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Basal Cell Carcinoma

BCC

Basal cell carcinoma, abbreviated as BBC, is the most common type of skin cancer affecting millions of individuals across the globe. The cancer starts from the basal cells of the skin and its appendages.

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Presentation

Basal cell carcinomas usually develop on the head and neck region which are majorly exposed to sun. Development of tumors in the trunk and legs is a rare occurrence [7]. A sore that does not heal and repeatedly bleeds is the preliminary sign of development of cancer. In addition to these, the tumor may appear as shiny or pearly lump and may bleed developing a crust over it. Individuals with dark skin tone develop a brown or black color lump. As the disease progresses, areas of chest or back may also develop scaly flesh colored patch. The patch may gradually enlarge. In rare cases, a white color wax scar may also develop. However, such type of tumors can easily go unnoticed.

Gangrene
  • He had symptoms suggestive of Raynaud's phenomenon that eventually led to digital gangrene. FNAC was done which was suggestive of basal cell carcinoma.[ncbi.nlm.nih.gov]
Cyanosis
  • Rombo syndrome Rombo syndrome is an autosomal dominant condition distinguished by basal cell carcinoma and atrophoderma vermiculatum, trichoepitheliomas, hypotrichosis milia, and peripheral vasodilation with cyanosis. [40] Alcohol consumption A study[emedicine.medscape.com]
  • PubMed CrossRef Google Scholar Michaëlsson G, Olson E, Westermark P (1981) The Rombo syndrome: a familial disorder with vermiculate atrophoderma, milia, hypotrichosis, trichoepitheliomas, basal cell carcinomas and peripheral vasodilation with cyanosis[doi.org]
Diplopia
  • Orbital invasion can cause diplopia, proptosis, and ophthalmoplegia. Any limitation in ocular movements and/or diplopia should be tested. BCC seldom causes regional or distant metastasis, with the exception of the metatypical basosquamous type.[emedicine.medscape.com]
Diplopia
  • Orbital invasion can cause diplopia, proptosis, and ophthalmoplegia. Any limitation in ocular movements and/or diplopia should be tested. BCC seldom causes regional or distant metastasis, with the exception of the metatypical basosquamous type.[emedicine.medscape.com]
Ulcer
  • The value of this model for the diagnosis of facial ulcers suspected to be a rodent ulcer basal cell carcinoma is suggested.[ncbi.nlm.nih.gov]
Papule
  • It presents as a red macule or papule; therefore, in most cases, it may easily be mistaken for a benign vascular lesion, such as a telangiectasia or angioma. PURPOSE: A red dot BCC in an older woman is described.[ncbi.nlm.nih.gov]
  • Superficial (about 30%): These types are red or pink, marginated, thin papules or plaques, commonly on the trunk, that are difficult to differentiate from psoriasis or localized dermatitis.[merckmanuals.com]
  • Nodular basal cell carcinoma appearing as a waxy, translucent papule with central depression and a few small erosions.[emedicine.medscape.com]
  • Appearance A basal cell lesion is often described by doctors as a pearly papule — "pearly" meaning that it has a slight shine, unlike benign (non-cancerous) lesions that are brown and scaly, and "papule" meaning that it's elevated above the surface of[verywell.com]
Fair Complexion
  • The primary cause of basal cell cancer is overexposure to the sun and those with fair complexions are especially susceptible. For the same reason, it occurs most often on sun-exposed areas of the body, which include the face, head and neck.[stanfordhealthcare.org]
  • Other risk factors include fair complexions in skin that freckles & burns easily; blue or green or other light-colored eyes; red or blond hair, actinic keratosis, a history of radiation treatment, or a weakened immune system.[texaschildrens.org]
  • Risk Factors Caucasians, especially those with blue eyes, a fair complexion, and red, blond, or light brown hair (Celtic ancestry), have the highest risk of BCC. BCC is possible but uncommon in African-Americans, Asians, and Hispanics.[verywell.com]
  • Having a fair complexion, which includes the following: Fair skin that freckles and burns easily, does not tan, or tans poorly. Blue or green or other light-colored eyes. Red or blond hair.[web.archive.org]
Anhidrosis
  • Bazex syndrome Features of Bazex syndrome include follicular atrophoderma (so-called ice pick marks, especially on dorsal hands), multiple basal cell carcinomas, and local anhidrosis (decreased or absent sweating). [34] Previous nonmelanoma skin cancer[emedicine.medscape.com]
Skin Ulcer
  • […] motility and assessment of proptosis Assessment of facial sensation Examination of the lesion includes assessment for: General appearance and extent of the lesion and periocular skin Distortion of eyelid architecture or eyelid malposition Presence of skin[eyewiki.aao.org]
  • People with chronic cutaneous inflammation, as seen in long-standing skin ulcers, are predisposed to the development of SCC. Immune suppression.[cancer.gov]
  • People with chronic sun damage, sites of prior burns, arsenic exposure, chronic cutaneous inflammation as seen in longstanding skin ulcers, and sites of previous x-ray therapy are predisposed to the development of SCC.[ 4 ] SCCs are composed of keratinizing[web.archive.org]
Facial Ulceration
  • Trigeminal trophic syndrome is an uncommon cause of facial ulcers, that affects the sensitive area of the trigeminal nerve.[ncbi.nlm.nih.gov]
Genital Lesions
  • Scrotal myofasciocutaneous flap was useful for covering the defect in the genital lesion. Moreover, this simple closure was helpful for early postoperative ambulation especially for aged male patients. 2016 Wiley Periodicals, Inc.[ncbi.nlm.nih.gov]

Workup

Skin examination and biopsy of the affected area form the diagnostic procedures for confirming basal cell carcinoma. The areas where the nodules have developed would be carefully examined. In addition, other parts of the body would also be carefully looked for signs of development of the nodules. Following this, a skin biopsy would also be carried out to detect the type of cancer present.

Treatment

The type of treatment to be employed greatly depends on the stage and the area affected. The following methods are administered for treating basal cell carcinoma:

  • Electrodesiccation and curettage: In this method, the surface of the lump is scraped using a curette and the base of the lump is seared using electrical needle. This method is used when the cancer develops in the ear or legs [8].
  • Surgical excision involves removing the cancerous tumor along with some healthy neighboring tissues [9].
  • Cryosurgery involves freezing of the cancer cells which is carried out using liquid nitrogen.
  • Mohs surgery is the treatment of choice for recurrent basal cell carcinomas. In such a type of surgical procedure the cancerous cells are removed after examining each and every layer. The layers are removed until no abnormal cells are observed [10].
  • Medications are the last resort when the cancer has not responded to other treatment regimes and has spread to other body parts.

Prognosis

The prognosis of the disease is extremely favorable with 100% survival rate if the cancer has not spread to other body parts. However, if treatment is not initiated on time then the cancer can spread to other parts causing significant morbidity and mortality of affected individuals. Cosmetic disfigurement is common in cases which have not received prompt treatment [6].

Etiology

Genetic mutations in the basal cells of the skin are known to be the major factors that trigger the development of basal cell carcinoma. Mutations in the cells cause damage to the DNA which occurs as a result of long term exposure to ultraviolet rays. In addition to ultraviolet rays of the sun, the radiation found in commercial lamps and tanning beds are also known to play a role in the causation of BBC. There are other factors such as exposure to toxic substances or a weakened immune system, which also significantly contribute to basal cell carcinoma. There have also been some pieces of evidence suggesting causation of BBC due to exposure of arsenic in water [2].

Epidemiology

The incidence of BBC is known to double every 25 years. It has been estimated that in the United States, about 1 million individuals are diagnosed with BBC every year. Amongst the individuals diagnosed, about 10,000 deaths occur due to cancer [3]. Caucasians are more affected due to basal cell carcinoma than any other race. It has also been estimated that BBC is a common occurrence in USA, Australia and Europe.

Sex distribution
Age distribution

Pathophysiology

Damage to the DNA of the basal cells causes BBC. Basal cells are situated beneath the epidermal layer of the skin. Under normal conditions, for new skin cells to develop, the old cells are pushed towards the surface where they slough off and die. This process is effectively controlled by the DNA of the skin cells. Mutation arising in the DNA causes the basal cells to multiply in an uncontrollable fashion. Such sequence of events causes accumulation of abnormal cells which eventually take form of cancerous tumors [4]. Exposure to ultraviolet radiation either through sun, commercial lamps or tanning beds also causes DNA damage. Individuals are therefore advised to wear protective clothing prior to stepping out in the sun [5].

Prevention

Long term exposure to ultraviolet rays is known to be the major cause of DNA mutation in individuals with basal cell carcinoma. Individuals are therefore advised to wear sun protective clothes before stepping out in sun. For the exposed body parts, applying sufficient quantity of sun protective lotion should be practiced. Individuals are also advised to avoid using tanning beds. Avoiding venturing out in the mid-day sun would also reduce the risk of developing basal cell carcinoma.

Summary

Basal cell carcinoma (BCC) rarely spreads to other parts of the body. In about 80% of the cases, basal cell carcinoma affects the head and neck since that they are mostly exposed to the ultraviolet rays of sun. The past decade has witnessed a significant rise in the incidence of basal cell carcinoma. BBC is a form of non-melanocytic skin cancer [1].

Patient Information

Definition

Basal cell carcinoma (BCC) is the most common form of skin cancer that originates in the basal cell of the skin. Such a type of carcinoma is also termed as “epitheliomas” as they rarely spread to other body parts. The rate of incidence of BBC is high in countries such as US, Europe and Australia.

Cause 

Mutation in the DNA of the basal cell due to exposure to ultraviolet rays is the major causative factor. In addition to these, frequent and prolonged use of tanning beds can also cause BBC. Exposure to environmental toxic compounds can also pose significant risk of developing BBC.

Symptoms

The tumors develop in the sun exposed areas. The lump is white and pearly in color which bleeds frequently and crust develops over it. In dark toned individuals, the lump is black or brown in color.

Diagnosis

Diagnosis of BBC is made by physical examination of the nodule. In addition, skin biopsy is done to further confirm the condition.

Treatment

Treatment of BBC involves surgical excision, electrodessication and curettage, cryosurgery, Mohs surgery and topical treatments. The type of method involved greatly depends on the location and the stage at which the cancer is diagnosed. Medications are often the last resort when other methods of treatment fail to bring about the desired effect.

References

Article

  1. Vitasa BC, Taylor HR, Strickland PT, et al. Association of nonmelanoma skin cancer and actinic keratosis with cumulative solar ultraviolet exposure in Maryland watermen. Cancer 1990; 65:2811.
  2. Cabrera HN, Gómez ML. Skin cancer induced by arsenic in the water. J Cutan Med Surg. Mar-Apr 2003;7(2):106-11.
  3. Rogers HW, Weinstock MA, Harris AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010; 146:283.
  4. Zhang H, Ping XL, Lee PK, Wu XL, Yao YJ, Zhang MJ, et al. Role of PTCH and p53 genes in early-onset basal cell carcinoma. Am J Pathol. Feb 2001;158(2):381-5.
  5. Zhang M, Qureshi AA, Geller AC, et al. Use of tanning beds and incidence of skin cancer. J Clin Oncol 2012; 30:1588.
  6. Miller SJ, Alam M, Andersen J, et al. Basal cell and squamous cell skin cancers. J Natl Compr Canc Netw 2010; 8:836.
  7. Erba P, Farhadi J, Wettstein R, Arnold A, Harr T, Pierer G. Morphoeic basal cell carcinoma of the face.Scand J Plast Reconstr Surg Hand Surg. 2007;41(4):184-8.
  8. Salasche SJ. Curettage and electrodesiccation in the treatment of midfacial basal cell epithelioma. J Am Acad Dermatol 1983; 8:496.
  9. Berman B. Scientific rationale: combining imiquimod and surgical treatments for basal cell carcinomas. J Drugs Dermatol. Jan 2008;7(1 Suppl 1):s3-6.
  10. Rowe DE, Carroll RJ, Day CL Jr. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol 1989; 15:424.

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Last updated: 2019-07-11 21:03