A3. Basal cell carcinoma and squamous cell carcinoma
Basal cell carcinoma
- Epidemiology
- Technically the most common cancer, but it is often excluded from data due to its low mortality and morbidity
- BCC accounts for 75% of all skin cancer
- Most common skin cancer
- Pathology
- Hedgehog pathway is often mutated
- Almost never metastasises, leading to low mortality and morbidity
- May cause local destruction, which may be severe if located on the face
- Types
- Nodular BCC
- Superficial BCC
- Morpheaform BCC
- Naevoid basal cell carcinoma syndrome
- Autosomal dominant disease
- Multiple BCC in young age
- Bone and neurological malformations
- +++
- Risk factors
- Chronic sun exposure
- Old age
- Skin types I and II
- Clinical features
- Pearly papule or nodule
- Rolled border
- Central crater of ulceration
- On sun-exposed skin
- Usually upper lip/nose area
- Slow growing
- Types
- Nodular BCC
- Superficial BCC
- On trunk
- Flat plaque lesion
- Nevoid basal cell carcinoma syndrome
- Prognosis
- Virtually never metastasizes
- Locally aggressive
- Diagnosis
- Clinical, based on typical symptoms
- Definite (histological) diagnoses often made after surgical excision of suspected lesion
- Full-thickness biopsy -> histology
- Treatment
- Surgery
- Surgical excision with 5 mm safety border
- Primary treatment is almost all cases
- Radiotherapy
- If surgery is not an option
- Chemotherapy
- Alternatives for superficial and small BCCs
- Cryosurgery
- Photodynamic therapy
- Laser ablation
- Topical chemotherapy
- Topical imiquimod
- Targeted therapy
- Vismodegib or sonidegib
- Hedgehog pathway inhibitors
- For metastatic BCC or BCC which recurs after surgery
- Follow-up
- Physical examination at 3, 6, 12 months
- Sun protection
Squamous cell carcinoma
- Epidemiology
- SCC accounts for 18% of all skin cancer
- Second most common skin cancer, after BCC
- Risk factors
- Chronic sun exposure
- Transplantation (transplant-related immunosuppression increases the risk 65-fold)
- Precancerous lesions
- Actinic keratosis
- Bowen disease (SCC in situ)
- Leukoplakia
- Radiation
- Chronic scars, ulcers
- Arsenic, tar
- Clinical features
- Painless, non-healing, bleeding ulcer or nodule
- Rapid growing
- On sun-exposed areas
- Prognosis
- Low risk of metastasis (5%)
- Worse prognosis in transplant patients
- Diagnosis
- Punch biopsy or after surgical excision
- Treatment
- Surgery
- Surgical excision with 5 mm safety border
- Primary treatment is almost all cases
- Radiotherapy
- If surgery is not an option
- As adjuvant therapy if high-risk features are discovered during pathological staging
- Immune therapy
- For advanced SCC
- Cemiplimab – anti-PD-1
- Alternatives for superficial and small SCCs
- Mohs micrographic surgery
- For low-risk, small SCC
- For metastasis
- Chemotherapy
- EGFR inhibitors – cetuximab
- PD-1 inhibitor – cemeplimab
- Follow-up
- Physical examination
- Regional ultrasound
- Chest x-ray
- Abdominal US
- Sun protection