Basal Cell Carcinoma

Question 1

What is Basal Cell Carcinoma?

Answer 1

• A slow-growing locally invasive malignant tumour of the epidermal keratinocytes
• Most common malignant skin tumour

Question 2

What are some of the Risk Factors for BCC?

Answer 2

• UV exposure
• Frequent repeated sunburn in childhood
• Fitzpatrick Skin Type 1 ( always burns and never tans)
• Increasing Age and Male
• Previous History of Cancer
• Immunosuppression
• Genetic Predisposition
• Gorlin-Goltz Syndrome

Question 3

What are the Different Types of BCC?

Answer 3

• Nodular (most common)
• Superficial (slightly scaly, irregular plaque, thin + translucent rolled border)
• Cystic
• Morphoeic (waxy, scar-like plaque with indistinct borders, infiltrate cutaneous nerves)
• Keratotic
• Pigmented

Question 4

What are the classical features of BCC?

Answer 4

• T (Telengiectasia)
• U (Ulceration)
• R ( Rolled Edges)
• P ( Pearly Edges)

Question 5

What is Gorlin- Goltz Syndrome?

Answer 5

• Nevoid Basal Cell Carcinoma Syndrome
• A genetic condition which greatly increases the risk of developing BCC’s
• Rare Autosomal Dominant Condition: PTCH1 gene mutation

Question 6

What are other clinical features of Gorlin-Goltz Syndrome?

Answer 6

• Broad Nasal Root
• Hypertolerism (wide-spaced eyes)
• Bifid Ribs
• Odontogenic Keratocysts
• Palmar and Plantar Pits in the hands
• Calcification of the Faux Celebri

Question 7

How would you describe the presentation of a Nodular BCC?:

Answer 7

• Red/ Flesh-coloured/ well defined borders with overlying telangiectasias

Question 8

How would you describe Superficial BCC?

Answer 8

• Erythematous plaque, dry/ crusted or a slight bluish tinge

Question 9

How would you describe Morphoeic BCC?

Answer 9

• Scar-like lesion or identation, commonly occur on the upper trunk or face
• whitish, compact, poorly-defined plaque or scar
• Deeply invasive

Question 10

How would you describe a Pigmented BCC ?

Answer 10

• Difficult to distinguish from Melanoma

Question 11

What is the Management for a BCC?

Answer 11

• Surgical and Non-Surgical

Question 12

What is the Surgical Treatment for BCC?

Answer 12

• Surgical Excision - Treatment of choice as it allows histological examination of the tumour and margins OR wide-local excision
• Moh’s Micrographic Surgery ( excision of the lesion and tissue borders are progressively excised until specimens are microscopically free of tumour - high risk recurrent tumours)

Question 13

What is the non-surgical treatment for BCC?

Answer 13

• Topical Immunotherapy (Imiquimod) - immune response modifier, applied 3/5 each week for 6/16 week
• 5- Fluorouracil - topical agent, twice daily for 6/12 weeks
• Radiotherapy
• Cryotherapy
• Curettage
• Cautery
• Photodynamic Therapy

Question 14

How can you differentiate between a High Risk and Low Risk lesion?

Answer 14

• Size >2cm
• Site (around eyes, nose, lips and ears)
• Poorly-defined margins
• Histological sub-type
• Histological features
• Previous treatment failure
• Immunosuppression

Question 15

What are the Surgical Excision Margins for a Low-risk lesion?

Answer 15

• small <2 cm = 4/5mm margins

Question 16

What are the Surgical Excision Margins for a High-risk lesion?

Answer 16

• 5mm margin

Question 17

What are the Surgical Excision Margins for Recurrent Lesions?

Answer 17

• 5 - 10mm margins
• Moh’s Surgery +/- Radiotherapy

Question 18

How can a BCC be prevented?

Answer 18

• Stay indoors / in the shade
• Wear covering clothing
• Apply high protection factor SPF50+
• Avoid indoor tanning (sun beds, solaria)

Question 19

Why is Moh’s Micrographic Surgery particularly useful?

Answer 19

• 1. Recurring or incompletely removed BCC
• 2. Areas where it would be cosmetically better to remove as little skin as possible
• 3. Sites of previous surgery or radiotherapy