Basal cell carcinoma differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Basal cell carcinoma}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Basal_cell_carcinoma]]
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.


==Overview==
==Overview==
There are differential diagnosis for patients with basal cell carcinoma within the following clinical variants: nodular, superficial, pigmented, and sclerodermiform (morpheiform).
Basal cell carcinoma must be differentiated from other common causes of skin lesions, such as [[squamous cell carcinoma]], microcystic adnexal carcinoma, trichoepithelioma/trichoblastoma, and [[merkel cell carcinoma]].


==Basal Carcinoma Differential Diagnosis==
==Basal Carcinoma Differential Diagnosis==
The following table summarizes common differential diagnosis for basal cell carcinoma<ref>https://online.epocrates.com/u/2935269/Basal+cell+carcinoma</ref>:
The following table summarizes common differential diagnosis for basal cell carcinoma :<ref>https://online.epocrates.com/u/2935269/Basal+cell+carcinoma</ref>
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"


| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Disease or Condition'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Differentiating Signs and Symptoms'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Differentiating Tests'''}}


|-


{| {{table}}
| '''Microcystic adnexal carcinoma'''||AKA sclerosing sweat duct carcinoma; simulate morpheaform variants of BCC; higher recurrence rate than BCC||Histopathology: there are more ductal structures lined by a cuticle of keratin, which are not prevalent in BCCs; it will occasionally be positive with [[cytokeratin]] 7 and CEA (usually negative in BCCs)<ref>{{cite journal| author=Smeets NW, Stavast-Kooy AJ, Krekels GA, Daemen MJ, Neumann HA| title=Adjuvant cytokeratin staining in Mohs micrographic surgery for basal cell carcinoma. | journal=Dermatol Surg | year= 2003 | volume= 29 | issue= 4 | pages= 375-7 | pmid=12656816 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12656816}}</ref>


| align="center" style="background:#f0f0f0;"|'''Disease/condition'''
|-


| align="center" style="background:#f0f0f0;"|'''Differentiating signs/symptoms'''
| '''Trichoepithelioma/trichoblastoma'''||There is a formation of papillary-mesenchymal bodies (follicular units that simulate bulb of the hair follicle); a characteristic stroma-stroma split; a lower [[apoptotic]] and mitotic rate than seen in BCC<ref>{{cite journal| author=Ackerman AB, Gottlieb GJ| title=Fibroepithelial tumor of pinkus is trichoblastic (Basal-cell) carcinoma. | journal=Am J Dermatopathol | year= 2005 | volume= 27 | issue= 2 | pages= 155-9 | pmid=15798443 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15798443}}</ref>||Histopathology: the characteristic stroma-epithelium split and increase in apoptotic bodies and mitotic figures is not seen; Immunohistochemical: a characteristic perinuclear dot-like pattern and high molecular weight cytokeratin cocktail


| align="center" style="background:#f0f0f0;"|'''Differentiating tests'''
|-
 
| '''Merkel cell carcinoma'''||This is a highly malignant neoplasm derived from cutaneous [[neuroendocrine]] cells<ref>{{cite journal| author=Massari LP, Kastelan M, Gruber F| title=Epidermal malignant tumors: pathogenesis, influence of UV light and apoptosis. | journal=Coll Antropol | year= 2007 | volume= 31 Suppl 1 | issue=  | pages= 83-5 | pmid=17469758 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17469758}}</ref>||Histopathology: opaque nuclei, no nucleoli, and increased nuclear/cytoplasmic ratio, peripheral palisading might be present


|-
|-


| Microcystic adnexal carcinoma||AKA sclerosing sweat duct carcinoma; simulate morpheaform variants of BCC; higher recurrence rate than BCC||Histopathology: there are more ductal structures lined by a cuticle of keratin, which are not prevalent in BCCs; it will occasionally be positive with cytokeratin 7 and CEA (usually negative in BCCs)<ref>{{cite journal| author=Smeets NW, Stavast-Kooy AJ, Krekels GA, Daemen MJ, Neumann HA| title=Adjuvant cytokeratin staining in Mohs micrographic surgery for basal cell carcinoma. | journal=Dermatol Surg | year= 2003 | volume= 29 | issue= 4 | pages= 375-7 | pmid=12656816 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12656816}}</ref>
| '''Squamous cell carcinoma (SCC)'''||It may impossible to distinguish between BCC and SCC<ref>{{cite journal| author=Raasch BA, Buettner PG, Garbe C| title=Basal cell carcinoma: histological classification and body-site distribution. | journal=Br J Dermatol | year= 2006 | volume= 155 | issue= 2 | pages= 401-7 | pmid=16882181 | doi=10.1111/j.1365-2133.2006.07234.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16882181}}</ref>||Histopathology: larger cells with prominent [[nucleoli]], foci of keratinization and formation of squamous whorls where the [[neoplastic]] cells tightly wrap around each other
 
|}
The following table summarizes other differential diagnosis for basal cell carcinoma:
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
 
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Clinical variant'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Differential Diagnosis'''}}


|-
|-


| Trichoepithelioma/trichoblastoma||There is a formation of papillary-mesenchymal bodies (follicular units that simulate bulb of the hair follicle); a characteristic stroma-stroma split; a lower apoptotic and mitotic rate than seen in BCC<ref>{{cite journal| author=Ackerman AB, Gottlieb GJ| title=Fibroepithelial tumor of pinkus is trichoblastic (Basal-cell) carcinoma. | journal=Am J Dermatopathol | year= 2005 | volume= 27 | issue= 2 | pages= 155-9 | pmid=15798443 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15798443}}</ref>||Histopathology: the characteristic stroma-epithelium split and increase in apoptotic bodies and mitotic figures is not seen; Immunohistochemical: a characteristic perinuclear dot-like pattern and high molecular weight cytokeratin cocktail
| '''Nodular BCC'''||Intradermal nevus
 
[[Sebaceous hyperplasia]]
 
Fibrous papule


|-
[[Molluscum contagiosum]]


| Merkel cell carcinoma||This is a highly malignant neoplasm derived from cutaneous neuroendocrine cells<ref>{{cite journal| author=Massari LP, Kastelan M, Gruber F| title=Epidermal malignant tumors: pathogenesis, influence of UV light and apoptosis. | journal=Coll Antropol | year= 2007 | volume= 31 Suppl 1 | issue=  | pages= 83-5 | pmid=17469758 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17469758}}</ref>||Histopathology: opaque nuclei, no nucleoli, and increased nuclear/cytoplasmic ratio, peripheral palisading might be present
[[Keratoacanthoma]]


|-
|-


| Squamous cell carcinoma (SCC)||It may impossible to distingish between BCC and SCC<ref>{{cite journal| author=Raasch BA, Buettner PG, Garbe C| title=Basal cell carcinoma: histological classification and body-site distribution. | journal=Br J Dermatol | year= 2006 | volume= 155 | issue= 2 | pages= 401-7 | pmid=16882181 | doi=10.1111/j.1365-2133.2006.07234.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16882181}}</ref>||Histopathology: larger cells with prominent nucleoli, foci of keratinization and formation of squamous whorls where the neoplastic cells tightly wrap around each other
| '''Superficial BCC'''||Discoid eczema


|}
[[Psoriasis]]
The following are other differential diagnosis for patients with basal cell carcinoma:
 
*'''Nodular BCC''':
[[Actinic keratosis]] (solar keratosis)
:*Intradermal naevus
:*Sebaceous hyperplasia
:*Fibrous papule
:*Molluscum contagiosum
:*Keratoacanthoma
*'''Superficial BCC''':
:*Discoid eczema
:*Psoriasis
:*Actinic keratosis (solar keratosis)
:*Lichen simplex
:*Bowen's disease
:*Seborrhoeic keratosis
*'''Pigmented BCC''':
:*Melanoma
*'''Sclerodermiform (morpheiform) BCC''':
:*Scar tissue
:*Localized scleroderma


{| {{table}}
Lichen simplex


| align="center" style="background:#f0f0f0;"|'''Clinical variant'''
[[Bowen's disease]]


| align="center" style="background:#f0f0f0;"|'''Differential diagnosis'''
[[Seborrhoeic keratosis]]


|-
|-


| Nodular BCC||Intradermal nevus
| '''Pigment BCC'''||[[Melanoma]]


Sebaceous hyperplasia
|-


Fibrous papule
| '''Sclerodermiform (morpheiform) BCC'''||Scar tissue
 
Molluscum contagiosum


Keratoacanthoma
Localized [[scleroderma]]


|}
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Pathology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Latest revision as of 18:14, 4 April 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.

Overview

Basal cell carcinoma must be differentiated from other common causes of skin lesions, such as squamous cell carcinoma, microcystic adnexal carcinoma, trichoepithelioma/trichoblastoma, and merkel cell carcinoma.

Basal Carcinoma Differential Diagnosis

The following table summarizes common differential diagnosis for basal cell carcinoma :[1]

Disease or Condition Differentiating Signs and Symptoms Differentiating Tests
Microcystic adnexal carcinoma AKA sclerosing sweat duct carcinoma; simulate morpheaform variants of BCC; higher recurrence rate than BCC Histopathology: there are more ductal structures lined by a cuticle of keratin, which are not prevalent in BCCs; it will occasionally be positive with cytokeratin 7 and CEA (usually negative in BCCs)[2]
Trichoepithelioma/trichoblastoma There is a formation of papillary-mesenchymal bodies (follicular units that simulate bulb of the hair follicle); a characteristic stroma-stroma split; a lower apoptotic and mitotic rate than seen in BCC[3] Histopathology: the characteristic stroma-epithelium split and increase in apoptotic bodies and mitotic figures is not seen; Immunohistochemical: a characteristic perinuclear dot-like pattern and high molecular weight cytokeratin cocktail
Merkel cell carcinoma This is a highly malignant neoplasm derived from cutaneous neuroendocrine cells[4] Histopathology: opaque nuclei, no nucleoli, and increased nuclear/cytoplasmic ratio, peripheral palisading might be present
Squamous cell carcinoma (SCC) It may impossible to distinguish between BCC and SCC[5] Histopathology: larger cells with prominent nucleoli, foci of keratinization and formation of squamous whorls where the neoplastic cells tightly wrap around each other

The following table summarizes other differential diagnosis for basal cell carcinoma:

Clinical variant Differential Diagnosis
Nodular BCC Intradermal nevus

Sebaceous hyperplasia

Fibrous papule

Molluscum contagiosum

Keratoacanthoma

Superficial BCC Discoid eczema

Psoriasis

Actinic keratosis (solar keratosis)

Lichen simplex

Bowen's disease

Seborrhoeic keratosis

Pigment BCC Melanoma
Sclerodermiform (morpheiform) BCC Scar tissue

Localized scleroderma

References

  1. ↑ https://online.epocrates.com/u/2935269/Basal+cell+carcinoma
  2. ↑ Smeets NW, Stavast-Kooy AJ, Krekels GA, Daemen MJ, Neumann HA (2003). "Adjuvant cytokeratin staining in Mohs micrographic surgery for basal cell carcinoma". Dermatol Surg. 29 (4): 375–7. PMID 12656816.
  3. ↑ Ackerman AB, Gottlieb GJ (2005). "Fibroepithelial tumor of pinkus is trichoblastic (Basal-cell) carcinoma". Am J Dermatopathol. 27 (2): 155–9. PMID 15798443.
  4. ↑ Massari LP, Kastelan M, Gruber F (2007). "Epidermal malignant tumors: pathogenesis, influence of UV light and apoptosis". Coll Antropol. 31 Suppl 1: 83–5. PMID 17469758.
  5. ↑ Raasch BA, Buettner PG, Garbe C (2006). "Basal cell carcinoma: histological classification and body-site distribution". Br J Dermatol. 155 (2): 401–7. doi:10.1111/j.1365-2133.2006.07234.x. PMID 16882181.
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