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Basal Cell Carcinoma (BCC)

Specialties > Cancer

Background Knowledge 🧠

Definition

  • Basal cell carcinoma (BCC) is a common skin cancer originating from basal cells in the epidermis.
  • It is the least aggressive form of skin cancer but can cause significant local destruction.
  • BCC rarely metastasises.

Epidemiology

  • Most common type of skin cancer.
  • Higher incidence in individuals over 50 years old.
  • Increased prevalence in fair-skinned individuals.
  • Greater risk in males compared to females.
  • Higher rates in regions with high UV exposure.

Aetiology and Pathophysiology

  • Primary risk factor is prolonged UV exposure.
  • Other factors include genetic predisposition, exposure to ionising radiation, and immunosuppression.
  • Mutations in the PTCH1 gene are commonly implicated.
  • Pathophysiology involves abnormal proliferation of basal cells in the epidermis.

Types

  • Nodular BCC: Most common type, appears as a pearly nodule.
  • Superficial BCC: Presents as erythematous, scaly patches.
  • Morpheaform (sclerosing) BCC: Scar-like appearance, more aggressive.
  • Pigmented BCC: Contains melanin, may be confused with melanoma.
  • Basosquamous carcinoma: Features of both BCC and squamous cell carcinoma, higher risk of metastasis.

Clinical Features 🌡️

Symptoms

  • Usually asymptomatic in early stages.
  • May present with non-healing sores.
  • Occasional bleeding or crusting.
  • Itching or tenderness in the affected area.

Signs

  • Pearly, translucent nodule with telangiectasia.
  • Rolled borders with central ulceration (rodent ulcer).
  • Erythematous, scaly plaques (superficial BCC).
  • Scar-like areas without distinct borders (morpheaform BCC).
  • Pigmented lesions that may mimic melanoma.

Investigations 🧪

Investigations

  • Clinical examination with dermoscopy.
  • Skin biopsy for histological confirmation.
  • High-resolution ultrasonography in select cases.
  • Consider MRI or CT for suspected deep tissue involvement.

Management 🥼

Management

  • Surgical excision with clear margins is the primary treatment.
  • Mohs micrographic surgery for high-risk or recurrent cases.
  • Cryotherapy for small, superficial lesions.
  • Topical treatments: Imiquimod or 5-fluorouracil for superficial BCC.
  • Radiotherapy for non-surgical candidates.

Complications

  • Local recurrence.
  • Invasion of surrounding tissues (muscle, bone).
  • Disfigurement due to extensive surgery.
  • Rare metastasis, typically to lymph nodes or lungs.

Prognosis

  • Excellent prognosis with early detection and treatment.
  • High cure rate for localised lesions.
  • Prognosis worsens with delayed diagnosis and larger lesions.
  • Regular follow-up is essential to monitor for recurrence.

Key Points

  • BCC is the most common but least aggressive form of skin cancer.
  • Early detection and treatment are crucial for favourable outcomes.
  • Surgical excision is the mainstay of treatment.
  • Patients require regular follow-up to monitor for recurrence.

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Cancer