Comprehensive physician-reviewed information about basal cell carcinoma, including warning sign photos, treatment options, symptoms, and risk factors. Skin nonmelanocytic tumors – Basal cell carcinoma (BCC) Nodular: Large tumor nodules in the dermis; Generally circumscribed. Superficial. Different variants as nodular, cystic, micronodular, superficial, pigment BCC are Nodular basal cell carcinoma comprises about % of the cases and.
|Published (Last):||15 March 2014|
|PDF File Size:||19.12 Mb|
|ePub File Size:||8.81 Mb|
|Price:||Free* [*Free Regsitration Required]|
Basal cell carcinoma BCC is the most common paraneoplastic disease among human neoplasms. The tumor affects mainly photoexposed areas, most often in the head and seldom appears on genitalia and perigenital region. BCC progresses slowly and metastases are found in less than 0.
Different variants as nodular, cystic, micronodular, superficial, pigment BCC are described in literature and the differential diagnosis in some cases could be difficult. Numerous therapeutic methods established for treatment of BCC, having their advantages or disadvantages, do not absolutely dissolve the risk of relapses. The early diagnostics based on the good knowledge and timely organized and adequate treatment is a precondition for better prognosis.
Despite the slow progress and numerous therapeutic methods, the basal cell carcinoma should not darcinoma underestimated. The high incidence of disease determines the big medical and social importance of this type of carcinomas.
Clinical variants, stages, and management of basal cell carcinoma
The high doses of UV light induct free oxygen radicals, which combined with the reduced antioxidant protection system result in different degeneration processes inclusive carcinogenesis.
The UV rays induct production of pyramidine dimers and loss of heterozygosity of both tumor suppressive protective genes-TP53 and PTCH, resulting in BCC as a sequence of microsatellite instability in selected tetra nucleotide combinations of the coding genes.
The genetic analysis of patients, not only with sporadic BCC, but also with autozome dominant Nevoid basal cell syndrome found mutations in PTCH1 gene located in 9q The tumor-suppressive gene P53 and melanocortin-1 reception gene[ 6 ] are also important for the development of neoplastic process. Besides ultraviolet radiation there are other exogenous carcinogens such as exposure to the ionizing radiation, arsenic,[ 7 ] industrial chemical substances such as vinyl chloride,[ 8 ] polycyclic aromatic hydrocarbonates,[ 9 ] as well as alkalizing agents.
The role of the immune system suppression in the pathogenesis of skin carcinomas is also suspected since the incidence of BCC increased among immune suppressed patients and the lesions affect mainly the photo nonexposed skin of the body and the upper limbs. Clinically it is presented by elevated, exophytic pearl-shaped nodules with telangiectasie on the surface and periphery [ Figure 1 ]. Subsequently, nodular BCC can extend into ulcerative or cystic pattern.
The endophytic nodules are presented clinically as flat enduring plaques. The hemorrhagic lesions can resemble hemangioma or melanoma, especially if are pigmented. The lesions with big sizes and the central necrosis are defined as ulcus rodens.
Histology revel nest-like infiltration from basaloid cells. Differential diagnosis can be made by traumatically changed dermal nevus and amelanotic melanoma.
Nodular basal cell carcinoma. One or more cystic nodes with different sizes located peripherally to the centrally placed tumor nests. The nests and clusters of tumor cells are surrounded by thick fibrotic stroma.
Clinically, it is presented basoeclular infiltrated plaque with slightly shining surface and not well-defined borders. Immunochemistry shows expression of smooth muscle alpha-actin in tumor stroma.
This version of basal cell carcinoma is presented as thin bundles of basaloid cells with nest-like configuration located between the collagenous fibers on the dermis and infiltrating in the depth. Clinically, it is a whitish, compact, not-well defined plaque [ Figure 3 ].
The most common localization is in the upper part of the trunk or the face. Seldom had the paresthesia or hyperesthesia as a symbol of perineural infiltration appeared, especially when the tumor is localized on face. This clinical version is often underestimated when the borders of surgical excision are estimated. Histologically this variant is presented as thin, nest-like bundles of basaloid cells infiltrating in the dermal collagenous fibers [ Figure 4 ]. Infiltrated lesion with irregular outlines and size in the forehead area of a 76 years old man.
Infiltrated basal cell carcinoma. Clinically found elevated or flat infiltrated tumors. Nodulra ulcerate seldom and have yellow-whitish color when they are flat, ostensibly clear outlines and thick at palpation. The most common localization is the skin of the back. On histology this tumor demonstrates small rounded nodules of basaloid cells and minimal palisading [ Figure 5 ].
Micronodular basal cell carcinoma. This version occurs as erythematous plaque with different sizes from several millimeters to more than 10 cm. There is an erythematous squamous plaque with clear borders, pearl-shape edge, superficial erosion, without tendencies for invasive growth [ Figure 6 ].
The regression areas are presented as pale sections with fibrosis. The differential diagnosis includes Bowen disease, psoriasis, or eczema. The numerous superficial BCC are basoceluular often in case of arsenic exposure. Histology showed nests of basaloid cells located subepidermally, with clear connection with the basal layer of the epidermis and no infiltration of tumor cells in the reticular dermis [ Crcinoma 7 ].
Superficial basal cell carcinoma. The pigmentation can be found in different clinical versions of basal cell carcinoma including nodular, micronodular, multifocal and superficial BCC, and the color varies from dark brown to black [ Figure 8 ]. Histology showed nests of basaloid cells, abundance of melanin and melanophages, and moderate inflammatory infiltrate.
The melanocytes are located among tumor nests, while the melanophages are present in the stroma. The differential diagnosis has to be made with malignant melanoma. An irregular, periphery spreading erosive pigmented plaque on head of a 78 years old woman.
These tumors usually originate as elevated pink or erythematous nodules that can resemble seborrheic keratoses or acrochordon. The lesions are solitary, seldom numerous, the most common location is on the skin of the back and affect especially women. Histology is typical carcioma Figure 9 ].
The radiotherapy is considered a prepossessing factor for tumor formation. The differential diagnosis includes actinic keratosis, keratoacanthoma, seborrheic keratosis, squamous cell carcinoma, etc. TNM classification of basal cell carcinoma[ 10 ].
Patients with a primary cutaneous BCC or other cutaneous carcinoma with or without the clinical, radiological, or pathological evidence of regional or distant metastases are divided into the following stages:. Any tumor size, one involved lymph node measuring 3 cm or less in size or tumor extension into the maxilla, mandible, orbit, or temporal bone.
Patients with tumor with direct or perineural invasion of skull nodulsr or those with two or more involved lymph nodes or multiple and distant metastases.
Basal Cell Carcinoma (BCC) –
It is the first line therapeutic method. The excision performs with mm margins outside the tumor, depending on the size and localization of the carcinoma. The microscope-controlled surgery consists of intraoperative of the wound edges for presence of tumor cells. The aim is to spare the tissues and to have small percentage of local relapses.
It is applied in primary BCCs with localization requiring maximal sparing of tissues nose, lips, eyelidsor with high risk of relapse nose, lips, temporal bones, mucous membranes, penis.
Tumors with diameter above 2 cm as well as tumors with unclear borders or with aggressive histological signs infiltrative, morphologic, perineural infiltrating are highly indicated for microscope-controlled surgery.
Imágenes clínicas de tipos de carcinoma basocelular
Quick and easy applicable methods for treatment of tumors with diameter sizes from 2 basocelulag 5 cm. This method is appliable in small-sized and well-defined BCC with clear borders and mainly when the patients have contraindications for surgical excision. As an easy, simple, and no time-consuming method, cryotherapy has certain advantages over surgical techniques in cases with multiple BCC tumors.
Specific contraindications are localizations in naso-labial fold, ala nasitragus, eyelid edge. As well as sugary is one of the initial historically method for BCC treatment.
We used fractional superficial X-ray therapy with total dose of Gy with excellent therapeutic result and relapse rate of 6. The contraindications of superficial X-ray therapy include Basal cell nevus syndrome, Bazex syndrome, Xeroderma pigmentosum, Epidermodysplasia verruciformissince the ionizing radiation can lead to carcinomw tumors in the area of radiation.
It is suitable for treatment of superficial BCC. According to recent data the recurrence rate after ablative laser therapy varies between 3. This method is based on the chemical destruction bssocelular the tumor. It basoceluoar limited use in nodular-ulcerative and superficial BCC, but there is a high degree of relapses because of underestimating of the lesion depth.
It is not applied in the area of the eyes, nose, lips, and cochlea. Photodynamic therapy is a relatively new method in which the tumor photosensitizes with methyl-aminolevulinate and irradiates with red light with wavelength of approximately nm[ 21 ] for treatment of basoceljlar or numerous superficial or morpheiform BCC. Despite the slow progress and numerous therapeutic methods, the BCC should not be underestimated.
Numerous methods of treatment do not absolutely dissolve the risk of relapses and if the case is neglected, let without further control or received no adequate basocdlular, BCC may destroys the underlying tissues and spread metastases. National Center for Biotechnology InformationU. Indian Dermatol Online J. DourmishevDarena Rusinova1 and Ivan Botev.
Author information Copyright and License information Disclaimer. Georgi Sofiiski Str, Sofia, Bulgaria.
This is an open-access carcijoma distributed under the basocelupar of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Basal cell carcinoma BCC is the most common paraneoplastic disease among human neoplasms.
Basal cell carcinoma, clinical variants, stages, treatment. Open in a separate window. Nodular basal cell carcinoma at the left zygomatic area in an 86 years old woman. Cystic BCC One or more cystic nodes with different sizes located peripherally to the centrally placed tumor nests. Sclerodermiform Morpheiform BCC The nests and clusters of tumor cells are surrounded by thick fibrotic stroma. Infiltrated basal cell carcinoma This version of basal cell carcinoma is presented as thin bundles of basaloid cells with nest-like configuration located between the collagenous fibers on the dermis and infiltrating in the depth.
Carcjnoma basal cell carcinoma Clinically found elevated or flat infiltrated tumors.
Superficial basal cell carcinoma This version occurs as erythematous plaque with different sizes from several millimeters to more than 10 cm. Erythematous squamous plaque in abdominal area of a 74 years old man. Pigment basal cell carcinoma The pigmentation can be found in different clinical basocleular of basal cell carcinoma including nodular, micronodular, multifocal and superficial BCC, and the color varies from dark brown to black [ Figure 8 ].