Rodent ulcer

Basal Cell carcinoma

1. Basundhara Chakrabarti Roll No-11 08-05-2017 1 RODENT ULCER

2. s 08-05-2017 2 =Rodent Ulcer….?

3. 08-05-2017 3 The tumour enlarges in size by burrowing and destroying the tissue locally like a rodent, hence the name rodent ulcer.

4. 08-05-2017 4 Definition It is a low grade, locally invasive carcinoma arising from basal layer of skin ( or adnexal basal layer of hair follicle) or muco-cutaneous junction. It does not arise from mucosa.

5. 08-05-2017 5 Etiology It is the commonest malignant skin tumour (70%). Common in places where exposure to UV light is more. More common in white-skinned people than blacks. Common in males , middle-aged than elderly. Other causes- Arsenics, Coal Tar, Aromatic hydrocarbons , Skin tumour syndromes.

6. Pathogenesis 08-05-2017 6 No apparent precursor lesion Hard to culture Resist transplantation Clinical Course Nodulo-ulcerarive type begins as a flesh coloured waxy nodule with telangectasia → enlarges → central ulceration → deepens → rolled out, beaded edges → destroys structures locally as deep as bone/ cartilage → aptly named rodent ulcer Rare metastasis(17%), but recurrence known after inadequate treatment.

7. 08-05-2017 7 Location Common site is face -above the line drawn between angle of mouth and ear lobule(90%)- Onghren’s line. It is called as tear cancer as it is commonly seen in the area where tear rolls down. Common Sites INNER CANTHUS OF EYE OUTER CANTHUS OF EYE NOSE ON AND AROUND NASOLABIAL FOLD ON THE FORE HEAD

8. Gross Pathology 08-05-2017 8 Pearly papule Nodular telangiectasias Central ulceration with rolled margins.

9. Histopathology 08-05-2017 9 Ovoid cells in nests with single outer Palisading layer

10. 08-05-2017 10 Types of BCC Nodular Basosquamous Superficial Pigmented Morphoeic

11. Clinical Features 08-05-2017 11 Middle aged man Non-tender Dry Slow growing Non mobile Raised and beaded edges with central scab No lymphatic or hematogenous spread High Risk BCC Size : >2cms Location: eye,nose,ear Ill defined margins Recurrent Immunosuppressed individuals

12. Clinical Presentation 08-05-2017 12

13. Investigation 08-05-2017 13 Wedge Biopsy X-Ray CT Scan

14. 08-05-2017 14 Management SURGICAL Excision Mohs Micrographic Surgery Two stage surgery NON SURGICAL Curettage Electrodessication Laser Vaporization RADIOTHERAPY Indications for surgery Rodent ulcer eroding bone or cartilage BCC close to eye Recurrence

15. 08-05-2017 15 Thank you