Basal cell carcinoma overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
The classification of basal cell carcinoma (BCC) is divided into many clinical variants. After sunlight exposure, cumulative DNA damage leads to mutations. There are many causes associated with basal cell carcinoma such as sunlight, gene mutations, and other conditions, for example, xeroderma pigmentosum. There are several differential diagnosis for basal cell carcinoma that may be differentiated clinically or histopathologically including microcystic adnexal carcinoma, trichoepithelioma/trichoblastoma, merkel cell carcinoma, and other squamous cell carcinoma. In 2014, the average annual incidence of basal cell carcinoma in the United States was 878 cases per 100,000 individuals. There are many causes associated with basal cell carcinoma such as sunlight, gene mutations, and other conditions, for example, xeroderma pigmentosum. The U.S. Preventive Services Task Force has found no evidence to recommend for or against screening. The American Cancer Society recommends that a health care provider examine the skin every year if the patient is older than 40 years, and every 3 years if the patient is between 20-40 years. Basal cell carcinoma is slow-growing and locally invasive. Common complications of BCC include reoccurrence and development of other types of skin cancer. The American Joint Committee on Cancer (AJCC) stages basal cell carcinoma based on the TNM system. T, M, and N are combined into stages, called stage grouping. The history and symptoms of basal cell carcinoma include skin growths on sun-exposed skin. The physical examination of basal cell carcinoma is based on a clinical exam. The laboratory tests of basal cell carcinoma consist of a biopsy and visualization of its histological findings. CT scans and radiography may be performed if there is involvement of deeper structures, such as the bone. After the suspicious lesion is evaluated, the medical therapy is divided into low-risk and high-risk basal cell carcinoma patients. Medical therapy consists of surgery, radiation therapy, and follow-up for recurrence. Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and cryosurgery. The primary prevention of basal cell carcinoma involves avoidance and protection from the sun. A skin biopsy and chemotherapeutic agents such as 5-Fluorouracil or Imiquimod may prevent the further development of basal cell carcinoma.
Historical Perspective
In 1827, Jacob Arthur, reported the "rodent ulcer". In 1900, Edmund Krompecher, identified the histological features as an epithelial carcinoma.
Classification
The classification of basal cell carcinoma (BCC) is divided into many clinical variants.
Pathophysiology
Basal cell carcinomas develop in the basal cell layer of the skin. Cumulative DNA damage leads to mutations, after sunlight exposure.
Causes
There are many causes associated with basal cell carcinoma such as sunlight, gene mutations, and other conditions, for example, xeroderma pigmentosum.
Differential Diagnosis
There are several differential diagnosis for basal cell carcinoma that may be differentiated clinically or histopathologically including microcystic adnexal carcinoma, trichoepithelioma/trichoblastoma, merkel cell carcinoma, and other squamous cell carcinoma.
Epidemiology and Demographics
In 2014, the average annual incidence of basal cell carcinoma in the United States was 878 cases per 100,000 individuals. The incidence increases with age and is higher in men. BCC is the most common in the Caucasian race.
Risk Factors
There are many causes associated with basal cell carcinoma such as sunlight, gene mutations, and other conditions, for example, xeroderma pigmentosum.
Screening
The U.S. Preventive Services Task Force has found no evidence to recommend for or against screening. The American Cancer Society recommends that a health care provider examine the skin every year if the patient is older than 40 years, and every 3 years if the patient is between 20-40 years.
Natural History, Complications, and Prognosis
Basal cell carcinoma is slow-growing and locally invasive. Common complications of BCC include reoccurrence and development of other types of skin cancer.
Staging
The American Joint Committee on Cancer (AJCC) stages basal cell carcinoma based on the TNM system. T, M, and N are combined into stages, called stage grouping.
History and Symptoms
The history and symptoms of basal cell carcinoma include skin growths on sun-exposed skin. They are fragile and may bleed easily.
Physical Examination
The physical examination of basal cell carcinoma is based on a clinical exam.
Diagnostic Studies
Laboratory Findings
The laboratory tests of basal cell carcinoma consist of a biopsy and visualization of its histological findings.
Other Diagnostic Studies
CT scans and radiography may be performed if there is involvement of deeper structures, such as the bone.
Medical Therapy
After the suspicious lesion is evaluated, the medical therapy is divided into low-risk and high-risk basal cell carcinoma patients. Medical therapy consists of surgery, radiation therapy, and follow-up for recurrence.
Surgery
Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and cryosurgery.
Primary Prevention
The primary prevention of basal cell carcinoma involves avoidance and protection from the sun.
Secondary Prevention
A skin biopsy and chemotherapeutic agents such as 5-Fluorouracil or Imiquimod may prevent the further development of basal cell carcinoma.