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
    • Most common type
  • 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
    • Only topical (5-FU)
  • 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