Basal cell carcinoma and treatments.pptx

Bcc spotter plastic surgery indication treatment

1. SPOTTER Dr. Surbhi Abrol

2. 85 year old female c/o Chronic lesion on forehead from last 10 years that has gradually increased in size. Painful , complaints of active discharge from central ulceration.

3. Basal cell carcinoma.

4. Characteristic features of BCC tumors include the following: Waxy papules with central depression Pearly appearance Erosion or ulceration, often central Bleeding, especially when traumatized Crusting Rolled (raised) border Translucency Telangiectases over the surface Slow growing (0.5 cm in 1-2 y)

5. There are 26 histological basal cell carcinoma subtypes. Nodular is the most common; other commonly encountered subtypes in clinical practice are: Nodular: well-defined, flesh- coloured , pearly nodule with telangiectasia ± central ulceration. These are the most common. Superficial: flat, pink, keratotic lesions usually in sun-damaged skin. These are the second most common. Infiltrative: poorly-defined yellow-white opacity. These are the third most common. Micronodular: small rounded nodules Pigmented: a dark lesion that can be confused for melanoma Morpheaform : indurated plaque with a sclerotic or fibrotic appearance.

6. Management : Standard surgical excision is suitable for the majority of primary BCCs. Current guidelines (British Association of Dermatology Guidelines 2021) recommend the following indications: Standard surgical excision as a first-line treatment in low-risk BCC. Immediate reconstruction of lesions with well-defined clinical margins Delayed definitive reconstruction, or Mohs micrographic surgery (MMS) in high-risk BCC with poorly defined clinical margins.

7. Completely excised in primary BCCs: 0.5% Completely excised in recurrent BCCs is 2.9% Mohs surgery for primary BCCs is 0.3-6.5% Deep margins should be into the subcutaneous fat or other deeper structures if needed. The peripheral margins should be excised as follows: Low-risk: 4 mm peripheral clinical surgical margin High risk: 5 mm peripheral clinical surgical margin Recurrent BCC: 5 mm peripheral clinical surgical margin Here are some statistics regarding the 5-year recurrence rate