Basal cell carcinoma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Shivali Marketkar, M.B.B.S. [2]

Overview

Basal cell carcinomas develop in the basal cell layer of the skin. Cumulative DNA damage caused by chronic sunlight exposure results in DNA mutations that predispose to the development of basal cell carcinoma. On gross pathology, basal cell carcinoma lesions may demonstrate pearly pink nodules with telangiectasias, rolled borders, and central crusting with or without an ulcerating lesion (rodent ulcer). On microscopic analysis, peripheral palisading nuclei are characteristic.

Pathophysiology

Genetics

 
 
 
Loss of PTCH1
 
 
 
Gain of function SMO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lack of SMO inhibition
 
 
 
Activation of
SMO-GLI signaling
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
↑GLI1 levels
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Changes in transcription
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tumorigenesis
 
 
 

Enviromental Exposure

Pathology

Basal cell carcinoma pathological features mainly depend upon the subtype. The following table summarizes them:[4][5]

Subtypes of BCC Gross features Microscopic features
Findings Images Findings Images
Nodular
M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
No machine-readable author provided. KGH assumed (based on copyright claims). [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], via Wikimedia Commons,https://upload.wikimedia.org/wikipedia/commons/b/b6/Basal_cell_carcinoma_histopathology_%283%29.jpg
Superficial
  • Well-circumscribed
  • Erythematous thin plaque or patch with scale
  • Central clearing and thin rolled borders
  • Most common on the trunk
Kelly Nelson (Photographer) [Public domain], via Wikimedia Commons,https://upload.wikimedia.org/wikipedia/commons/3/32/Basal_cell_carcinoma%2C_superficial.jpg
  • Multiple lobular foci of basaloid palisading keratinocyte tumors
  • These are usually attached superficially to the epidermis with a myxoid stroma and band-like lichenoid infiltrate
machine-readable author provided. KGH assumed (based on copyright claims). [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], via Wikimedia Commons
Infundibulocystic
  • Well-circumscribed pearly papule
  • Most common on the head and neck region
  • Well-circumscribed
  • Anastomosing strands of basaloid cells and scattered infundibulum-like cystic structures
Fibroepithelial
  • Skin-colored/erythematous
  • Sessile plaque/pedunculated papulonodule
  • They have a predilection for trunk region
  • Multiple collections of delicate strands of epidermal basaloid keratinocytes
  • These are usually arranged in a reticular pattern within a spindle cell stroma
Morpheaform
  • Infiltrated plaque with poorly defined borders and shiny surface
  • Most common on head and neck region
Dermatology Centre, Salford Royal Hospital, NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK.
  • Thin cords of basaloid cells surrounded by a sclerotic collagenous stroma
  • Absent peripheral palisading and stromal cleft formation
  • Positive staining of tumor stroma with smooth muscle alpha-actin
Department of Pathology, Columbia University Medical Center, New York, USA
Infiltrative
  • Poorly defined
  • Indurated, flat or depressed plaque with white, yellow, or pale pink color
  • They may have overlying crusts, erosions, ulcerations, or papules
Kelly Nelson (Photographer) [Public domain], via Wikimedia Commons,https://upload.wikimedia.org/wikipedia/commons/9/9b/Basal_cell_carcinoma_%281%29.jpg,
  • Thin cords with angulated ends of few basaloid keratinocytes
  • Usually embedded in a classic mucinous/myxoid stroma
Micronodular
  • Erythematous macule or thin papule/plaque
  • Multiple small aggregates of basaloid cells within the dermis, with subtle peripheral palisading and retraction artifact
Basosquamous
  • Majority found on the head and neck
  • Well-defined nodular or superficial BCC component overlying an invasive front showing basal cell carcinoma and squamous cell carcinoma histologic feature

Video

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References

  1. Mohan SV, Chang AL (2014). "Advanced Basal Cell Carcinoma: Epidemiology and Therapeutic Innovations". Curr Dermatol Rep. 3: 40–45. doi:10.1007/s13671-014-0069-y. PMC 3931971. PMID 24587976.
  2. Pellegrini C, Maturo MG, Di Nardo L, Ciciarelli V, Gutiérrez García-Rodrigo C, Fargnoli MC (November 2017). "Understanding the Molecular Genetics of Basal Cell Carcinoma". Int J Mol Sci. 18 (11). doi:10.3390/ijms18112485. PMC 5713451. PMID 29165358.
  3. Yunoki T, Tabuchi Y, Hirano T, Miwa S, Imura J, Hayashi A (November 2018). "Gene networks in basal cell carcinoma of the eyelid, analyzed using gene expression profiling". Oncol Lett. 16 (5): 6729–6734. doi:10.3892/ol.2018.9484. PMC 6202553. PMID 30405815.
  4. Cameron, Michael C.; Lee, Erica; Hibler, Brian P.; Barker, Christopher A.; Mori, Shoko; Cordova, Miguel; Nehal, Kishwer S.; Rossi, Anthony M. (2019). "Basal cell carcinoma". Journal of the American Academy of Dermatology. 80 (2): 303–317. doi:10.1016/j.jaad.2018.03.060. ISSN 0190-9622.
  5. Sehgal VN, Chatterjee K, Pandhi D, Khurana A (2014). "Basal cell carcinoma: pathophysiology". Skinmed. 12 (3): 176–81. PMID 25134314.


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