Module 3 - Skin & Soft Tissue Lesions

Basal Cell Carcinoma

Clinical Information:

• Most common malignant neoplasm of the skin
• Slow growing and rarely metastatic (<0.1%)
• Can cause significant local destruction leading to disfigurement or death
• Origin in epidermal basal cells
• Sun exposure is most significant cause
• Found most often on head and neck (85%) in fair-skinned patients > 40 years

 

Morphology:

A.) Nodular form

• Most common form
• Pearly white or pink dome-shaped papule

B.) Pigmented form

• Contains melanocytes, but maintains white, pearly border
• Can be mistaken for melanoma or seborrheic keratosis
• Often resembles a dermal nevus
• Telangiectatic vessels readily visible
• Centre frequently ulcerates, leading to a crust and scaly appearance

C). Superficial/Erythematous form

• Least aggressive form
• Most often found on trunk and extremities
• Poorly defined red, scaly plaques resembling eczema or psoriasis
• Pearly, slightly raised border

D.) Morpheaform/Sclerosing carcinoma

• More aggressive form
• Firm, waxy, flat or slightly raised, white to yellow lesion
• Resembles scleroderma
• Often displays deep infiltration and local recurrence

Treatment:

• Excisional biopsy (3-5 mm margin) (99% of lesions)
• Moh’s micrographic surgery (only in specialized centres)
• Curettage with electrodesiccation
• Cryotherapy
• Radiation therapy  (only in special circumstances)

 

Author: SP Zinn