BASAL CELL CARCINOMA
Basal cell carcinoma (BCC) is the commonest form of skin cancer (80%). BCC are composed of cells similar to those in the basal area of the epidermis and its appendages. While BCC very rarely metastasize, they can cause significant morbidity by local tissue invasion and destruction, particularly on the head and neck.
Etiology:
- environmental and genetic factors
- cumulative lifetime UV exposure (sunlight and artificial light)
- The likelihood of developing BCC increases with age
Men are affected twice as often as women. The higher incidence in men is probably due to increased recreational and occupational exposure to the sun. Other risk factors include
- Trauma appears to play a part in the development of some BCC and there are reports of tumors arising in sites of traumatic injury or burn
- Smoking
- Immunosuppression
BCC tend to be slow growing, often increasing in size by 2-3 mm a year. Most lesions are reported by the patient as never fully healing and either bleed or produce a scab from time to time
Clinical findings
- I. Nodulo-ulcerative - This is the most common type. An early lesion is a small glistening translucent skin- colored papule that slowly enlarges. Central necrosis, although not invariable, leaves an ulcer with an adherent crust and a rolled pearly edge. Fine
telangiectatic vessels often run across the tumor’s surface. Without treatment such lesions may reach 1–2 cm in diameter in 5–10 years.
- II. Cystic - The lesion is at first like the nodular type, but later cystic changes predominate and the nodule becomes tense and more translucent, with marked telangiectasia.
- III. Cicatricial (morphoeic) - These are slowly expanding yellow or white waxy plaques with an ill-defined edge. Ulceration and crusting, followed by fibrosis, are common, and the lesion may look like an enlarging scar.
- IV. Superficial (multicentric)- These arise most often on the trunk. Several lesions may be present, each expanding slowly as a pink or brown scaly plaque with a fine ‘whipcord’ edge. Such lesions can grow to more than 10 cm in diameter.
- V. Pigmented - Pigment may be present in all types of basal cell carcinoma causing all or part of the tumor to be brown or have specks of brown or black within it
Treatment:
- Excision, with 0.5 cm of surrounding normal skin, is the treatment of choice for discrete nodular and cystic tumors in patients under 60 years.