Skin Cancer- Basal Cell Carcinoma Most Common

Basal Cell Carcinoma Most Common Cancer If Skin.
This short Presentation will help students to easily learn the main features.

1. BASAL CELL CARCINOMA MICRO TEACHING BY DR SHIPRA SINGH

2. Definition- Basal Cell Carcinoma is a slowly progressing nonmelanocytic skin cancer, That arises from the basal cells- small round cells found in the lower layer of the epidermis. It is the most common skin cancer. It is locally invasive. Also known as Rodent Ulcer .

3. BASAL CELL CARCINOMA

4. Risk Factors- PHYSICAL CHARACTERISTICS- Blond Or Red Hair, Blue green eyes, light skin color . EXPOSURES- Arsenic, coaltar , ionizing radiation, smoking, tanning bed use, ultraviolet light, chronic trauma, burns. GENETIC SYNDROMES Albinism, Xeroderma pigmentosum , Bazex syndrome, Gorlin syndrome. IMMUNOSUPPRESSION- Recipient of solid organ transplant.

5. Etiology and Pathogenesis- The cause of BCC is multifactorial. DNA mutation in the (PTCH) patch tumour suppressor gene, part of hedgehog signalling pathway (SHH). It is triggered by exposure to ultraviolet radiation. BCC Is a locally invasive skin tumor which rarely metastasis.

6. Characteristics- Slow-growing, 0.5 cm in 1 to 2 years.
Varies in size, from a few millimetres to several centimetres in diameter. Grossly- Skin colored pink or pigmented. Waxy papules with the central depression. Pearly appearance. Oozing crusted areas. Rolled edges. Telangiectases over surface Black blue areas.

7. BCC Distribution- Head and neck-60% Nose-10% Trunk-30% Extremities-10%

8. Types of BCC BASED ON HISTOLOGY Nodular- Most common Superficial- Common Morphoiec Basosquamous Other histologic types- micronodular , infiltrating, keratotic , adenoid, cystic basal, pigmented, BASED ON CLINICAL COURSE Advanced BCC Reccurent BCC

9. NODULAR BCC Most common type. Shiny pearly nodule with smooth surface with telangiectases . Has rounded lobules of small hypochromatic cells with peripheral palisading cells and cleft like spaces seperated by fibromyxoid stroma. Has potentially aggressive subtypes- Micronodular , Microcystic , Infilrative . Ddx - Intradermal nevus Squamous cell carcinoma Molluscum contagiosum Seborrheic keratosis

10. Superficial BCC Most common type in younger adults. Location upper trunk and shoulders. Slightly scaly, irregular plaque. Multiple microerosions . Island of basaloid tumor cells are closely associated with superficial epithelium. Pigmented BCC- A Superficial Pigmented bcc brown plaques with irregular borders. Ddx - Bowens disease Pagets disease Psoriasis Eczema Melanoma

11. Morphoiec BCC Also known as morphoeiform or sclerosing bcc. Location Mid facial sites. Flat, slightly depressed fibrotic, Firm lesion with indistinct borders. Cords of hyperchromatic tumor cells embedded in dense collagenised hypocellular matrix. Ddx - Scar Localised scleroderma Desmoplastic trichoepithelioma

12. BASOSQUAMOUS BCC Most aggressive. Propensity to metasesize . Infiltrative growth Keratinizing BCC with squamous pearls. Ddx - Squamous cell carcinoma

13. Recurrent BCC Recurrence due to incomplete Excision. Occurs in Morphoeic , micronodular , and infiltrative subtypes.

14. Advanced BCC Large ofter neglected tumours. Several centimetres in diameter. Deeply infiltrative into tissue. Difficult to treat surgically.

15. DIAGNOSIS Dermoscopy Cytology SKIN BIOPSY - Shave biopsy - Punch biopsy Excisional biopsy

16. TREATMENT Curretage and electrosessication . Mohs micrographic surgery Radiation Cryosurgery Photodynamic therapy Topical medications

17. Prevention Protect skin from sun exposure. Wear covered clothing. Apply high protection factors SPF-50 broad spectrum. Avoid indoor tanning beds. Be attentive of any skin rash, prolonged non healing ulcer. Itching, Bleeding from a scar or mole.