera BegumDr. Shameera Begum

2. PATIENT DETAILSPATIENT DETAILS
Mr. Vijayaragavan
77 years / Male
MR/17/007209
Biopsy No.: 93/17
Nature of specimen: Excision biopsy
H/o : Swelling in the anterior abdominal wall x 40 years
L/E: 5x4 cm, pedunculated mass, firm, non – fluctuant, bleeds on
touch
Clinical diagnosis: ?Abdominal wall papilloma

3. Gross examinationGross examination
Container labeled papilloma –
Right thorax
• Received single skin
covered soft tissue mass
measuring 7x5x4 cm
• External surface - nodular
with ulceration

4. • Cut section through nodular
areas show a well-defined
grey white tumor with
cystic spaces filled with
haemorrhage.
• Cut section of tumor shows
areas of dense
haemorrhage and necrosis.
• Tumor is 1.5 cm away from
DRM, 0.2 cm away from all
margins

6. Scanner View

10. Cleft
Abrupt
keratinisation

14. IMPRESSIONIMPRESSION
• Locally infiltrating Basal Cell Carcinoma with varied
features including proliferating trichilemmal tumor
component
• Lateral margins, deep resected margin (Pedicle) –
free of tumor

15. BASAL CELL CARCINOMABASAL CELL CARCINOMA
• Also known as Basal cell epithelioma, basalioma, rodent ulcer
• Derives its name from cytologic similarity of these tumor to
normal basal cells of epidermis

16. Cell of originCell of origin
• Germinal epithelial cell Basal keratinocytes
OR
• outer root sheath of hair follicle
OR
• Pleuripotent embryonal cells with adnexal differentiation

17. Basal cell carcinomaBasal cell carcinoma
• Most frequent form of skin cancer
• Caucasians
• Slow growing, locally destructive tumor
• As a rule, BCC s do not metastasize
SITE
– 85% on the head (face) and neck; 20-30% lesions occur on
nose alone
– 10-15% in sun protected parts of the body, mainly upper
trunk and legs.
– Except in the nevoid basal cell carcinoma syndrome
(Gorlin syndrome), rarely occur on the palms or soles.

18. CLINICAL PRESENTATIONSCLINICAL PRESENTATIONS
• Different Variants of BCC have different clinical presentation:
1. Nodular or nodulocystic, noduloulcerative
2. Superficial BCC
3. Morphea – like, fibrosing BCC
4. Fibroepithelioma (Pinkus)

19. Nodular or nodulocystic, noduloulcerativeNodular or nodulocystic, noduloulcerative
• Commonest
• Pearly papules or nodules with
telangiectasia at the borders
• Occasionally may have bleeding,
crusting or ulceration
• Pigmented BCC – nodular with brown
pigmentation

20. Superficial BCCSuperficial BCC
• Occurs predominantly on the trunk
• One or several lesions
• Erythematous, scaling, only slightly infiltrated patches that
slowly increase in size by peripheral extension
• Common in DM ,CRF, HIV

21. Morphea –like , fibrosing BCCMorphea –like , fibrosing BCC
• Clinical resemblance to
localized scleroderma or
morphea.
• Solitary, flat or slightly
depressed, indurated,
yellowish plaque.
• Surface is smooth and shiny.
• Border is often ill defined.
• Ulceration

22. Fibroepithelioma (Pinkus):
• Most common location is
the back
• Raised, moderately firm,
slightly pedunculated
nodules, covered by
smooth, slightly reddened
skin.
• Clinically, they resemble
fibromas..

23. Histopathological typesHistopathological types
NODULAR BCC
• Common basal cell carcinoma has a lobulated appearance
with masses of small keratinocytes
• An outer layer of palisaded larger cells.
• The stroma can be fibroblastic or have inflammatory cells
• Retraction artifacts are observed around tumor lobules.
• Extensive intralobular and stromal collections of basophilic
mucin may be present. The tumor cells are uniform, although
mild atypia, mitosis +
• Necrosis, apoptosis, calcification, and mucin production are
variable

24. Nodular bccNodular bcc

26. • Variants of nodular BCC:
– Nodulo-cystic Bcc
– Pigmented BCC
– Clear cell bcc
– Adenoid bcc
– with differentiation (pilar,sebaceous,sweat gland)
– Granular bcc

27. PIGMENTED BCCPIGMENTED BCC

28. Clear cell BCC

29. Superficial spreading BCC
Small epithelial buds arise from epidermis and extend into superficial
dermis, mimicking hair germs.

30. Fibrosing/sclerosing (Morpheaform)
BCC
Narrow tumor bands (2–3 cells thick) with dense cell-rich stroma.

31. Fibroepithelioma of Pinkus

32. Micronodular BCC

33. Basosquamous BCC

34. Differential diagnosis
• Trichoblastoma
• Desmoplastic trichoepithelioma
• Squamous cell carcinoma with basaloid
features
• Proliferating trichilemmal tumor

35. Desmoplastic tricoepitheliomas
Symmetrical, centrally-depressed basaloid tumor with cells in strands and forming
horn-filled microcysts; does not extend beneath mid-dermis

36. Trichoblastoma
Symmetrical tumor with uniform basaloid tumor islands, primary hair germs, distinct
tumor stroma separated from normal connective tissue by clefting. No connection
with epidermis

37. • The stroma of trichoepitheliomas and
trichoblastomas is CD34 positive,
• but that around basal cell carcinomas is CD34
negative.
• Bcl-2 staining of basal cell carcinomas shows
diffuse uptake throughout the tumor
aggregate, but trichoepitheliomas stain only
along the outermost epithelial Layer.

38. Squamous cell carcinoma

39. Proliferating trichilemmal tumor
• Uncommon appendageal skin tumor
• Elderly women
• Arises from the external root sheath of the hair follicle
• Most commonly observed on the scalp
Gross
• Multinodular, may be huge
• May coexist with trichilemmal cyst
Microscopy
• Solid with pushing borders and lobulated contour, usually involves
epidermis but may open into skin surface
• Bands of squamous epithelium with trichilemmal-type abrupt
keratinization
• May have prominent atypia, focal stromal invasion

40. Proliferating trichilemmal tumor