Basal cell carcinoma diagnosis,treatment,

1. VISHNU PRIYA ANGURAJ
TSMU
Grp-14

2.  Basal cell carcinoma (BCC) is a slow
progressing nonmelanocytic skin cancer
 that arises from basal cells (ie, small,
round cells found in the lower layer of the
epidermis).

3.  It is the most common skin cancer (80%)
 Estimated 3.3 million cases are diagnosed per
year(US) and incidence doubles every 25 years
 The incidence high in areas of ↑UV radiation
(Australia,South africa)
 estimated lifetime risk of 33-39% for men and
23-28% for women
 Men >Women
 It increases with age (50-80 yrs )
 Rare in <40 yrs (5-15%)

5.  Sun damage
 Repeated prior episodes of sunburn
 Fair skin, blue eyes and blond or
red hair ( also affect darker skin
types)
 Previous cutaneous injury, thermal
burn, disease
(eg cutaneous lupus, sebaceous
naevus)

6.  Inherited syndromes: BCC is a particular problem
for families with basal cell naevus syndrome
(Gorlin syndrome), Bazex syndrome, Rombo
syndrome and xeroderma pigmentosum
,albinism
 Other risk factors include ionising radiation,
exposure to arsenic, coal tar, smoking tanning bed
and immune suppression due
to disease or medicines

7.  The cause of BCC is multifactorial.
 DNA mutations in the patched
(PTCH) tumour suppressor gene, part of hedgehog
signalling pathway (SHH)
 triggered by exposure to ultraviolet radiation
 Various spontaneous and inherited gene
defects predispose to BCC

9.  BCC is a locally invasive skin tumour and rarely
metastatize(< 0.01%)
 The main characteristics are:
 Slow growing: 0.5 cm in 1-2 years
 Varies in size from a few millimetres to several
centimetres in diameter
 Skin coloured, pink or pigmented
 Spontaneous bleeding or ulceration
 Waxy papules with central depression
 Pearly appearance

10.  Oozing or crusted areas: In large BCCs
 Rolled (raised) border
 Translucency
 Telangiectases over the surface
 Black-blue or brown areas

11. BCC distrubution :
Head and neck 60%
Nose 14%
Trunk 30%
Extremities 10%

12.  There are several distinct clinical types of
BCC, and over 20 histological growth
patterns of BCC
 Nodular
 Superficial
 Morphoeic
 Basisquamous
 Fibroepithelial tumour of Pinkus

13.  Most common type of facial BCC
 Shiny or pearly nodule with a smooth
surface with telangiectases
 May have central depression or ulceration,
so its edges appear rolled
 Cystic variant is soft, with jelly-like contents
 Micronodular, microcystic and infiltrative
types are potentially aggressive subtypes

15.  Most common type in younger adults
 Most common type on upper trunk and
shoulders
 Slightly scaly, irregular plaque
 Thin, translucent rolled border
 Multiple microerosions

17.  Also known as morphoeiform or sclerosing
BCC
 Usually found in mid-facial sites
 Waxy, scar-like plaque with indistinct
borders
 Flat or slightly depressed, fibrotic, and firm
 Wide and deep subclinical extension

19.  Mixed basal cell carcinoma (BCC)
and squamous cell carcinoma (SCC)
 Infiltrative growth pattern
 Potentially more aggressive than other forms of BCC

20.  Warty plaque
 Usually on trunk

21.  Superficial
 Nodular
 Micronodular
 Infiltrating
 Sclerosing/ morpheaform
 Metatypical
 Infundibulocystic
 keratotic
 Adenoid
 Cystic basal
 Pigmented

22.  Characteristics of recurrent BCC often
include:
 Incomplete excision or narrow margins at
primary excision
 Morphoeic, micronodular, and infiltrative
subtypes
 Location on head and neck

23.  Advanced BCC
 Advanced BCCs are large, often neglected tumours.
 They may be several centimetres in diameter
 They may be deeply infiltrating into tissues below the
skin
 They are difficult or impossible to treat surgically

24.  Nevi malignant melanoma
 Keratoacanthoma
 Seborrheic keratosis
 Bowen disease
 Actinic keratosis
 Squamous cell carcinoma

25.  Skin biopsy
 To confirm and diagnose bcc and its subtype
Shave biopsy
Punch biospy
 Cytology
 Histologic findings
 Laser doppler (eyelids tumor margins)

27.  Treatment depends on size ,location and type of
BCC
 Curretage and electrosessication
 Mohs micrographic surgery
 Excisional surgery
 Radiation
 Cryosurgery
 Photodynamic theray
 Laser surgery
 Topical medications

28.  Curretage and electricdesiccation : The growth is
scraped off with a curette, an instrument with a sharp,
ring-shaped tip), then the tumor site is desiccated
(burned) with an electrocautery needle.
 Small lesions
 Leaves round whiitish scar
 Not suitable for advanced bcc, in high
risk sites.

29.  Excision means the lesion is cut out and the skin
stitched up.
 Most appropriate treatment for nodular, infiltrative
and morphoeic BCCs
 Should include 3 to 5 mm margin of normal skin
around the tumour
 Very large lesions may require flap or skin graft to
repair the defect
 Further surgery is recommended for lesions that are
incompletely excised

31.  Cryotherapy is the treatment of a superficial
skin lesion by freezing it, usually with liquid nitrogen.
 Suitable for small superficial BCCs on covered areas of
trunk and limbs
 Results in a blister that crusts over and heals within
several weeks.
 Leaves permanent white mark

32.  Photodynamic therapy (PDT) refers to a technique in
which BCC is treated with a photosensitising chemical,
and exposed to light several hours later.
 Topical photosensitisers include aminolevulinic acid
lotion and methyl aminolevulinate cream
 Suitable for low-risk small, superficial BCCs
 Results in inflammatory reaction, maximal 3–4 days
after procedure
 Treatment repeated 7 days after initial treatment
 Excellent cosmetic results

34.  Radiotherapy or X-ray treatment can be used to treat
primary BCCs or as adjunctive treatment if margins are
incomplete.
 Mainly used if surgery is not suitable
 Best avoided in young patients and in genetic conditions
predisposing to skin cancer
 Best cosmetic results achieved using multiple fractions
 Typically, patient attends once-weekly for several weeks
 Causes inflammatory reaction followed by scar
 Risk of radiodermatitis, late recurrence, and new tumours

35.  Imiquimod cream
 Imiquimod is an immune response modifier.
 Best used for superficial BCCs less than 2 cm diameter
 Applied three to five times each week, for 6–16 weeks
 Fluorouracil cream
 5-Fluorouracil cream is a topical cytotoxic agent.
 Used to treat small superficial basal cell carcinomas
 Requires prolonged course, eg twice daily for 6–12 weeks
 Causes inflammatory reaction
 Has high recurrence rates

37.  SURGERY
 TARGET THERAPY (SHH PATHWAY INHIBITORS)
 Vismodegib (Erivedge™)
 Sonidegib (Odomzo®)

38.  Protect skin from sun exposure daily, year-round and
lifelong.
 Stay indoors or under the shade in the middle of the
day
 Wear covering clothing
 Apply high protection factor SPF50+ broad-
spectrum sunscreens generously to exposed skin if
outdoors
 Avoid indoor tanning (sun beds, solaria)