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Basal cell carcinoma natural history

2015-08-05T18:51:22Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Basal cell carcinoma is slow-growing and locally invasive. Common complications of BCC commonly include reccurrence and development of other types of skin cancer. Prognosis is usually excellent, but the tumor is usually locally invasive and may be destructive.

==Natural History==
*Patients with basal cell carcinoma are often asymptomatic
*Basal cell carcinoma is slow-growing and locally invasive
*The overall risk of [[metastases]] is estimated to be less than 0.1%
*The risk of invasion and recurrence is based on size, duration, location and subtype (sclerodermiform/morpheaform and micronodular clinical variants have a higher risk)
*Even without a recurrence, a personal history of basal cell carcinoma increases the risk of developing all types of skin cancers

==Complications==
Complications of basal cell carcinoma are the following:
*Reccurrence
*Development of other types of skin cancer
*[[Metastasis]]
*Jaw [[cysts]] (90% by 40 years)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Ovarian]] [[calcification]] or [[fibroma]] (24%)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Medulloblastoma]] (5%)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Cardiac [[fibroma]] (3%)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Cleft palate]] (5%)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Ophthalmic complications, such as squint or [[cataracts]] (26%)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>

==Prognosis==
*Prognosis of basal cell carcinoma is usually excellent.
*Although basal cell carcinoma rarely [[metastasis|metastasizes]], it grows locally with invasion and destruction of local tissues, without stopping
*The cancer can impinge on vital structures and result in loss of extension or loss of function or rarely death
*The vast majority of cases can be successfully treated before serious complications occur

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Lung cancer staging

2015-08-05T18:32:59Z

Saarah Alkhairy:

{{Lung cancer}}

{{CMG}}; '''Associate Editor(s)-In-Chief:''' Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, {{CZ}}; {{Rim}}; '''Assistant Editor(s)-In-Chief:''' [[User:Michael Maddaleni|Michael Maddaleni, B.S.]]

==Overview==
Lung [[cancer staging]] is an assessment of the degree of spread of the cancer from its original source. It is an important factor affecting the [[prognosis]] and potential treatment of lung cancer. Non-small cell lung carcinoma is staged from IA ("one A", best prognosis) to IV ("four", worst prognosis)<ref>{{cite book | last =Mountain | first =CF | authorlink = | coauthors =Libshitz HI, Hermes KE | title =A Handbook for Staging, Imaging, and Lymph Node Classification | publisher =Charles P Young Company | date =2003 | url =http://www.ctsnet.org/book/mountain/index.html | accessdate =2007-09-01 }}</ref>. [[Small cell lung carcinoma]] is classified as limited ''stage'' and ''extensive stage''<ref name="Collins">{{cite journal | last = Collins | first = LG | coauthors = Haines C, Perkel R, Enck RE | title = Lung cancer: diagnosis and management | journal = American Family Physician | volume = 75 | issue = 1 | pages = 56–63 | publisher = American Academy of Family Physicians | date = Jan 2007 | url= http://www.aafp.org/afp/20070101/56.html | pmid =17225705 | accessdate =2007-08-10 }}</ref>.

==TNM Classification of Lung Cancer==
===T: Primary Tumor===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description'''
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |TX || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Primary tumor cannot be assessed. OR Tumor is demonstrated by the presence of malignant cells in bronchial washings or [[sputum]], but is not visualized by imaging or [[bronchoscopy]].
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | T0 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is no evidence of primary tumor.
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Tis ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Carcinoma in situ
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T1 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor has the following characteristics: The greatest dimension is <3 cm AND The tumor is surrounded by lung or [[visceral pleura]] AND The tumor does not extend to the main bronchus as demonstrated by the absence of bronchoscopic evidence of invasion more proximal than the lobar bronchus.
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T2 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor has the following characteristics: 
The greatest dimension is >3cm
 OR 
The tumor involves the main bronchus, 2 cm or more distal to the [[carina]].
 OR 
The tumor invades the [[visceral pleura]].
 OR 
There is evidence of [[atelectasis]] or obstructive [[pneumonitis]] that extends to the hilar region without the involvement of the entire lung.
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T3 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor is of any size AND it directly invades any of the following: [[chest wall]] (including superior sulcus tumors), [[diaphragm]], mediastinal pleura, parietal [[pericardium]].
 OR The tumor is localized in the main bronchus at a distance less than 2 cm distal to the [[carina]] but without the involvement of the [[carina]].
 OR There is evidence of associated [[atelectasis]] or obstructive [[pneumonitis]] of the entire lung.
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T4 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor is of any size that invades any of the following: [[mediastinum]], [[heart]], great vessels, [[trachea]], [[esophagus]], [[vertebral body]], [[carina]] OR There is/are separate tumor nodule(s) in the same lobe. OR 
The tumor is associated with malignant [[pleural effusion]].
|}

===N:Regional Lymph Nodes===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |NX ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |the regional [[lymph node]]s cannot be assessed.
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N0 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is no evidence of regional lymph node metastasis.
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N1 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is [[metastasis]] in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension.
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N2 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is [[metastasis]] in ipsilateral mediastinal and/or subcarinal lymph node(s).
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N3 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is [[metastasis]] in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s).
|}

===M: Distant Metastasis===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description'''
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |MX ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Distant metastasis cannot be assessed.
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is no evidence of distant [[metastasis]].
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M1 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is evidence of [[distant]] metastasis which includes the presence of separate tumor nodule(s) in a different lobe (ipsilateral or contralateral).
|}

==Classification of Lung Cancer by Staging==
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Stage'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''N'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''M'''
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Occult carcinoma''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |TX|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N0|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage 0''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Tis ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IA''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IB''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N0 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IIA''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left rowspan="2"|'''Stage IIB''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N1 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left rowspan="2" |'''Stage IIIA''' ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T1, T2|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N2 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T3|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N1, N2 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left rowspan="2"|'''Stage IIIB''' ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Any T|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N3 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T4 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Any N ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IV'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Any T ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Any N ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M1
|}

==Procedures==
There are currently multiple different procedures available to stage lung cancer. They can be broken down into two over-arching categories, [[invasive]] and minimally invasive.

The invasive procedures are:

* [[EUS-NA]] ([[esophageal]] [[endoscopic]] [[ultrasound]] with needle [[aspiration]])
* [[TBNA]] ([[transbronchial needle aspiration]])
* [[EBUS-NA]] ([[endobronchial ultrasound with needle aspiration]])
* [[TTNA]] ([[transthoracic needle aspiration]])
* [[VATS staging]] (video assisted [[thoracic]] surgery) ''aka'' [[thoracoscopy]]
* Extended cervical mediastinoscopy
* [[Chamberlain procedure]]

The minimally invasive procedures are:

* EBUS-FNA (endobronchial ultrasound guided fine needle aspiration)
* EUS-FNA (esophogeal endoscopic ultrasound guided fine needle aspiration)

==References==
{{reflist|2}}

{{Tumors}}

[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Types of cancer]]
[[Category:Lung cancer]]
[[Category:Oncology]]

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Lung cancer screening

2015-08-05T18:29:57Z

Saarah Alkhairy:

__NOTOC__
{{Lung cancer}}

{{CMG}}

==Overview==
Lung cancer screening is a strategy used to identify early [[lung cancer]] in people, before they develop symptoms. [[Screening (medicine)|Screening]] refers to the use of medical tests to detect disease in asymptomatic people. Screening studies for lung cancer have only been done in high risk populations, such as smokers and workers with occupational exposure to certain substances. This is because radiation exposure from screening could actually induce carcinogenesis|cancer formation in a small percentage of screened subjects, so this risk should be mitigated by a (relatively) high prevalence of lung cancer in the population being screened. A pulmonary nodule larger than 5 to 6 mm is considered a positive result for screening with [[x-ray]] or [[computed tomography]].<ref name="pmid23420233">{{cite journal| author=Henschke CI, Yip R, Yankelevitz DF, Smith JP, International Early Lung Cancer Action Program Investigators*| title=Definition of a positive test result in computed tomography screening for lung cancer: a cohort study. | journal=Ann Intern Med | year= 2013 | volume= 158 | issue= 4 | pages= 246-52 | pmid=23420233 | doi=10.7326/0003-4819-158-4-201302190-00004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23420233 }} </ref>

==Practice Guidelines==
* In 2013, a clinical practice guideline by the U.S. Preventive Services Task Force ([[USPSTF]]) recommended screening for lung cancer among smokers and former smokers who are between 55 to 80 years old and who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).<ref name="www.uspreventiveservicestaskforce.org">{{Cite web | last = | first = | title = http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm | url = http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm | publisher = | date = | accessdate = 31 December 2013 }}</ref>

* [[Clinical practice guideline]]s issued by the [[American College of Chest Physicians]] in 2013 recommend<ref name="pmid23649455">{{cite journal| author=Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB| title=Screening for Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2013 | volume= 143 | issue= 5 Suppl | pages= e78S-92S | pmid=23649455 | doi=10.1378/chest.12-2350 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23649455 }} [http://general-medicine.jwatch.org/cgi/content/full/2013/522/2 Summary in JournalWatch]</ref>:
:"For smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years, we suggest that annual screening with LDCT should be offered in settings that can deliver the comprehensive care provided to NLST participants."

* In 2007, a [[clinical practice guideline]] by [[American College of Chest Physicians]] recommended not to screen for lung cancer.<ref name="pmid17873156">{{cite journal |author=Alberts WM |title=Diagnosis and Management of Lung Cancer Executive Summary: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) |journal= |volume=132 |issue=3_suppl |pages=1S–19S |year=2007 |pmid=17873156 |doi=10.1378/chest.07-1860}}</ref>

* In 2004, a clinical practice guideline by the [http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force (USPSTF)] gave a [http://www.ahrq.gov/clinic/3rduspstf/ratings.htm grade I recommendation] indicating that "the evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer".<ref name="pmid15126258">{{cite journal |author=U.S. Preventive Services Task Force |title=Lung cancer screening: recommendation statement |journal=Ann. Intern. Med. |volume=140 |issue=9 |pages=738-9 |year=2004 |pmid=15126258 |doi=|url=http://www.annals.org/cgi/content/full/140/9/738}}</ref><ref name="pmid15126259">{{cite journal |author=Humphrey LL, Teutsch S, Johnson M |title=Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography: an update for the U.S. Preventive Services Task Force |journal=Ann. Intern. Med. |volume=140 |issue=9 |pages=740-53 |year=2004 |pmid=15126259 |doi=|url=http://www.annals.org/cgi/content/full/140/9/740}}</ref>

==Studies of efficacy==
Regular chest radiography and sputum examination programs were not effective in reducing mortality from lung cancer.<ref name="pmid14973979">{{cite journal |author=Manser RL, Irving LB, Stone C, Byrnes G, Abramson M, Campbell D |title=Screening for lung cancer |journal=Cochrane database of systematic reviews (Online) |volume= |issue=1 |pages=CD001991 |year=2004 |pmid=14973979 |doi=10.1002/14651858.CD001991.pub2}}</ref> Earlier studies (Mayo Lung Project and Czechoslovakia lung cancer screening study, combining over 17,000 smokers) showed earlier detection of lung cancer was possible but mortality was not improved. Simply detecting a tumor at an earlier stage may not necessarily yield improved mortality. For example, plain radiography resulted in increased time from diagnosis of cancer until death and those cancers being detected by screening tended to be earlier stages. However, these patients continued to die at the same rate as those who are not screened. At present, no professional or specialty organization advocates screening for lung cancer outside of clinical trials.

A computed tomography (CT) scan can uncover tumors not yet visible on an X-ray. CT scanning is now being actively evaluated as a screening tool for lung cancer in high risk patients, and it is showing promising results. The USA-based National Cancer Institute is currently completing a randomized trial comparing CT scans with chest radiographs. Several single-institution trials are ongoing around the world.

The International Early Lung Cancer Action Project is a cohort study 31,000 high-risk patients that found benefit from screening.<ref name="pmid17065637">{{cite journal |author=Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS |title=Survival of patients with stage I lung cancer detected on CT screening |journal=N. Engl. J. Med. |volume=355 |issue=17 |pages=1763-71 |year=2006 |pmid=17065637 |doi=10.1056/NEJMoa060476}}</ref> In this study 85% of the 484 detected lung cancers were stage I and thus highly treatable. Mathematically these stage I patients would have an expected 10-year survival of 88%. However, there was no randomization of patients (all received CT scans and there was no comparison group receiving only x-rays) and the patients were not actually followed out to 10 years post detection (the median followup was 40 months).

A cohort of 3,200 current or former smokers found no benefit. These patients were screened for 4 years and offered 3 or 4 CT scans. Lung cancer diagnoses were 3 times as high, and surgeries were 10 times as high, as predicted by a model, but there were no significant differences between observed and expected numbers of advanced cancers or deaths.<ref name="pmid17341709">{{cite journal |author=Bach PB, Jett JR, Pastorino U, Tockman MS, Swensen SJ, Begg CB |title=Computed tomography screening and lung cancer outcomes |journal=JAMA |volume=297 |issue=9 |pages=953-61 |year=2007 |pmid=17341709 |doi=10.1001/jama.297.9.953}}</ref>

Subsequent [[randomized controlled trial]]s have been performed or are in progress<ref name="pmid15603850">{{cite journal |author=Gohagan JK, Marcus PM, Fagerstrom RM, ''et al'' |title=Final results of the Lung Screening Study, a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer |journal=Lung Cancer |volume=47 |issue=1 |pages=9-15 |year=2005 |pmid=15603850 |doi=10.1016/j.lungcan.2004.06.007}}</ref>.
* The National Lung Screening Trial (NLST) reported reduction advanced-stage cancers diagnosed.<ref name="pmid24004119">{{cite journal| author=Aberle DR, DeMello S, Berg CD, Black WC, Brewer B, Church TR et al.| title=Results of the two incidence screenings in the National Lung Screening Trial. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 10 | pages= 920-31 | pmid=24004119 | doi=10.1056/NEJMoa1208962 | pmc=PMC4307922 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24004119 }} </ref>
* The DANTE trial has been inconclusive.<ref name="pmid25760561">{{cite journal| author=Infante M, Cavuto S, Lutman FR, Passera E, Chiarenza M, Chiesa G et al.| title=Long-Term Follow-up Results of the DANTE Trial, a Randomized Study of Lung Cancer Screening with Spiral Computed Tomography. | journal=Am J Respir Crit Care Med | year= 2015 | volume= 191 | issue= 10 | pages= 1166-75 | pmid=25760561 | doi=10.1164/rccm.201408-1475OC | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25760561 }} </ref>

==Screening for Lung Cancer U.S. Preventive Services Task Force Recommendation Statement 2013 (DO NOT EDIT)<ref name="www.uspreventiveservicestaskforce.org">{{Cite web | last = | first = | title = http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm | url = http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm | publisher = | date = | accessdate = 31 December 2013 }}</ref>==
{|class="wikitable"
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' The USPSTF recommends annual screening for lung cancer with low-dose [[CT|computed tomography]] (LDCT) in adults aged 55 to 80 years who have a 30 pack-year [[smoking]] history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. ''([[USPSTF guidelines classification scheme#Evidence Quality Rating|Grade B]])''<nowiki>"</nowiki>
|-
|}

== References ==
{{Reflist|2}}
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Pulmonology]]
[[Category:Lung cancer]]
[[Category:Oncology]]

{{WH}}
{{WS}}

Lung cancer differential diagnosis

2015-08-05T18:26:46Z

Saarah Alkhairy:

__NOTOC__
{{Lung cancer}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Lung cancer must be differentiated from other diseases that cause [[hemoptysis]], [[cough]], [[dyspnea]], [[wheeze]], [[chest pain]], [[dysphonia]], [[dysphagia]], unexplained weight loss, unexplained loss of appetite, and [[fatigue]] such as pneumonia, bronchitis, metastatic cancer from a non-thoracic primary site, infectious granuloma, pulmonary tuberculosis, tracheal tumors, and a thyroid mass.

==Lung Cancer Differential Diagnosis==
The table below summarizes the findings that differentiate lung cancer from the most common other conditions that cause [[hemoptysis]], [[cough]], [[dyspnea]], [[wheeze]], [[chest pain]], [[dysphonia]], [[dysphagia]], unexplained weight loss, unexplained loss of appetite, and [[fatigue]]<ref>{{Small cell lung cancer [Internet]. BMJ Publishing Group Limited 2015 [updated 2014 Oct 29]. Available from: http://bestpractice.bmj.com/best-practice/monograph/1081/diagnosis/differential.html}}</ref>.
{| {{table}}

| align="center" style="background:#f0f0f0;"|'''Condition/disease'''

| align="center" style="background:#f0f0f0;"|'''Signs/symptoms'''

| align="center" style="background:#f0f0f0;"|'''Tests'''

|-

| '''Pneumonia/bronchitis'''||Typical symptoms include [[fever]], cough, [[dyspnea]], and chest pain; recurrent pneumonia or bronchitis in a smoker or former smoker should raise the suspicion of lung cancer||'''CXR''' is the first test performed; '''[[CT]] imaging''' can be helpful to evaluate pulmonary masses that might not be well visualised with chest x-ray; '''bronchoscopy''' can also be used to assess for endobronchial lesions or to biopsy suspicious pulmonary masses

|-

| '''Carcinoid tumor'''||Often asymptomatic with normal physical examination; may cause cough, dyspnea, [[hemoptysis]], unilateral wheezing, or post-obstructive pneumonia if the tumor is endobronchial or compressing the central bronchi ||'''CT chest:''' 80% of carcinoid tumors appear as an endobronchial nodule and 20% as a parenchymal nodule, with smooth, rounded borders and is highly vascularized; '''flexible [[bronchoscopy]]''' shows raised, pink, vascular, lobulated lesions; '''endobronchial forceps biopsy''' is usually required for pathology to be diagnostic; bronchial brushings, sputum specimens, and lavage fluid rarely provide sufficient tissue for a conclusive diagnosis

|-

| '''Metastatic cancer from a non-thoracic primary site'''||Signs and symptoms depend on the location of the primary tumor and distant disease and may include pain, weight loss, malaise, cough, dyspnea, clubbing, or focal wheezing; physical findings may be present depending on the location and extent of the disease||'''CT chest''' shows one or multiple nodules of variable sizes from diffuse micronodular opacities (miliary) to well-defined masses, lesions are often irregular and in the periphery of the lower lung zones; '''CT/MRI head, CT abdomen and pelvis:''' extrapulmonary cancers that commonly [[metastasis]] to the lung include melanoma, [[thyroid]] carcinoma, esophageal cancer; ovarian cancer; sarcomas; and adenocarcinomas of the colon, breast, kidney, and testis; '''PET-FDG scan''' shows increased uptake in both primary and distant sites, certain metastatic lesions, such as renal cell carcinoma, have a lower probability of 18-fluorodeoxyglucose (FDG) uptake; '''CT-guided transthoracic needle aspiration (TTNA)''' can reveal characteristic malignant cells, pneumothorax complicates 20% to 30% of TTNA procedures, the choice between bronchoscopy and TTNA is based on lesion size, location, risks, and local expertise; '''biopsy during flexible bronchoscopy and biopsy''' may show characteristic malignant cells, bronchoscopy has a 100% yield for endobronchial lesions (which are extremely rare in metastatic deposits from other primary tumors)

|-

| '''Infectious granuloma'''||History may include travel to endemic areas, pet/animal exposures, and specific leisure activities (e.g., caving); may feature cough, dyspnea, hemoptysis, weight loss, fever, joint aches, skin lesions, and night sweats, or no symptoms; many possible causes: ''[[Histoplasma capsulatum]]'', ''[[Mycobacterium tuberculosis]]'', ''[[Coccidioides immitis]]'', ''[[Cryptococcus neoformans]]'', ''[[Aspergillus]]'', ''[[Pseudallescheria boydii]]'', ''Fusarium'' species, [[zygomycetes]], and others; non-specific skin findings may be seen in [[atypical mycobacteria]] and [[cryptococcosis]]; [[lymphadenopathy]] may be present with active disease||'''CT-guided TTNA''' can be used for diagnostic sampling, pneumothorax complicates 20% to 30% of TTNA procedures, the choice between bronchoscopy and TTNA is based on lesion size, location, risks, and local expertise; '''CT chest''' typically shows lesions <2 cm diameter and round with smooth borders, old granulomatous disease may feature central, laminated, or diffuse calcification pattern, mediastinal lymphadenopathy without calcifications is sometimes present, nodules from angioinvasive fungi (e.g., Aspergillus, Pseudallescheria boydii, Fusarium species, and zygomycetes) may demonstrate the "halo sign" (ground-glass opacity surrounding the nodule), occasionally, calcifications can be seen in the spleen or liver; '''fungal serologies:''' positive during active infection; '''flexible bronchoscopy and biopsy''' can sometimes provide sample for identification and culture and sensitivity of organism; '''PET:''' usually negative (<2.5 standardised uptake values), may be positive in active infectious processes

|-

| '''Sarcoidosis'''||Cough, dyspnea, [[fatigue]] weight loss, fever, night sweats, rash, eye pain, [[photophobia]] blurred vision, and red eye; pulmonary examination is usually unrevealing; can affect any organ, so physical findings depend on specific organs affected; skin lesions including maculopapular eruptions, subcutaneous nodular lesions, and red-purple skin lesions||'''CT chest:''' mediastinal adenopathy often present with sarcoid. Sarcoid nodules have predilection for upper zones, although can be located throughout the lung; '''flexible bronchoscopy and biopsy''' can demonstrate presence of non-caseating granulomas; '''CT-guided TTNA''' can provide access to material from some lesions inaccessible to flexible bronchoscopy; '''laboratory markers:''' ACE elevation may be seen in sarcoidosis but is non-specific

|-

| '''Rheumatoid arthritis'''||Arthralgias, pain, skin nodules, [[pleural effusions]], [[pleuritis]], joint pain, and deformity||'''CT chest''' typically shows lung nodule 3 mm to 7 cm, predominantly in peripheral upper and mid-lung zones, may show cavitation; '''flexible bronchoscopy and biopsy''' shows rheumatoid necrobiotic nodule, necrobiotic nodules demonstrate a central zone of eosinophilic fibrinoid necrosis surrounded by palisading fibroblasts, the nodule often centered on necrotic inflamed blood vessels; '''laboratory markers:''' patients with lung nodules due to rheumatoid arthritis frequently have high levels of rheumatoid factor, although seronegative cases have been reported

|-

| '''Wegener's granulomatosis'''||Cough, chest pain, dyspnea, hemoptysis, rhinorrhoea, epistaxis, ear/sinus pain, hoarseness, [[fever]], fatigue, anorexia, weight loss, palpable purpura, painful ulcers, uveitis, upper airway [[inflammation]], and sinus pain||'''CT chest shows''' solitary or multiple lung nodules, airways are frequently affected; '''Flexible bronchoscopy or CT-guided TTNA''' may show necrotising granulomatous inflammation; '''laboratory markers:''' anti-neutrophil cytoplasmic antibody (ANCA), ANCA testing results depend on the extent and severity of the disease

|-

| '''Arteriovenous malformation'''||Dyspnea is uncommon, may cause [[hemoptysis]], pulmonary [[bruit]], arteriovenous communications, or hemorrhagic [[telangiectasia]] in the skin, mucous membranes, and other organs, cyanosis and finger clubbing may be present, eurological symptoms from cerebral aneurysms, cerebral emboli||'''CT chest''' shows round or oval nodule(s) with feeding artery and draining vein often identified, most common in lower lobes, multiple lesions in 30% of cases, usually round or oval, ranging from 1 cm to several cm in diameter; '''pulmonary angiography''' confirms presence and location of AVMs, identifies feeding arterial and venous structures, in cases of significant hemoptysis, pulmonary angiogram is combined with bronchial artery embolisation; '''ABG analysis''' may show decreased pO2 and decreased oxygen saturation when AV flow is severe., in cases of severe systemic AVMs, chronic hypoxemia may cause polycythemia

|-

| '''Amyloidosis'''||Weight loss, [[paresthesias]], dyspnea, and fatigue are the most common symptoms associated with amyloidosis and are common to all systemic forms; weight loss of >9 kg is common; small vessel involvement can cause jaw or limb claudication, and rarely [[angina]]; amyloid purpura is present in about 1 in 6 patients, typically peri-orbital; eyelid petechiae are common; hepatomegaly >5 cm below the right costal margin is seen in 10% of patients and splenomegaly is usually of modest degree||'''CT chest''' shows lung involvement characterised by focal pulmonary nodules, tracheobronchial lesions, or diffuse alveolar deposits; '''serum immunofixation''' shows presence of monoclonal protein; urine immunofixation shows presence of monoclonal protein; '''immunoglobulin free light chain assay''' shows abnormal kappa to lambda ratio

|-

| '''Bronchiolitis obliterans organizing pneumonia (BOOP)'''||Normally presents as a flu-like illness followed by a second illness lasting 1 to 4 months, with low-grade fever, non-productive cough, malaise, dyspnea, and weight loss; sometimes features pleuritic [[chest pain]] and hemoptysis; in most patients, auscultation reveals fine, dry lung crackles; finger clubbing is unusual||'''CT chest''' typical features include: patchy "ground-glass" opacities in a sub-pleural and/or peribronchovascular distribution; thickening of bronchial walls and cylindrical dilation; 3 to 5 mm diameter centrilobular nodules or other ill-defined nodules, [[mediastinal]] lymphadenopathy, pleural effusions; '''pulmonary function tests''' typically show a restrictive pattern; '''bronchoalveolar lavage (BAL''' shows a mixed cell pattern, with an increase in lymphocytes, neutrophils, eosinophils, mast cells, foamy macrophages, and occasional plasma cells, CD4+/CD8+ cell ratio is decreased, the ratio of lymphocytes to CD8+ cells is significantly increased; '''transbronchial lung biopsy in combination with BAL''' can be a useful approach, prior to possible open biopsy; '''open lung biopsy''' is often required for a definitive diagnosis

|-

| '''Pulmonary tuberculosis'''||Cough longer than 2 to 3 weeks, discolored or bloody [[sputum]], night sweats, weight loss, loss of appetite, and/or pleuritic chest pain||'''Chest x-ray:''' primary disease commonly presents as middle and lower lung zone infiltrates, ipsilateral adenopathy, atelectasis from airway compression, and pleural effusion can be seen, reactivation-type (post-primary) pulmonary TB usually involves apical and/or posterior segment of right upper lobe, apicoposterior segment of left upper lobe, or superior segment of either lower lobe, with or without cavitation, as disease progresses it spreads to other segments/lobes; '''sputum smear:''' positive for acid-fast bacilli (AFB), sputum may be spontaneously expectorated or induced, and at least 3 specimens should be collected (minimum 8 hours apart, including an early morning specimen, which is the best way to detect ''Mycobacterium tuberculosis''), organisms other than ''M. tuberculosis'', especially on-tuberculous mycobacteria (e.g., ''M. kansasii'' and ''M. avium'' , may be positive for AFB stain; '''nucleic acid amplification tests (NAAT):''' positive for ''M. tuberculosis'' DNA or RNA amplification tests for rapid diagnosis, may be used on sputum or any sterile body fluid

|-

| '''Non-Hodgkin's lymphoma (NHL)'''||Aggressive NHL may present with fever, drenching night sweats, malaise, weight loss, cough, shortness of breath, abdominal discomfort, headache, change in mental status, dizziness, ataxia, pleural effusion, [[lymphadenopathy]], pallor, [[purpura]], [[jaundice]], hepatomegaly, splenomegaly, skin nodules, and abnormal neurological examination, low-grade NHL patients often minimally symptomatic or asymptomatic||'''CT chest:''' frequently anterior mediastinum, can determine if mass is cystic or solid and whether it contains calcium or fat, contrast enhancement provides information concerning vascularisation of the mass and relationship to adjacent structures; '''FBC with differential:''' shows thrombocytopenia, pancytopenia; '''Blood smear:''' shows nucleated red blood cells, giant platelets; '''lymph node biopsy with immunohistochemistry:''' shows characteristic cells, preferably obtain excisional or core biopsy to provide information on lymph node architecture; '''mediastinoscopy:''' used to sample mediastinal nodes

|-

| '''Hodgkin's lymphoma'''||Predominantly a disease of young adults; most patients present with a several-month history of persistent adenopathy, most commonly of the cervical chain||'''Plain chest x-ray:''' typically shows mediastinal mass/large mediastinal [[adenopathy]]; '''PET scan:''' involved sites appear fluorodeoxyglucose (FDG)-avid (bright) with PET imaging; '''lymph node biopsy with immunohistochemistry:''' the Hodgkin's cell can be a characteristic Reed-Sternberg cell, or one of its variants, such as the lacunar cell in the nodular sclerosis subtype; in nodular lymphocyte-predominant Hodgkin's lymphoma, the characteristic cell is the [[lymphocytic]] and histiocytic (L&H) cell, also referred to as a popcorn cell

|-

| '''Thymoma/thymic carcinoma'''||Approximately 30% of patients with thymoma are asymptomatic at the time of diagnosis; may also present with cough, chest pain, signs of upper airway congestion, superior vena cava syndrome, dysphagia, or hoarseness; may have features of paraneoplastic syndromes associated with thymoma including [[myasthenia gravis]], [[polymyositis]], [[lupus erythematosus]], [[rheumatoid arthritis]], thyroiditis, and [[Sjogren's syndrome]]; about 30% of patients have symptoms suggestive of myasthenia gravis (e.g., ptosis, double vision)||'''Plain chest x-ray:''' in 50% of the patients, thymomas are detected by chance with plain-film chest radiography; CT chest: 90% occur in anterior mediastinum; '''Positron emission tomography (PET):''' may be of value in determining malignancy and extramediastinal involvement; '''pre-operative biopsy:''' indicated if there are atypical features or if imaging suggests invasive tumor and patient is under consideration for induction therapy

|-

| '''Bronchogenic cyst'''||Usually diagnosed in infancy and childhood, although 50% are diagnosed after 15 years of age; Approximately 50% of patients are asymptomatic; in adults, chest pain (often pleuritic) and dysphagia (due to esophageal compression) are the most common symptoms; may also feature recurrent cough and chest infection/pneumonia, superior vena cava syndrome, tracheal compression, and [[pneumothorax]]||'''Two-view chest radiography:''' typically shows a sharply demarcated spherical mass of variable size, most commonly located in the middle mediastinum around the carina, can appear as a solid tumor or show air-fluid level if cyst is infected or contains secretions; '''CT chest:''' frequently middle mediastinum, typically at level of the mediastinum, calcifications may also be seen; '''MRI:''' frequently middle mediastinum, typically at level of the [[mediastinum]], T2-weighted images show a homogeneous mass of moderate-to-bright intensity, on T1-weighted images, lesions may vary in intensity depending on protein content of the cyst

|-

| '''Tracheal tumors'''||Common symptoms include dyspnea, cough, hemoptysis, wheeze, and [[stridor]]; less commonly, hoarseness and dysphagia may be present||'''Plain chest radiographs''' are generally insensitive for detection of tracheal tumors, clues that may indicate the presence of a tracheal tumour include abnormal calcification, tracheal narrowing, post-obstructive pneumonia, and/or atelectasis; '''helical CT''' enables accurate calculation of tumor volumes and can help differentiate mucosal lesions from submucosal lesions; '''MRI''' can be useful in assessing extension into surrounding tissue and vascular anatomy; '''[[bronchoscopy]]''' allows direct visualisation, opportunity for biopsy, and potential for laser treatment

|-

| '''Thyroid mass'''||Symptoms and signs depend on size of mass; may be visible/palpable as lump on anterior aspect of neck; may present with [[dysphagia]], hoarseness, difficulty breathing, and pain in neck or throat; may also be signs and symptoms of hyper- or hypothyroidism depending on the nature of the mass||'''Laboratory testing''' should include thyroid function panel, with TSH, free T4, free T3; I-123 thyroid scan is ordered for patients with overt or subclinical [[hyperthyroidism]] a hyperfunctioning (hot) nodule is almost always benign, most nodules are hypofunctioning (cold) (most of these are benign, but malignant nodules are also cold); '''ultrasound and doppler''' can be used to define dimensions of thyroid nodules and solid/cystic component(s), features suspicious of malignancy include microcalcifications, a more tall-than-wide shape, hypervascularity, marked hypoechogenicity, or irregular margins, it can also guide fine-needle aspiration, which can reveal malignant cells or cyst fluid; '''CT neck''' can evaluate cervical lymph nodes in cases of medullary thyroid cancer, and extension of the scan into the chest can help evaluate a retrosternal thyroid mass

|}

'''Other conditions that can be mistaken for lung cancer including the following:'''
*[[Pneumomediastinum]]
*[[Empyema]]
*[[Abscess]]
*[[Pneumothorax]] (tension and traumatic)
*[[Pleural effusion]]
*[[Pneumothorax]]
*[[Superior Vena Cava Syndrome]]

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Pulmonology]]
[[Category:Lung cancer]]
[[Category:Oncology]]

{{WH}}
{{WS}}

Lung cancer differential diagnosis

2015-08-05T18:13:33Z

Saarah Alkhairy:

__NOTOC__
{{Lung cancer}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Lung cancer must be differentiated from other diseases that cause [[hemoptysis]], [[cough]], [[dyspnea]], [[wheeze]], [[chest pain]], [[dysphonia]], [[dysphagia]], unexplained weight loss, unexplained loss of appetite, and [[fatigue]] such as pneumonia, bronchitis, metastatic cancer from a non-thoracic primary site, infectious granuloma, pulmonary tuberculosis, tracheal tumors, and a thyroid mass.

==Lung Cancer Differential Diagnosis==
The table below summarizes the findings that differentiate lung cancer from the most common other conditions that cause [[hemoptysis]], [[cough]], [[dyspnea]], [[wheeze]], [[chest pain]], [[dysphonia]], [[dysphagia]], unexplained weight loss, unexplained loss of appetite, and [[fatigue]]<ref>{{Small cell lung cancer [Internet]. BMJ Publishing Group Limited 2015 [updated 2014 Oct 29]. Available from: http://bestpractice.bmj.com/best-practice/monograph/1081/diagnosis/differential.html}}</ref>.
{| {{table}}

| align="center" style="background:#f0f0f0;"|'''Condition/disease'''

| align="center" style="background:#f0f0f0;"|'''Signs/symptoms'''

| align="center" style="background:#f0f0f0;"|'''Tests'''

|-

| '''Pneumonia/bronchitis'''||Typical symptoms include [[fever]], cough, [[dyspnea]], and chest pain; recurrent pneumonia or bronchitis in a smoker or former smoker should raise the suspicion of lung cancer||'''CXR''' is the first test performed; '''[[CT]] imaging''' can be helpful to evaluate pulmonary masses that might not be well visualised with chest x-ray; '''bronchoscopy''' can also be used to assess for endobronchial lesions or to biopsy suspicious pulmonary masses

|-

| '''Carcinoid tumor'''||Often asymptomatic with normal physical examination; may cause cough, dyspnea, [[hemoptysis]], unilateral wheezing, or post-obstructive pneumonia if the tumor is endobronchial or compressing the central bronchi ||'''CT chest:''' 80% of carcinoid tumors appear as an endobronchial nodule and 20% as a parenchymal nodule, with smooth, rounded borders and is highly vascularized; '''flexible [[bronchoscopy]]''' shows raised, pink, vascular, lobulated lesions; '''endobronchial forceps biopsy''' is usually required for pathology to be diagnostic; bronchial brushings, sputum specimens, and lavage fluid rarely provide sufficient tissue for a conclusive diagnosis

|-

| '''Metastatic cancer from a non-thoracic primary site'''||Signs and symptoms depend on the location of the primary tumor and distant disease and may include pain, weight loss, malaise, cough, dyspnea, clubbing, or focal wheezing; physical findings may be present depending on the location and extent of the disease||'''CT chest''' shows one or multiple nodules of variable sizes from diffuse micronodular opacities (miliary) to well-defined masses, lesions are often irregular and in the periphery of the lower lung zones; '''CT/MRI head, CT abdomen and pelvis:''' extrapulmonary cancers that commonly [[metastasis]] to the lung include melanoma, [[thyroid]] carcinoma, esophageal cancer; ovarian cancer; sarcomas; and adenocarcinomas of the colon, breast, kidney, and testis; '''PET-FDG scan''' shows increased uptake in both primary and distant sites, certain metastatic lesions, such as renal cell carcinoma, have a lower probability of 18-fluorodeoxyglucose (FDG) uptake; '''CT-guided transthoracic needle aspiration (TTNA)''' can reveal characteristic malignant cells, pneumothorax complicates 20% to 30% of TTNA procedures, the choice between bronchoscopy and TTNA is based on lesion size, location, risks, and local expertise; '''biopsy during flexible bronchoscopy and biopsy''' may show characteristic malignant cells, bronchoscopy has a 100% yield for endobronchial lesions (which are extremely rare in metastatic deposits from other primary tumors)

|-

| '''Infectious granuloma'''||History may include travel to endemic areas, pet/animal exposures, and specific leisure activities (e.g., caving); may feature cough, dyspnea, hemoptysis, weight loss, fever, joint aches, skin lesions, and night sweats, or no symptoms; many possible causes: ''[[Histoplasma capsulatum]]'', ''[[Mycobacterium tuberculosis]]'', ''[[Coccidioides immitis]]'', ''[[Cryptococcus neoformans]]'', ''[[Aspergillus]]'', ''[[Pseudallescheria boydii]]'', ''Fusarium'' species, [[zygomycetes]], and others; non-specific skin findings may be seen in [[atypical mycobacteria]] and [[cryptococcosis]]; [[lymphadenopathy]] may be present with active disease||'''CT-guided TTNA''' can be used for diagnostic sampling, pneumothorax complicates 20% to 30% of TTNA procedures, the choice between bronchoscopy and TTNA is based on lesion size, location, risks, and local expertise; '''CT chest''' typically shows lesions <2 cm diameter and round with smooth borders, old granulomatous disease may feature central, laminated, or diffuse calcification pattern, mediastinal lymphadenopathy without calcifications is sometimes present, nodules from angioinvasive fungi (e.g., Aspergillus, Pseudallescheria boydii, Fusarium species, and zygomycetes) may demonstrate the "halo sign" (ground-glass opacity surrounding the nodule), occasionally, calcifications can be seen in the spleen or liver; '''fungal serologies:''' positive during active infection; '''flexible bronchoscopy and biopsy''' can sometimes provide sample for identification and culture and sensitivity of organism; '''PET:''' usually negative (<2.5 standardised uptake values), may be positive in active infectious processes

|-

| '''Sarcoidosis'''||Cough, dyspnea, [[fatigue]] weight loss, fever, night sweats, rash, eye pain, [[photophobia]] blurred vision, and red eye; pulmonary examination is usually unrevealing; can affect any organ, so physical findings depend on specific organs affected; skin lesions including maculopapular eruptions, subcutaneous nodular lesions, and red-purple skin lesions||'''CT chest:''' mediastinal adenopathy often present with sarcoid. Sarcoid nodules have predilection for upper zones, although can be located throughout the lung; '''flexible bronchoscopy and biopsy''' can demonstrate presence of non-caseating granulomas; '''CT-guided TTNA''' can provide access to material from some lesions inaccessible to flexible bronchoscopy; '''laboratory markers:''' ACE elevation may be seen in sarcoidosis but is non-specific

|-

| '''Rheumatoid arthritis'''||Arthralgias, pain, skin nodules, [[pleural effusions]], [[pleuritis]], joint pain, and deformity||CT chest typically shows lung nodule 3 mm to 7 cm, predominantly in peripheral upper and mid-lung zones, may show cavitation; '''flexible bronchoscopy and biopsy''' shows rheumatoid necrobiotic nodule, necrobiotic nodules demonstrate a central zone of eosinophilic fibrinoid necrosis surrounded by palisading fibroblasts, the nodule often centered on necrotic inflamed blood vessels; '''laboratory markers:''' patients with lung nodules due to rheumatoid arthritis frequently have high levels of rheumatoid factor, although seronegative cases have been reported

|-

| '''Wegener's granulomatosis'''||Cough, chest pain, dyspnea, hemoptysis, rhinorrhoea, epistaxis, ear/sinus pain, hoarseness, [[fever]], fatigue, anorexia, weight loss, palpable purpura, painful ulcers, uveitis, upper airway [[inflammation]], and sinus pain||'''CT chest shows''' solitary or multiple lung nodules, airways are frequently affected; '''Flexible bronchoscopy or CT-guided TTNA''' may show necrotising granulomatous inflammation; '''laboratory markers:''' anti-neutrophil cytoplasmic antibody (ANCA), ANCA testing results depend on the extent and severity of the disease

|-

| '''Arteriovenous malformation'''||Dyspnea is uncommon, may cause [[hemoptysis]], pulmonary [[bruit]], arteriovenous communications, or hemorrhagic [[telangiectasia]] in the skin, mucous membranes, and other organs, cyanosis and finger clubbing may be present, eurological symptoms from cerebral aneurysms, cerebral emboli||'''CT chest''' shows round or oval nodule(s) with feeding artery and draining vein often identified, most common in lower lobes, multiple lesions in 30% of cases, usually round or oval, ranging from 1 cm to several cm in diameter; '''pulmonary angiography''' confirms presence and location of AVMs, identifies feeding arterial and venous structures, in cases of significant hemoptysis, pulmonary angiogram is combined with bronchial artery embolisation; '''ABG analysis''' may show decreased pO2 and decreased oxygen saturation when AV flow is severe., in cases of severe systemic AVMs, chronic hypoxemia may cause polycythemia

|-

| '''Amyloidosis'''||Weight loss, [[paresthesias]], dyspnea, and fatigue are the most common symptoms associated with amyloidosis and are common to all systemic forms; weight loss of >9 kg is common; small vessel involvement can cause jaw or limb claudication, and rarely [[angina]]; amyloid purpura is present in about 1 in 6 patients, typically peri-orbital; eyelid petechiae are common; hepatomegaly >5 cm below the right costal margin is seen in 10% of patients and splenomegaly is usually of modest degree||'''CT chest''' shows lung involvement characterised by focal pulmonary nodules, tracheobronchial lesions, or diffuse alveolar deposits; '''serum immunofixation''' shows presence of monoclonal protein; urine immunofixation shows presence of monoclonal protein; '''immunoglobulin free light chain assay''' shows abnormal kappa to lambda ratio

|-

| '''Bronchiolitis obliterans organizing pneumonia (BOOP)'''||Normally presents as a flu-like illness followed by a second illness lasting 1 to 4 months, with low-grade fever, non-productive cough, malaise, dyspnea, and weight loss; sometimes features pleuritic [[chest pain]] and hemoptysis; in most patients, auscultation reveals fine, dry lung crackles; finger clubbing is unusual||'''CT chest''' typical features include: patchy "ground-glass" opacities in a sub-pleural and/or peribronchovascular distribution; thickening of bronchial walls and cylindrical dilation; 3 to 5 mm diameter centrilobular nodules or other ill-defined nodules, [[mediastinal]] lymphadenopathy, pleural effusions; '''pulmonary function tests''' typically show a restrictive pattern; '''bronchoalveolar lavage (BAL''' shows a mixed cell pattern, with an increase in lymphocytes, neutrophils, eosinophils, mast cells, foamy macrophages, and occasional plasma cells, CD4+/CD8+ cell ratio is decreased, the ratio of lymphocytes to CD8+ cells is significantly increased; '''transbronchial lung biopsy in combination with BAL''' can be a useful approach, prior to possible open biopsy; '''open lung biopsy''' is often required for a definitive diagnosis

|-

| '''Pulmonary tuberculosis'''||Cough longer than 2 to 3 weeks, discolored or bloody [[sputum]], night sweats, weight loss, loss of appetite, and/or pleuritic chest pain||'''Chest x-ray:''' primary disease commonly presents as middle and lower lung zone infiltrates, ipsilateral adenopathy, atelectasis from airway compression, and pleural effusion can be seen, reactivation-type (post-primary) pulmonary TB usually involves apical and/or posterior segment of right upper lobe, apicoposterior segment of left upper lobe, or superior segment of either lower lobe, with or without cavitation, as disease progresses it spreads to other segments/lobes; '''sputum smear:''' positive for acid-fast bacilli (AFB), sputum may be spontaneously expectorated or induced, and at least 3 specimens should be collected (minimum 8 hours apart, including an early morning specimen, which is the best way to detect ''Mycobacterium tuberculosis''), organisms other than ''M. tuberculosis'', especially on-tuberculous mycobacteria (e.g., ''M. kansasii'' and ''M. avium'' , may be positive for AFB stain; '''nucleic acid amplification tests (NAAT):''' positive for ''M. tuberculosis'' DNA or RNA amplification tests for rapid diagnosis, may be used on sputum or any sterile body fluid

|-

| '''Non-Hodgkin's lymphoma (NHL)'''||Aggressive NHL may present with fever, drenching night sweats, malaise, weight loss, cough, shortness of breath, abdominal discomfort, headache, change in mental status, dizziness, ataxia, pleural effusion, [[lymphadenopathy]], pallor, [[purpura]], [[jaundice]], hepatomegaly, splenomegaly, skin nodules, and abnormal neurological examination, low-grade NHL patients often minimally symptomatic or asymptomatic||'''CT chest:''' frequently anterior mediastinum, can determine if mass is cystic or solid and whether it contains calcium or fat, contrast enhancement provides information concerning vascularisation of the mass and relationship to adjacent structures; '''FBC with differential:''' shows thrombocytopenia, pancytopenia; '''Blood smear:''' shows nucleated red blood cells, giant platelets; '''lymph node biopsy with immunohistochemistry:''' shows characteristic cells, preferably obtain excisional or core biopsy to provide information on lymph node architecture; '''mediastinoscopy:''' used to sample mediastinal nodes

|-

| '''Hodgkin's lymphoma'''||Predominantly a disease of young adults; most patients present with a several-month history of persistent adenopathy, most commonly of the cervical chain||'''Plain chest x-ray:''' typically shows mediastinal mass/large mediastinal [[adenopathy]]; '''PET scan:''' involved sites appear fluorodeoxyglucose (FDG)-avid (bright) with PET imaging; '''lymph node biopsy with immunohistochemistry:''' the Hodgkin's cell can be a characteristic Reed-Sternberg cell, or one of its variants, such as the lacunar cell in the nodular sclerosis subtype; in nodular lymphocyte-predominant Hodgkin's lymphoma, the characteristic cell is the [[lymphocytic]] and histiocytic (L&H) cell, also referred to as a popcorn cell

|-

| '''Thymoma/thymic carcinoma'''||Approximately 30% of patients with thymoma are asymptomatic at the time of diagnosis; may also present with cough, chest pain, signs of upper airway congestion, superior vena cava syndrome, dysphagia, or hoarseness; may have features of paraneoplastic syndromes associated with thymoma including [[myasthenia gravis]], [[polymyositis]], [[lupus erythematosus]], [[rheumatoid arthritis]], thyroiditis, and [[Sjogren's syndrome]]; about 30% of patients have symptoms suggestive of myasthenia gravis (e.g., ptosis, double vision)||'''Plain chest x-ray:''' in 50% of the patients, thymomas are detected by chance with plain-film chest radiography; CT chest: 90% occur in anterior mediastinum; '''Positron emission tomography (PET):''' may be of value in determining malignancy and extramediastinal involvement; '''pre-operative biopsy:''' indicated if there are atypical features or if imaging suggests invasive tumor and patient is under consideration for induction therapy

|-

| '''Bronchogenic cyst'''||Usually diagnosed in infancy and childhood, although 50% are diagnosed after 15 years of age; Approximately 50% of patients are asymptomatic; in adults, chest pain (often pleuritic) and dysphagia (due to esophageal compression) are the most common symptoms; may also feature recurrent cough and chest infection/pneumonia, superior vena cava syndrome, tracheal compression, and [[pneumothorax]]||'''Two-view chest radiography:''' typically shows a sharply demarcated spherical mass of variable size, most commonly located in the middle mediastinum around the carina, can appear as a solid tumor or show air-fluid level if cyst is infected or contains secretions; '''CT chest:''' frequently middle mediastinum, typically at level of the mediastinum, calcifications may also be seen; '''MRI:''' frequently middle mediastinum, typically at level of the [[mediastinum]], T2-weighted images show a homogeneous mass of moderate-to-bright intensity, on T1-weighted images, lesions may vary in intensity depending on protein content of the cyst

|-

| '''Tracheal tumors'''||Common symptoms include dyspnea, cough, hemoptysis, wheeze, and [[stridor]]; less commonly, hoarseness and dysphagia may be present||'''Plain chest radiographs''' are generally insensitive for detection of tracheal tumors, clues that may indicate the presence of a tracheal tumour include abnormal calcification, tracheal narrowing, post-obstructive pneumonia, and/or atelectasis; '''helical CT''' enables accurate calculation of tumor volumes and can help differentiate mucosal lesions from submucosal lesions; '''MRI''' can be useful in assessing extension into surrounding tissue and vascular anatomy; '''[[bronchoscopy]]''' allows direct visualisation, opportunity for biopsy, and potential for laser treatment

|-

| '''Thyroid mass'''||Symptoms and signs depend on size of mass; may be visible/palpable as lump on anterior aspect of neck; may present with [[dysphagia]], hoarseness, difficulty breathing, and pain in neck or throat; may also be signs and symptoms of hyper- or hypothyroidism depending on the nature of the mass||'''Laboratory testing''' should include thyroid function panel, with TSH, free T4, free T3; I-123 thyroid scan is ordered for patients with overt or subclinical [[hyperthyroidism]] a hyperfunctioning (hot) nodule is almost always benign, most nodules are hypofunctioning (cold) (most of these are benign, but malignant nodules are also cold); '''ultrasound and doppler''' can be used to define dimensions of thyroid nodules and solid/cystic component(s), features suspicious of malignancy include microcalcifications, a more tall-than-wide shape, hypervascularity, marked hypoechogenicity, or irregular margins, it can also guide fine-needle aspiration, which can reveal malignant cells or cyst fluid; '''CT neck''' can evaluate cervical lymph nodes in cases of medullary thyroid cancer, and extension of the scan into the chest can help evaluate a retrosternal thyroid mass

|}

'''Other conditions that can be mistaken for lung cancer including the following:'''
*[[Pneumomediastinum]]
*[[Empyema]]
*[[Abscess]]
*[[Pneumothorax]] (tension and traumatic)
*[[Pleural effusion]]
*[[Pneumothorax]]
*[[Superior Vena Cava Syndrome]]

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Pulmonology]]
[[Category:Lung cancer]]
[[Category:Oncology]]

{{WH}}
{{WS}}

Basal cell carcinoma secondary prevention

2015-08-05T17:46:55Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
A skin [[biopsy]] and chemotherapeutic agents such as [[5-Fluorouracil]] or [[Imiquimod]] may prevent the further development of basal cell carcinoma.

==Basal Cell Carcinoma Secondary Prevention==
*Skin [[biopsy]]
:*To view the biopsy algorithm of a suspected lesion , click [[Basal cell carcinoma laboratory tests|'''here''']] 
*Chemotherapeutic agents such as [[5-Fluorouracil]] or [[Imiquimod]]
:*It is usually recommended to individuals with extensive sun damage, history of multiple skin cancers, or precancerous growths
:*It is often repeated every 2 to 3 years

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma staging

2015-08-05T17:44:03Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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.

==Basal Cell Carcinoma Staging==
The American Joint Committee on Cancer (AJCC) stages basal cell carcinoma based on the TNM system: 
T - tumor
 
N - lymph nodes
 
M - metastasis

The following table summarizes the '''T''' categories:
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''T Categories'''

| align="center" style="background:#f0f0f0;"|'''Description'''

|-

| '''Tis'''||Carcinoma in situ

|-

| '''T1'''||The tumor is blank 2 cm across AND has 0-1 high-risk features

|-

| '''T2'''||The tumor is > 2 cm across AND has > 2 high-risk features

|-

| '''T3'''||The tumor has grown into facial bones

|-

| '''T4'''||The tumor has grown into other bones in the body or into the base of the skull

|}
The following table summarizes the '''N''' categories:
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''N categories'''

| align="center" style="background:#f0f0f0;"|'''Description'''

|-

| '''N0'''||The tumor has not spread to the lymph nodes

|-

| '''N1'''||The tumor has spread to 1 lymph node on the same side of the body as the main tumor AND is ≤ 3 cm across

|-

| '''N2a'''||The tumor has spread to 1 lymph node on the same side of the body as the main tumor AND is > 3 cm and ≤ 6 cm across

|-

| '''N2b'''||The tumor has spread to > 1 lymph node on the same side of the body as the main tumor AND is ≤ 6 cm across

|-

| '''N2c'''||The tumor has spread to > 1 lymph node on the other side of the body as the main tumor AND is ≤ 6 cm across

|-

| '''N3'''||The tumor has spread to any nearby lymph node AND is > 6 cm across

|}

The following table summarizes the '''M''' categories:
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''M categories'''

| align="center" style="background:#f0f0f0;"|'''Description'''

|-

| '''M0'''||The tumor has not spread to distant organs

|-

| '''M1'''||The tumor has spread to distant organs

|}

The T, N, and M categories are combined into stages. The following table summarizes the '''stage grouping'''.
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Stage'''

| align="center" style="background:#f0f0f0;"|'''TNM Grouping'''

|-

| '''0'''||Tis, N0, M0

|-

| '''I'''||T1, N0, M0

|-

| '''II'''||T2, N0, M0

|-

| '''III'''||T3, N0, M0; T1-T3, N1, M0

|-

| '''IV'''||T1-T3, N2, M0; Any T, N3, M0; T4, any N, M0; Any T, any N, M1

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma surgery

2015-08-05T17:37:17Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and [[cryosurgery]].

==Basal Cell Carcinoma Surgery==
Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and [[cryosurgery]].

===Electrodesiccation and Curettage===
A curette is used to remove the tumor away from adjacent normal skin. Curetting is often followed by electrodesiccation, and the entire process may be repeated 1-2 more times. Electrodesiccation and curettage is a brief procedure and is effective in treating primary nodular and superficial basal cell carcinoma. The disadvantage of this procedure is it leaves a white, [[atrophic]] scar<ref name="pmid1820764">{{cite journal| author=Silverman MK, Kopf AW, Grin CM, Bart RS, Levenstein MJ|title=Recurrence rates of treated basal cell carcinomas. Part 2: Curettage-electrodesiccation. | journal=J Dermatol Surg Oncol | year= 1991 | volume= 17 | issue= 9 | pages= 720-6 | pmid=1820764 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1820764 }} </ref>.

===Surgical Excision===
Surgical excision is performed to remove and examine the specimen under a microscope. The larger mount of skin that is removed, the higher the cure rate. Normally, 3-4 mm margins of normal skin are removed. Although surgical excision is more time-consuming and costly compared to curettage, it produces cure rates as high as 95%<ref name="pmid9723063">{{cite journal| author=Grabski WJ, Salasche SJ| title=Positive surgical excision margins of a basal cell carcinoma. |journal=Dermatol Surg | year= 1998 | volume= 24 | issue= 8 | pages= 921-4 | pmid=9723063 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9723063 }} </ref>.

===Mohs Micrographic Surgery===
Mohs surgery involves removal of the tumor and a thin rim of normal-appearing skin<ref name="pmid15270883">{{cite journal| author=Smeets NW, Kuijpers DI, Nelemans P, Ostertag JU, Verhaegh ME, Krekels GA et al.| title=Mohs' micrographic surgery for treatment of basal cell carcinoma of the face--results of a retrospective study and review of the literature. | journal=Br J Dermatol | year= 2004 | volume= 151 | issue= 1 | pages= 141-7 | pmid=15270883 | doi=10.1111/j.1365-2133.2004.06047.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15270883 }} </ref>.

Mohs micrographic surgery is indicated for the following:
*Tumors with poorly defined clinical borders
*Tumors with diameters > 1 cm located anywhere on the face
*Tumors with diameters > 2 cm located in areas other than the face
*Tumors with infiltrative or morpheaform/sclerotic histopathologic patterns
*Tumors arising in regions where a good cosmetic outcome is important

===Cryosurgery===
Cryosurgery may be considered for small, clinically well-defined primary tumors. This procedure is especially useful for patients who are debilitated with medical conditions. [[Liquid nitrogen]] is applied to the tumor, the treatment stops when the temperature reaches -60°C<ref name="pmid17642878">{{cite journal| author=Kaur S, Thami GP, Kanwar AJ| title=Basal cell carcinoma--treatment with cryosurgery. | journal=Indian J Dermatol Venereol Leprol | year= 2003 | volume= 69 | issue= 2 |pages= 188-90 | pmid=17642878 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17642878 }} </ref>.

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma surgery

2015-08-05T17:35:44Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and [[cryosurgery]].

==Basal Cell Carcinoma Surgery==
Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and [[cryosurgery]].

===Electrodesiccation and Curettage===
A curette is used to remove the tumor away from adjacent normal skin. Curetting is often followed by electrodesiccation, and the entire process may be repeated 1-2 more times. Electrodesiccation and curettage is a brief procedure and is effective in treating primary nodular and superficial basal cell carcinoma. The disadvantage of this procedure is it leaves a white, [[atrophic]] scar<ref name="pmid1820764">{{cite journal| author=Silverman MK, Kopf AW, Grin CM, Bart RS, Levenstein MJ|title=Recurrence rates of treated basal cell carcinomas. Part 2: Curettage-electrodesiccation. | journal=J Dermatol Surg Oncol | year= 1991 | volume= 17 | issue= 9 | pages= 720-6 | pmid=1820764 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1820764 }} </ref>.

===Surgical Excision===
Surgical excision is performed to remove and examine the specimen under a microscope. The larger mount of skin that is removed, the higher the cure rate. Normally, 3-4 mm margins of normal skin are removed. Although surgical excision is more time-consuming and costly compared to curettage, it produces cure rates as high as 95%<ref name="pmid9723063">{{cite journal| author=Grabski WJ, Salasche SJ| title=Positive surgical excision margins of a basal cell carcinoma. |journal=Dermatol Surg | year= 1998 | volume= 24 | issue= 8 | pages= 921-4 | pmid=9723063 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9723063 }} </ref>.

===Mohs Micrographic Surgery===
Mohs surgery involves removal of the tumor and a thin rim of normal-appearing skin<ref name="pmid15270883">{{cite journal| author=Smeets NW, Kuijpers DI, Nelemans P, Ostertag JU, Verhaegh ME, Krekels GA et al.| title=Mohs' micrographic surgery for treatment of basal cell carcinoma of the face--results of a retrospective study and review of the literature. | journal=Br J Dermatol | year= 2004 | volume= 151 | issue= 1 | pages= 141-7 | pmid=15270883 | doi=10.1111/j.1365-2133.2004.06047.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15270883 }} </ref>. Mohs micrographic surgery is indicated for the following:
*Tumors with poorly defined clinical borders
*Tumors with diameters > 1 cm located anywhere on the face
*Tumors with diameters > 2 cm located in areas other than the face
*Tumors with infiltrative or morpheaform/sclerotic histopathologic patterns
*Tumors arising in regions where a good cosmetic outcome is important

===Cryosurgery===
Cryosurgery may be considered for small, clinically well-defined primary tumors. This procedure is especially useful for patients who are debilitated with medical conditions. [[Liquid nitrogen]] is applied to the tumor, the treatment stops when the temperature reaches -60°C<ref name="pmid17642878">{{cite journal| author=Kaur S, Thami GP, Kanwar AJ| title=Basal cell carcinoma--treatment with cryosurgery. | journal=Indian J Dermatol Venereol Leprol | year= 2003 | volume= 69 | issue= 2 |pages= 188-90 | pmid=17642878 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17642878 }} </ref>.

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma natural history

2015-08-05T15:48:48Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Basal cell carcinoma is slow-growing and locally invasive. Common complications of BCC commonly include reccurrence and development of other types of skin cancer. Prognosis is usually excellent, but the tumor is usually locally invasive and may be destructive.

==Natural History==
*Patients with basal cell carcinoma are often asymptomatic
*Basal cell carcinoma is slow-growing and locally invasive
*The overall risk of [[metastases]] is estimated to be less than 0.1%
*The risk of invasion and recurrence is based on size, duration, location and subtype (sclerodermiform/morpheaform and micronodular clinical variants have a higher risk)
*Even without a recurrence, a personal history of basal cell carcinoma increases the risk of developing all types of skin cancers

==Complications==
Complications of basal cell carcinoma are the following:
*Reccurrence
*Development of other types of skin cancer
*[[Metastasis]]
*Jaw [[cysts]] (90% by 40 years)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Ovarian]] [[calcification]] or [[fibroma]] (24%)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Medulloblastoma]] (5%)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Cardiac fibroma (3%)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Cleft palate]] (5%)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Ophthalmic complications, such as squint or [[cataracts]] (26%)<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>

==Prognosis==
*Prognosis of basal cell carcinoma is usually excellent.
*Although basal cell carcinoma rarely [[metastasis|metastasizes]], it grows locally with invasion and destruction of local tissues, without stopping
*The cancer can impinge on vital structures and result in loss of extension or loss of function or rarely death
*The vast majority of cases can be successfully treated before serious complications occur

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma risk factors

2015-08-05T15:18:25Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Both genetic diseases and environmental factors (sunlight exposure) predispose individuals to an increased risk of developing basal cell carcinoma.

==Basal Cell Carcinoma Risk Factors==
There are some environmental and genetic risk factors that may predispose to basal cell carcinoma.

The following table summarizes the causes of basal cell carcinoma (BCC):
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Risk Factor'''

| align="center" style="background:#f0f0f0;"|'''Description'''

|-

| '''Radiation exposure'''||Sunlight (UV light), tanning beds, and x-rays exposure are associated with basal cell carcinoma formation<ref name="pmid15737190">{{cite journal| author=Lim JL, Stern RS| title=High levels of ultraviolet B exposure increase the risk of non-melanoma skin cancer in psoralen and ultraviolet A-treated patients. | journal=J Invest Dermatol | year= 2005 | volume= 124 | issue= 3 | pages= 505-13 | pmid=15737190 | doi=10.1111/j.0022-202X.2005.23618.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15737190}}</ref>

|-

| '''Gene mutations'''||TP53 gene mutations and the inappropriate activation of the [[hedgehog signaling pathway]] (loss-of-function mutations in tumor-suppressor protein patched homologue 1 ([[PTCH1]]) and gain-of-function mutations in sonic hedgehog (SHH), smoothened (SMO), and Gli) are associated with basal cell carcinoma<ref name="pmid20546211">{{cite journal| author=de Zwaan SE, Haass NK| title=Genetics of basal cell carcinoma. | journal=Australas J Dermatol | year= 2010 | volume= 51 | issue= 2 | pages= 81-92; quiz 93-4 | pmid=20546211 | doi=10.1111/j.1440-0960.2009.00579.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20546211 }} </ref>

|-
| '''Physical features'''||Red/blonde hair, blue/green eyes, freckling, and skin types I and II (skin that always burns and never/only sometimes tans) are associated with an increased risk for basal cell carcinoma<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-
| '''Albinism'''||[[Albinism]] is associated with an increased risk for basal cell carcinoma<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-
| '''Gender'''||The male gender is associated with an increased risk for basal cell carcinoma<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-
| '''Xeroderma pigmentosum'''||This an [[autosomal recessive]] disorder; it results in the inability to repair ultraviolet-induced DNA damage; pigmentary changes are seen early in life, followed by the development of basal cell carcinoma, [[squamous cell carcinoma]], and [[malignant melanoma]]; other features include corneal opacities, eventual blindness, and neurological deficits<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-

| '''Epidermodysplastic verruciformis'''||Epidermodysplastic verruciformis is an autosomal recessive disorder characterized by the development of basal cell carcinoma and squamous cell carcinoma from warts ([[human papillomavirus]] infection)<ref name="pmid15149508">{{cite journal| author=Harwood CA, Surentheran T, Sasieni P, Proby CM, Bordea C, Leigh IM et al.| title=Increased risk of skin cancer associated with the presence of epidermodysplasia verruciformis human papillomavirus types in normal skin. | journal=Br J Dermatol | year= 2004 | volume= 150 | issue= 5 | pages= 949-57 | pmid=15149508 | doi=10.1111/j.1365-2133.2004.05847.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15149508 }} </ref>

|-

| '''Nevoid basal cell carcinoma syndrome'''||This is an [[autosomal dominant]] disorder that can result in basal cell carcinomas, multiple odontogenic keratocysts, palmoplantar pitting, [[intracranial calcification]], and rib anomalies<ref name="pmid10355946">{{cite journal| author=Cohen MM| title=Nevoid basal cell carcinoma syndrome: molecular biology and new hypotheses. | journal=Int J Oral Maxillofac Surg | year= 1999 | volume= 28 | issue= 3 | pages= 216-23 | pmid=10355946 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10355946}}</ref>

|-

| '''Bazex Syndrome'''||The features of Bazex syndrome include follicular atrophoderma, multiple basal cell carcinomas, and local [[anhidrosis]]<ref>Centers for Disease Control and Prevention (CDC). Sunburn prevalence among adults--United States, 1999, 2003, and 2004. MMWR Morb Mortal Wkly Rep. 2007 Jun 1. 56(21):524-8</ref>

|-

| '''Rombo syndrome'''||Rombo syndrome is an [[autosomal dominant]] condition distinguished by basal cell carcinoma and atrophoderma vermiculatum, trichoepitheliomas, [[hypotrichosis]] milia, and peripheral [[vasodilation]] with [[cyanosis]]<ref name="pmid6177160">{{cite journal| author=Michaëlsson G, Olsson E, Westermark P| title=The Rombo syndrome: a familial disorder with vermiculate atrophoderma, milia, hypotrichosis, trichoepitheliomas, basal cell carcinomas and peripheral vasodilation with cyanosis. | journal=Acta Derm Venereol | year= 1981 | volume= 61 | issue= 6 | pages= 497-503 | pmid=6177160 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6177160 }} </ref>

|}

Other risk factors for the development of basal cell carcinoma are the following<ref>http://www.cancercare.on.ca/pdf/pebc15-1s.pdf</ref>:
*Current immunosuppressive therapy after organ transplantation
*Personal history of skin cancer
*Two or more first-degree relatives with [[melanoma]]
*Total of 100 nevi or at least five atypical (dysplastic) [[nevi]]
*More than 250 treatments with psoralen plus ultraviolet A (UVA) therapy for [[psoriasis]]
*Radiation therapy for cancer as a child

==References==

{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma pathophysiology

2015-08-05T14:36:00Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}};{{AE}}{{SM}}

==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===
*Basal cell carcinoma may develop as a result of basal cell nevus syndrome (Gorlin's syndrome) which is additionally characterized by odontogenic keratocysts of the jaw, palmar or plantar (sole of the foot) pits, calcification of the [[falx cerebri]] (in the center line of the brain), and rib abnormalities
*The cause of the syndrome is a mutation in the [[PTCH1]] tumor-suppressor gene at chromosome 9q22.3, which inhibits the [[hedgehog signaling pathway]]
*A mutation in the [[smoothened|SMO]] gene (also on the hedgehog pathway) predisposes to the development of basal cell carcinoma<ref>{{cite journal |author=Epstein EH, Shepard JA, Flotte TJ |title=Case records of the Massachusetts General Hospital. Case 3-2008. An 80-year-old woman with cutaneous basal-cell carcinomas and cysts of the jaws |journal=N Engl J Med |volume=358 |issue=4 |pages=393–401 |year=2008 |month=Jan |pmid=18216361 |doi=10.1056/NEJMcpc0707893 |url=}}</ref>

===Enviromental Exposure===
*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
*While [[DNA repair]] eliminates most UV-induced damage, not all cross-links are excised, which eventually results in [[mutation]]s
*Apart from the mutagenesis, sunlight depresses the local [[immune system]], possibly decreasing immune surveillance for new tumor cells

===Gross Pathology===
[[Image:Basalioma.jpg‎|left|200px]] 
The image above depicts basal cell carcinoma in a 75 year old male.
The following features are characteristic on gross pathology:
*Pearly pink nodules
*Telangiectasias
*Rolled borders
*Central crusting
*Ulcerating lesion (rodent ulcer)

===Microscopic Pathology===
Shown below is a classic micrograph of basal cell carcinoma(H&E stain).The following features are characteristic:
*Peripheral palisading nuclei
*Myxoid stroma
*Artefactual clefting
[[Image:Basal_cell_carcinoma_-_2_-_intermed_mag.jpg‎|left|200px]]
 
Shown below is the image of nodular variant of Basal cell carcinoma
[[Image:basal cell carcinoma pathology.jpg|left|200px]]

 

 
===Video===
{{#ev:youtube|JnJXrFnvOKs}}

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma pathophysiology

2015-08-05T14:32:40Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}};{{AE}}{{SM}}

==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===
*Basal cell carcinoma may develop as a result of basal cell nevus syndrome (Gorlin's syndrome) which is additionally characterized by odontogenic keratocysts of the jaw, palmar or plantar (sole of the foot) pits, calcification of the [[falx cerebri]] (in the center line of the brain), and rib abnormalities.
*The cause of the syndrome is a mutation in the [[PTCH1]] tumor-suppressor gene at chromosome 9q22.3, which inhibits the [[hedgehog signaling pathway]]. A mutation in the [[smoothened|SMO]] gene (also on the hedgehog pathway) predisposes to the development of basal cell carcinoma.<ref>{{cite journal |author=Epstein EH, Shepard JA, Flotte TJ |title=Case records of the Massachusetts General Hospital. Case 3-2008. An 80-year-old woman with cutaneous basal-cell carcinomas and cysts of the jaws |journal=N Engl J Med |volume=358 |issue=4 |pages=393–401 |year=2008 |month=Jan |pmid=18216361 |doi=10.1056/NEJMcpc0707893 |url=}}</ref>

===Enviromental Exposure===
*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
*While [[DNA repair]] eliminates most UV-induced damage, not all cross-links are excised, which eventually results in [[mutation]]s
*Apart from the mutagenesis, sunlight depresses the local [[immune system]], possibly decreasing immune surveillance for new tumor cells

===Gross Pathology===
[[Image:Basalioma.jpg‎|left|200px]] 
The image above depicts basal cell carcinoma in a 75 year old male.
The following features are characteristic on gross pathology:
*Pearly pink nodules
*Telangiectasias
*Rolled borders
*Central crusting
*Ulcerating lesion (rodent ulcer)

===Microscopic Pathology===
Shown below is a classic micrograph of basal cell carcinoma(H&E stain).The following features are characteristic:
*Peripheral palisading nuclei
*Myxoid stroma
*Artefactual clefting
[[Image:Basal_cell_carcinoma_-_2_-_intermed_mag.jpg‎|left|200px]]
 
Shown below is the image of nodular variant of Basal cell carcinoma
[[Image:basal cell carcinoma pathology.jpg|left|200px]]

 

 
===Video===
{{#ev:youtube|JnJXrFnvOKs}}

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma classification

2015-08-05T14:04:52Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Basal cell carcinoma may be classified as nodular, cystic, sclerodermiform, infiltrated, micronodular, superficial, and pigment basal cell carcinoma and fibroepithelioma of Pinkus.

==Basal Cell Carcinoma Classification==
The following table summarizes the classification of the clinical variants of basal cell carcinoma (BCC)<ref name="DourmishevRusinova2013">{{cite journal|last1=Dourmishev|first1=LyubomirA|last2=Rusinova|first2=Darena|last3=Botev|first3=Ivan|title=Clinical variants, stages, and management of basal cell carcinoma|journal=Indian Dermatology Online Journal|volume=4|issue=1|year=2013|pages=12|issn=2229-5178|doi=10.4103/2229-5178.105456}}</ref>:
{| {{table}}

| align="center" style="background:#f0f0f0;"|'''Clinical Variants'''

| align="center" style="background:#f0f0f0;"|'''Description'''

|-

| '''Nodular BCC'''||Comprises about 60-80% of cases; most commonly found on the skin of the head; '''clinically:''' elevated, exophytic pearl-shaped nodules with [[telangiectasias]] on the surface and periphery; '''histologically:''' nest-like infiltration from basaloid cells

|-

| '''Cystic BCC'''||≥ 1 cystic node with different sizes located peripherally to the centrally placed [[tumor]] nests

|-

| '''Sclerodermiform (morpheiform) BCC'''||The tumor cells are surrounded by fibrotic stroma; '''clinically:''' infiltrated plaque with a slightly shining surface and not well-defined borders; '''immunochemistry:''' expression of smooth muscle alpha-actin

|-

| '''Infiltrated BCC'''||Most common found on the upper part of the trunk or face; '''clinically:''' whitish, compact, not well-defined plaque; '''histologically:''' thin, nest-like bundles of basaloid cells infiltrating in the dermal [[collagenous]] fibers

|-

| '''Micronodular BCC'''||Most commonly found on the skin of the back; '''clinically:''' may be flat or elevated; yellow-whitish color when flat, clear outlines and thick at palpation; '''histologically:''' small rounded nodules of basaloid cells and minimal palisading

|-

| '''Superficial BCC'''||Comprises about 10-30% of cases; '''clinically:''' erythematous squamous plaque with clear borders, pearl-shape edge, superficial erosion, without tendencies for invasive growth; '''histologically:''' nests of basaloid cells located subepidermally, connection with the basal layer of the epidermis and no infiltration of tumor cells in the reticular dermis

|-

| '''Pigment BCC'''||The color varies from dark brown to black; '''clinically:''' nodular, micronodular, multifocal, supercial; '''histologically:''' nests of basaloid cells, melanocytes and melanophages, moderate [[inflammatory]] infiltrate

|-

| '''Fibroepithelioma of Pinkus'''||Most commonly on the skin of the back; affects women especially; '''clinically:''' elevated pink or [[erythematous]] nodules; '''histologically:''' trabecular, elongated, and branched thin strands of basaloid cells

|}

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma overview

2015-08-05T14:02:31Z

Saarah Alkhairy:

{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
The classification of basal cell carcinoma (BCC) is divided into many clinical variants. 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. 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. 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.

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma natural history

2015-08-05T13:12:30Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Basal cell carcinoma is slow-growing and locally invasive. Common complications of BCC commonly include reccurrence and development of other types of skin cancer. Prognosis is usually excellent, but the tumor is usually locally invasive and may be destructive.

==Natural History==
*Patients with basal cell carcinoma are often asymptomatic
*Basal cell carcinoma is slow-growing and locally invasive
*The overall risk of [[metastases]] is estimated to be less than 0.1%
*The risk of invasion and recurrence is based on size, duration, location and subtype (sclerodermiform/morpheaform and micronodular clinical variants have a higher risk)
*Even without a recurrence, a personal history of basal cell carcinoma increases the risk of developing all types of skin cancers

==Complications==
Complications of basal cell carcinoma are the following:
*Reccurrence
*Development of other types of skin cancer
*[[Metastasis]]
*[[Ovarian]] [[calcification]] or [[fibroma]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Medulloblastoma]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Cardiac fibroma]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Cleft palate]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Ophthalmic complications, such as squint or [[cataract]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>

==Prognosis==
*Prognosis of basal cell carcinoma is usually excellent.
*Although basal cell carcinoma rarely [[metastasis|metastasizes]], it grows locally with invasion and destruction of local tissues, without stopping
*The cancer can impinge on vital structures and result in loss of extension or loss of function or rarely death
*The vast majority of cases can be successfully treated before serious complications occur

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma natural history

2015-08-05T13:11:33Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Basal cell carcinoma is slow-growing and locally invasive. Common complications of BCC commonly include reccurrence and development of other types of skin cancer. Prognosis is usually excellent, but the tumor is usually locally invasive and may be destructive.

==Natural History==
*Patients with basal cell carcinoma are often asymptomatic.

*Basal cell carcinoma is slow-growing and locally invasive.
*The overall risk of [[metastases]] is estimated to be less than 0.1%.
*The risk of invasion and recurrence is based on size, duration, location and subtype (sclerodermiform/morpheaform and micronodular clinical variants have a higher risk).
*Even without a recurrence, a personal history of basal cell carcinoma increases the risk of developing all types of skin cancers.

==Complications==
Complications of basal cell carcinoma are the following:
*Reccurrence
*Development of other types of skin cancer
*[[Metastasis]]
*[[Ovarian]] [[calcification]] or [[fibroma]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Medulloblastoma]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Cardiac fibroma]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*[[Cleft palate]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Ophthalmic complications, such as squint or [[cataract]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>

==Prognosis==
*Prognosis of basal cell carcinoma is usually excellent.
*Although basal cell carcinoma rarely [[metastasis|metastasizes]], it grows locally with invasion and destruction of local tissues, without stopping
*The cancer can impinge on vital structures and result in loss of extension or loss of function or rarely death
*The vast majority of cases can be successfully treated before serious complications occur

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma classification

2015-08-05T13:03:24Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Basal cell carcinoma may be classified as nodular, cystic, sclerodermiform, infiltrated, micronodular, superficial, and pigment basal cell carcinoma and fibroepithelioma of Pinkus

==Basal Cell Carcinoma Classification==
The following table summarizes the classification of the clinical variants of basal cell carcinoma (BCC)<ref name="DourmishevRusinova2013">{{cite journal|last1=Dourmishev|first1=LyubomirA|last2=Rusinova|first2=Darena|last3=Botev|first3=Ivan|title=Clinical variants, stages, and management of basal cell carcinoma|journal=Indian Dermatology Online Journal|volume=4|issue=1|year=2013|pages=12|issn=2229-5178|doi=10.4103/2229-5178.105456}}</ref>:
{| {{table}}

| align="center" style="background:#f0f0f0;"|'''Clinical Variants'''

| align="center" style="background:#f0f0f0;"|'''Description'''

|-

| '''Nodular BCC'''||Comprises about 60-80% of cases; most commonly found on the skin of the head; '''clinically:''' elevated, exophytic pearl-shaped nodules with [[telangiectasias]] on the surface and periphery; '''histologically:''' nest-like infiltration from basaloid cells

|-

| '''Cystic BCC'''||≥ 1 cystic node with different sizes located peripherally to the centrally placed [[tumor]] nests

|-

| '''Sclerodermiform (morpheiform) BCC'''||The tumor cells are surrounded by fibrotic stroma; '''clinically:''' infiltrated plaque with a slightly shining surface and not well-defined borders; '''immunochemistry:''' expression of smooth muscle alpha-actin

|-

| '''Infiltrated BCC'''||Most common found on the upper part of the trunk or face; '''clinically:''' whitish, compact, not well-defined plaque; '''histologically:''' thin, nest-like bundles of basaloid cells infiltrating in the dermal [[collagenous]] fibers

|-

| '''Micronodular BCC'''||Most commonly found on the skin of the back; '''clinically:''' may be flat or elevated; yellow-whitish color when flat, clear outlines and thick at palpation; '''histologically:''' small rounded nodules of basaloid cells and minimal palisading

|-

| '''Superficial BCC'''||Comprises about 10-30% of cases; '''clinically:''' erythematous squamous plaque with clear borders, pearl-shape edge, superficial erosion, without tendencies for invasive growth; '''histologically:''' nests of basaloid cells located subepidermally, connection with the basal layer of the epidermis and no infiltration of tumor cells in the reticular dermis

|-

| '''Pigment BCC'''||The color varies from dark brown to black; '''clinically:''' nodular, micronodular, multifocal, supercial; '''histologically:''' nests of basaloid cells, melanocytes and melanophages, moderate [[inflammatory]] infiltrate

|-

| '''Fibroepithelioma of Pinkus'''||Most commonly on the skin of the back; affects women especially; '''clinically:''' elevated pink or [[erythematous]] nodules; '''histologically:''' trabecular, elongated, and branched thin strands of basaloid cells

|}

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma medical therapy

2015-08-05T12:51:42Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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.

==Basal Cell Carcinoma Medical Therapy==
After the suspicious lesion is evaluated, the medical therapy is divided into low-risk and high-risk basal cell carcinoma patients.

The table below summarizes the characteristics in low-risk and high-risk lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''H&P'''

| align="center" style="background:#f0f0f0;"|'''Low Risk'''

| align="center" style="background:#f0f0f0;"|'''High Risk'''

|-

| '''Location/size'''||Area L < 20 mm; Area M < 10 mm; Area H < 6 mm||Area L ≥ 20 mm; Area M ≥ 10 mm; Area H ≥ 6 mm

|-

| '''Borders'''||Well defined||Poorly defined

|-

| '''Primary vs. recurrent'''||Primary||Recurrent

|-

| '''Immunosuppression'''||(-)||(+)

|-

| '''Site of prior radiation therapy'''||(-)||(+)

|-

| '''Subtype'''||[[Nodular]], superficial||Aggressive growth pattern

|-

| '''Perineural involvement'''||(-)||(+)

|}

'''Area H''' = “mask areas” of face (central face, eyelids, eyebrows, periorbital, nose, lips [cutaneous and vermilion], chin, [[mandible]], preauricular and postauricular skin/sulci, temple, ear), [[genitalia]], hands, and feet

'''Area M''' = cheeks, forehead, scalp, neck, and pre-tibial area

'''Area L''' = trunk and extremities (excluding pre-tibial area, hands, feet, nail units, and ankles)

The algorithm below demonstrates a treatment protocol for '''low-risk''' lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Low Risk Basal Cell.jpg|800px]]

The algorithm below demonstrates a treatment protocol for '''high-risk''' lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:High Risk Basal Cell.jpg|800px]]

After the primary treatment, a follow-up is performed to evaluate for recurrence of the tumor.

The algorithm below demonstrates a follow-up protocol<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Followup Basal Cell.jpg|800px]]

Other medical therapy techniques include the following:
*'''Oral [[vismodegib]]''' - was approved by the FDA in January 2012 for adult patients with locally advanced basal cell carcinoma who are not candidates for surgery or radiation
*'''[[Radiotherapy]]''' - used in elderly patients with extensive lesions when surgery is inappropriate
*'''Topical [[photodynamic therapy]]''' - particularly for the management of superficial BCC that involves the application of a topical emulsion-based 5-aminolaevulinic acid
*'''[[Fluorouracil]]''' - particularly for the management of multiple superficial BCC on the trunk and limbs
*'''[[Imiquimod]]''' - particularly for the management of superficial BCC

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma epidemiology and demographics

2015-07-29T17:12:06Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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.

==Epidemiology and Demographics==
===Incidence===
*In 2014, the average annual incidence of BCC in the United States was 878 cases per 100,000 individuals<ref name="pmid24587976">{{cite journal| author=Mohan SV, Chang AL| title=Advanced Basal Cell Carcinoma: Epidemiology and Therapeutic Innovations. | journal=Curr Dermatol Rep | year= 2014 | volume= 3 | issue= | pages= 40-45 | pmid=24587976 | doi=10.1007/s13671-014-0069-y | pmc=PMC3931971 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24587976 }} </ref>

===Age===
*The incidence of BCC increases with age - persons aged 55 to 75 years have about a 100-fold higher incidence of BCC than those younger than 20 years<ref>Scotto J, Fears TR, Fraumeni JF Jr, et al. Incidence of nonmelanoma skin cancer in the United States in collaboration with Fred Hutchinson Cancer Research Center. NIH publication No. 83-2433, U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, Bethesda, MD 1983:xv. p.11</ref>

===Gender===
*The incidence of BCC is 30% higher in men than in women (particularly with the superficial type)<ref name="pmid10411152">{{cite journal| author=Hannuksela-Svahn A, Pukkala E, Karvonen J| title=Basal cell skin carcinoma and other nonmelanoma skin cancers in Finland from 1956 through 1995. | journal=Arch Dermatol | year= 1999 | volume= 135 | issue= 7 | pages= 781-6 | pmid=10411152 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10411152}}</ref><ref name="pmid8942434">{{cite journal| author=Green A, Battistutta D, Hart V, Leslie D, Weedon D| title=Skin cancer in a subtropical Australian population: incidence and lack of association with occupation. The Nambour Study Group. | journal=Am J Epidemiol | year= 1996 | volume= 144 | issue= 11 | pages= 1034-40 | pmid=8942434 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8942434}}</ref><ref name="pmid2312827">{{cite journal| author=Chuang TY, Popescu A, Su WP, Chute CG| title=Basal cell carcinoma. A population-based incidence study in Rochester, Minnesota. | journal=J Am Acad Dermatol | year= 1990 | volume= 22 | issue= 3 | pages= 413-7 | pmid=2312827 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2312827}}</ref>

===Race===
*Basal cell carcinoma is common among the Caucasian race, and very uncommon among the African American race and other darker-skinned populations<ref>American Cancer Society. Cancer facts and figures 2000. www.cancer.org.2001 (Accessed on March 08, 2005)</ref>

===Developed and Developing Countries===
*States closer to the equator, such as Hawaii and California, have a higher incidence of BCC compared to midwestern states<ref name="pmid2312827">{{cite journal| author=Chuang TY, Popescu A, Su WP, Chute CG| title=Basal cell carcinoma. A population-based incidence study in Rochester, Minnesota. | journal=J Am Acad Dermatol | year= 1990 | volume= 22 | issue= 3 | pages= 413-7 | pmid=2312827 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2312827 }} </ref><ref name="pmid8335736">{{cite journal| author=Reizner GT, Chuang TY, Elpern DJ, Stone JL, Farmer ER| title=Basal cell carcinoma in Kauai, Hawaii: the highest documented incidence in the United States. | journal=J Am Acad Dermatol | year= 1993 | volume= 29 | issue= 2 Pt 1 | pages= 184-9 | pmid=8335736 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8335736 }} </ref>

*An increasing incidence over time has also been noted in other countries, such as Canada, Finland, and Australia<ref name="pmid10411152">{{cite journal| author=Hannuksela-Svahn A, Pukkala E, Karvonen J| title=Basal cell skin carcinoma and other nonmelanoma skin cancers in Finland from 1956 through 1995. | journal=Arch Dermatol | year= 1999 | volume= 135 | issue= 7 | pages= 781-6 | pmid=10411152 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10411152 }} </ref><ref name="pmid8436431">{{cite journal| author=Marks R, Staples M, Giles GG| title=Trends in non-melanocytic skin cancer treated in Australia: the second national survey. | journal=Int J Cancer | year= 1993 | volume= 53 | issue= 4 | pages= 585-90 | pmid=8436431 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8436431 }} </ref><ref name="pmid16021129">{{cite journal| author=Demers AA, Nugent Z, Mihalcioiu C, Wiseman MC, Kliewer EV| title=Trends of nonmelanoma skin cancer from 1960 through 2000 in a Canadian population. | journal=J Am Acad Dermatol | year= 2005 | volume= 53 | issue= 2 | pages= 320-8 | pmid=16021129 | doi=10.1016/j.jaad.2005.03.043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16021129 }} </ref>
*Basal cell carcinoma (BCC) is the most common skin cancer among the Far-east Asian race<ref name="pmid20465642">{{cite journal| author=Yap FB| title=Clinical characteristics of basal cell carcinoma in a tertiary hospital in Sarawak, Malaysia. | journal=Int J Dermatol | year= 2010 | volume= 49 | issue= 2 | pages= 176-9 | pmid=20465642 | doi=10.1111/j.1365-4632.2009.04342.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20465642 }} </ref>
*Majority of Far-east Asian race are Chinese (44.2%), Malays (32.6%), Bidayuhs (14.0%), and Ibans (6.9%)<ref name="pmid20465642">{{cite journal| author=Yap FB| title=Clinical characteristics of basal cell carcinoma in a tertiary hospital in Sarawak, Malaysia. | journal=Int J Dermatol | year= 2010 | volume= 49 | issue= 2 | pages= 176-9 | pmid=20465642 | doi=10.1111/j.1365-4632.2009.04342.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20465642 }} </ref>

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma screening

2015-07-29T15:45:02Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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 Carcinoma Screening==
*The U.S. Preventive Services Task Force has found no evidence to recommend for or against screening<ref>{{cite journal|title=Screening for Skin Cancer: U.S. Preventive Services Task Force Recommendation Statement|journal=Annals of Internal Medicine|volume=150|issue=3|year=2009|pages=188|issn=0003-4819|doi=10.7326/0003-4819-150-3-200902030-00008}}</ref>.
:*Task Force members state that “clinicians should remain alert for skin lesions with malignant features noted in the context of physical examinations performed for other purposes,” and recognize that “even without formal screening programs, mortality from basal cell and squamous cell carcinoma is low compared with mortality from melanoma, but early detection and treatment may reduce morbidity and disfigurement from these cancers.”<ref>http://www.aafp.org/afp/2004/1015/p1481.html#afp20041015p1481-b22</ref>
*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

==References==

{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma screening

2015-07-29T15:44:16Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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 Carcinoma Screening==
*The U.S. Preventive Services Task Force has found no evidence to recommend for or against screening<ref>{{cite journal|title=Screening for Skin Cancer: U.S. Preventive Services Task Force Recommendation Statement|journal=Annals of Internal Medicine|volume=150|issue=3|year=2009|pages=188|issn=0003-4819|doi=10.7326/0003-4819-150-3-200902030-00008}}</ref>.
:*Nevertheless, the Task Force members state that “clinicians should remain alert for skin lesions with malignant features noted in the context of physical examinations performed for other purposes,” and recognize that “even without formal screening programs, mortality from basal cell and squamous cell carcinoma is low compared with mortality from melanoma, but early detection and treatment may reduce morbidity and disfigurement from these cancers.”<ref>http://www.aafp.org/afp/2004/1015/p1481.html#afp20041015p1481-b22</ref>
*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

==References==

{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma medical therapy

2015-07-28T20:14:09Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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.

==Basal Cell Carcinoma Medical Therapy==
After the suspicious lesion is evaluated, the medical therapy is divided into low-risk and high-risk basal cell carcinoma patients.

The table below summarizes the characteristics in low-risk and high-risk lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''H&P'''

| align="center" style="background:#f0f0f0;"|'''Low Risk'''

| align="center" style="background:#f0f0f0;"|'''High Risk'''

|-

| '''Location/size'''||Area L < 20 mm; Area M < 10 mm; Area H < 6 mm||Area L ≥ 20 mm; Area M ≥ 10 mm; Area H ≥ 6 mm

|-

| '''Borders'''||Well defined||Poorly defined

|-

| '''Primary vs. recurrent'''||Primary||Recurrent

|-

| '''Immunosuppression'''||(-)||(+)

|-

| '''Site of prior radiation therapy'''||(-)||(+)

|-

| '''Subtype'''||[[Nodular]], superficial||Aggressive growth pattern

|-

| '''Perineural involvement'''||(-)||(+)

|}

'''Area H''' = “mask areas” of face (central face, eyelids, eyebrows, periorbital, nose, lips [cutaneous and vermilion], chin, [[mandible]], preauricular and postauricular skin/sulci, temple, ear), [[genitalia]], hands, and feet

'''Area M''' = cheeks, forehead, scalp, neck, and pre-tibial area

'''Area L''' = trunk and extremities (excluding pre-tibial area, hands, feet, nail units, and ankles)

The algorithm below demonstrates a treatment protocol for '''low-risk''' lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Low Risk Basal Cell.jpg|800px]]

The algorithm below demonstrates a treatment protocol for '''high-risk''' lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Low Risk Basal Cell.jpg|800px]]

After the primary treatment, a follow-up is performed to evaluate for recurrence of the tumor.

The algorithm below demonstrates a follow-up protocol<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Followup Basal Cell.jpg|800px]]

Other medical therapy techniques include the following:
*'''Oral [[vismodegib]]''' - was approved by the FDA in January 2012 for adult patients with locally advanced basal cell carcinoma who are not candidates for surgery or radiation
*'''[[Radiotherapy]]''' - used in elderly patients with extensive lesions when surgery is inappropriate
*'''Topical [[photodynamic therapy]]''' - particularly for the management of superficial BCC that involves the application of a topical emulsion-based 5-aminolaevulinic acid
*'''[[Fluorouracil]]''' - particularly for the management of multiple superficial BCC on the trunk and limbs
*'''[[Imiquimod]]''' - particularly for the management of superficial BCC

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma overview

2015-07-28T19:56:33Z

Saarah Alkhairy:

{{Basal cell carcinoma}}
{{CMG}} {{AE}} 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.

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Basal cell carcinoma overview

2015-07-28T19:54:52Z

Saarah Alkhairy:

{{Basal cell carcinoma}}
{{CMG}}

==Overview==
In 1827, Jacob Arthur, reported the "rodent ulcer". In 1900, Edmund Krompecher, identified the histological features as an epithelial carcinoma. 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. The incidence increases with age and is higher in men. BCC is the most common in the Caucasian race. 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. They are fragile and may bleed easily. 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.

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma secondary prevention

2015-07-28T19:41:44Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
A skin [[biopsy]] and chemotherapeutic agents such as [[5-Fluorouracil]] or [[Imiquimod]] may prevent the further development of basal cell carcinoma.

==Basal Cell Carcinoma Secondary Prevention==
*Skin [[biopsy]]
To view the biopsy algorithm of a suspected lesion , click [[Basal cell carcinoma laboratory tests|'''here''']] 
*Chemotherapeutic agents such as [[5-Fluorouracil]] or [[Imiquimod]]
:*It is usually recommended to individuals with extensive sun damage, history of multiple skin cancers, or precancerous growths
:*It is often repeated every 2 to 3 years

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma surgery

2015-07-28T19:40:38Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and [[cryosurgery]].

==Basal Cell Carcinoma Surgery==
Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and [[cryosurgery]].

===Electrodesiccation and Curettage===
A curette is used to remove the tumor away from adjacent normal skin. Curetting is often followed by electrodesiccation, and the entire process may be repeated 1-2 more times. lectrodesiccation and curettage is a brief procedure and is effective in treating primary nodular and superficial basal cell carcinoma. The disadvantage of this procedure is it leaves a white, [[atrophic]] scar<ref name="pmid1820764">{{cite journal| author=Silverman MK, Kopf AW, Grin CM, Bart RS, Levenstein MJ|title=Recurrence rates of treated basal cell carcinomas. Part 2: Curettage-electrodesiccation. | journal=J Dermatol Surg Oncol | year= 1991 | volume= 17 | issue= 9 | pages= 720-6 | pmid=1820764 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1820764 }} </ref>.

===Surgical Excision===
Surgical excision is performed to remove and examine the specimen under a microscope. The larger mount of skin that is removed, the higher the cure rate. Normally, 3-4 mm margins of normal skin are removed. Although surgical excision is more time-consuming and costly compared to curettage, it produces cure rates as high as 95%<ref name="pmid9723063">{{cite journal| author=Grabski WJ, Salasche SJ| title=Positive surgical excision margins of a basal cell carcinoma. |journal=Dermatol Surg | year= 1998 | volume= 24 | issue= 8 | pages= 921-4 | pmid=9723063 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9723063 }} </ref>.

===Mohs Micrographic Surgery===
Mohs surgery involves removal of the tumor and a thin rim of normal-appearing skin<ref name="pmid15270883">{{cite journal| author=Smeets NW, Kuijpers DI, Nelemans P, Ostertag JU, Verhaegh ME, Krekels GA et al.| title=Mohs' micrographic surgery for treatment of basal cell carcinoma of the face--results of a retrospective study and review of the literature. | journal=Br J Dermatol | year= 2004 | volume= 151 | issue= 1 | pages= 141-7 | pmid=15270883 | doi=10.1111/j.1365-2133.2004.06047.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15270883 }} </ref>. Mohs micrographic surgery is indicated for the following:
*Tumors with poorly defined clinical borders
*Tumors with diameters > 1 cm located anywhere on the face
*Tumors with diameters > 2 cm located in areas other than the face
*Tumors with infiltrative or morpheaform/sclerotic histopathologic patterns
*Tumors arising in regions where a good cosmetic outcome is important

===Cryosurgery===
Cryosurgery may be considered for small, clinically well-defined primary tumors. This procedure is especially useful for patients who are debilitated with medical conditions. [[Liquid nitrogen]] is applied to the tumor, the treatment stops when the temperature reaches -60°C<ref name="pmid17642878">{{cite journal| author=Kaur S, Thami GP, Kanwar AJ| title=Basal cell carcinoma--treatment with cryosurgery. | journal=Indian J Dermatol Venereol Leprol | year= 2003 | volume= 69 | issue= 2 |pages= 188-90 | pmid=17642878 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17642878 }} </ref>.

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma medical therapy

2015-07-28T19:38:42Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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.

==Basal Cell Carcinoma Medical Therapy==
After the suspicious lesion is evaluated, the medical therapy is divided into low-risk and high-risk basal cell carcinoma patients.

The table below summarizes the characteristics in low-risk and high-risk lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''H&P'''

| align="center" style="background:#f0f0f0;"|'''Low Risk'''

| align="center" style="background:#f0f0f0;"|'''High Risk'''

|-

| '''Location/size'''||Area L <20 mm; Area M <10 mm; Area H <6 mm||Area L ≥20 mm; Area M ≥10 mm; Area H ≥6 mm

|-

| '''Borders'''||Well defined||Poorly defined

|-

| '''Primary vs. recurrent'''||Primary||Recurrent

|-

| '''Immunosuppression'''||(-)||(+)

|-

| '''Site of prior radiation therapy'''||(-)||(+)

|-

| '''Subtype'''||[[Nodular]], superficial||Aggressive growth pattern

|-

| '''Perineural involvement'''||(-)||(+)

|}

'''Area H''' = “mask areas” of face (central face, eyelids, eyebrows, periorbital, nose, lips [cutaneous and vermilion], chin, [[mandible]], preauricular and postauricular skin/sulci, temple, ear), [[genitalia]], hands, and feet

'''Area M''' = cheeks, forehead, scalp, neck, and pre-tibial area

'''Area L''' = trunk and extremities (excluding pre-tibial area, hands, feet, nail units, and ankles)

The algorithm below demonstrates a treatment protocol for '''low-risk''' lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Low Risk Basal Cell.jpg|800px]]

The algorithm below demonstrates a treatment protocol for '''high-risk''' lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Low Risk Basal Cell.jpg|800px]]

After the primary treatment, a follow-up is performed to evaluate for recurrence of the tumor.

The algorithm below demonstrates a follow-up protocol<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Followup Basal Cell.jpg|800px]]

Other medical therapy techniques include the following:
*'''Oral [[vismodegib]]''' - was approved by the FDA in January 2012 for adult patients with locally advanced basal cell carcinoma who are not candidates for surgery or radiation
*'''[[Radiotherapy]]''' - used in elderly patients with extensive lesions when surgery is inappropriate
*'''Topical photodynamic therapy''' - particularly for the management of superficial BCC that involves the application of a topical emulsion-based 5-aminolaevulinic acid
*'''[[Fluorouracil]]''' - particularly for the management of multiple superficial BCC on the trunk and limbs
*'''[[Imiquimod]]''' - particularly for the management of superficial BCC

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma history and symptoms

2015-07-28T19:36:34Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
The history and symptoms of basal cell carcinoma include skin growths on sun-exposed skin. They are fragile and may bleed easily.

==Basal Cell Carcinoma History and Symptoms==
Basal cell carcinoma develops on areas that are exposed to the sun, particularly the head and neck. These tumors are fragile and may bleed easily.

The appearance of these tumors can be any of the following:
*Flat, firm, pale/yellow areas
*Raised reddish patches that may be itchy
*Small, pink/red, [[translucent]], shiny, pearly bumps, which might have blue, brown, or black areas
*Pink growths with raised edges and a lower area in their center
*Open sores that don’t heal, or that heal and reappear

==References==

{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma laboratory tests

2015-07-28T19:35:37Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
The laboratory tests of basal cell carcinoma consist of a biopsy and visualization of its histological findings.

==Basal cell Carcinoma Laboratory Tests==

===Biopsy===
A skin [[biopsy]] can prove the diagnosis of basal cell carcinoma. An excisional or punch biopsy can visualize the depth of the tumor.

The algorithm below demonstrates a biopsy protocol for patients with a suspected [[lesion]]<ref>http://www.aafp.org/afp/2004/1015/p1481.html</ref>.
[[Image:Biopsy BCC.jpg|800px]]

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma other diagnostic studies

2015-07-28T19:34:50Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
[[CT scans]] and [[radiography]] may be performed if there is involvement of deeper structures, such as the bone.

==Other Diagnostic Studies==
[[CT scans]] and [[radiography]] may be performed if there is involvement of deeper structures, such as the bone.

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma natural history

2015-07-28T19:33:34Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Basal cell carcinoma is slow-growing and locally invasive. Common complications of BCC include reoccurrence and development of other types of skin cancer.

==Natural History==
*Basal cell carcinoma is slow-growing and locally invasive
*The overall risk of [[metastases]] is estimated to be less than 0.1%
*The risk of invasion and recurrence is based on size, duration, location and subtype (sclerodermiform/morpheaform and micronodular clinical variants have a higher risk)
*Even without a recurrence, a personal history of basal cell carcinoma increases the risk of developing all types of skin cancer by about 40% in five years<ref>Fauci AS, Braunwald E, Kasper DL, et al. Harrison’s Principles of Internal Medicine, 17th ed. McGraw-Hill, New York 2008</ref>

==Complications==
Complications of basal cell carcinoma are the following:
*Reoccurrence
*Development of other types of skin cancer
*[[Metastasis]]
*[[Ovarian]] [[calcification]] or [[fibroma]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Medulloblastoma<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Cardiac fibroma<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Cleft palate<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Ophthalmic abnormalities such as squint or cataract<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>

==Prognosis==
Although basal cell carcinoma rarely [[metastasis|metastasizes]], it grows locally with invasion and destruction of local tissues, without stopping. The cancer can impinge on vital structures and result in loss of extension or loss of function or rarely death. The vast majority of cases can be successfully treated before serious complications occur. The recurrence rate for the above treatment options ranges from 50% to 1% or less.

In choosing the therapy, one must weigh the benefit gained from the morbidity of the procedure. As most basal cell carcinomas are slow growing, and not deadly; the health and age of the patient must be considered. Although difficult to discuss, radiation therapy, topical [[chemotherapy]], or no treatment at all should be considered in ill or frail individuals in difficult to excise tumor of no immediate harm to the individual. While methods with the highest cure rate should be considered for young and healthy individuals with long life expectancy.

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma natural history

2015-07-28T19:32:59Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Basal Cell Carcinoma is slow-growing and locally invasive. Common complications of BCC include reoccurrence and development of other types of skin cancer.

==Natural History==
*Basal Cell Carcinoma is slow-growing and locally invasive
*The overall risk of [[metastases]] is estimated to be less than 0.1%
*The risk of invasion and recurrence is based on size, duration, location and subtype (sclerodermiform/morpheaform and micronodular clinical variants have a higher risk)
*Even without a recurrence, a personal history of basal cell carcinoma increases the risk of developing all types of skin cancer by about 40% in five years<ref>Fauci AS, Braunwald E, Kasper DL, et al. Harrison’s Principles of Internal Medicine, 17th ed. McGraw-Hill, New York 2008</ref>

==Complications==
Complications of basal cell carcinoma are the following:
*Reoccurrence
*Development of other types of skin cancer
*[[Metastasis]]
*[[Ovarian]] [[calcification]] or [[fibroma]]<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Medulloblastoma<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Cardiac fibroma<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Cleft palate<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>
*Ophthalmic abnormalities such as squint or cataract<ref name="EvansLadusans1993">{{cite journal|last1=Evans|first1=D G|last2=Ladusans|first2=E J|last3=Rimmer|first3=S|last4=Burnell|first4=L D|last5=Thakker|first5=N|last6=Farndon|first6=P A|title=Complications of the naevoid basal cell carcinoma syndrome: results of a population based study.|journal=Journal of Medical Genetics|volume=30|issue=6|year=1993|pages=460–464|issn=1468-6244|doi=10.1136/jmg.30.6.460}}</ref>

==Prognosis==
Although basal cell carcinoma rarely [[metastasis|metastasizes]], it grows locally with invasion and destruction of local tissues, without stopping. The cancer can impinge on vital structures and result in loss of extension or loss of function or rarely death. The vast majority of cases can be successfully treated before serious complications occur. The recurrence rate for the above treatment options ranges from 50% to 1% or less.

In choosing the therapy, one must weigh the benefit gained from the morbidity of the procedure. As most basal cell carcinomas are slow growing, and not deadly; the health and age of the patient must be considered. Although difficult to discuss, radiation therapy, topical [[chemotherapy]], or no treatment at all should be considered in ill or frail individuals in difficult to excise tumor of no immediate harm to the individual. While methods with the highest cure rate should be considered for young and healthy individuals with long life expectancy.

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Basal cell carcinoma screening

2015-07-28T19:31:34Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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 Carcinoma Screening==
*The U.S. Preventive Services Task Force has found no evidence to recommend for or against screening<ref>{{cite journal|title=Screening for Skin Cancer: U.S. Preventive Services Task Force Recommendation Statement|journal=Annals of Internal Medicine|volume=150|issue=3|year=2009|pages=188|issn=0003-4819|doi=10.7326/0003-4819-150-3-200902030-00008}}</ref>.
*Nevertheless, the Task Force members state that “clinicians should remain alert for skin lesions with malignant features noted in the context of physical examinations performed for other purposes,” and recognize that “even without formal screening programs, mortality from basal cell and squamous cell carcinoma is low compared with mortality from melanoma, but early detection and treatment may reduce morbidity and disfigurement from these cancers.”<ref>http://www.aafp.org/afp/2004/1015/p1481.html#afp20041015p1481-b22</ref>
*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

==References==

{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma risk factors

2015-07-28T19:30:46Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
There are many causes associated with basal cell carcinoma such as sunlight, gene mutations, and other conditions, for example, [[xeroderma pigmentosum]].

==Basal Cell Carcinoma Risk Factors==
There are some environmental and genetic risk factors that may predispose to basal cell carcinoma.

The following table summarizes the causes of basal cell carcinoma (BCC):
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Risk Factor'''

| align="center" style="background:#f0f0f0;"|'''Description'''

|-

| '''Radiation exposure'''||Sunlight (UV light), tanning beds, and x-rays exposure are associated with basal cell carcinoma formation<ref name="pmid15737190">{{cite journal| author=Lim JL, Stern RS| title=High levels of ultraviolet B exposure increase the risk of non-melanoma skin cancer in psoralen and ultraviolet A-treated patients. | journal=J Invest Dermatol | year= 2005 | volume= 124 | issue= 3 | pages= 505-13 | pmid=15737190 | doi=10.1111/j.0022-202X.2005.23618.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15737190}}</ref>

|-

| '''Gene mutations'''||TP53 gene mutations and the inappropriate activation of the [[hedgehog signaling pathway]] (loss-of-function mutations in tumor-suppressor protein patched homologue 1 ([[PTCH1]]) and gain-of-function mutations in sonic hedgehog (SHH), smoothened (SMO), and Gli) are associated with basal cell carcinoma<ref name="pmid20546211">{{cite journal| author=de Zwaan SE, Haass NK| title=Genetics of basal cell carcinoma. | journal=Australas J Dermatol | year= 2010 | volume= 51 | issue= 2 | pages= 81-92; quiz 93-4 | pmid=20546211 | doi=10.1111/j.1440-0960.2009.00579.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20546211 }} </ref>

|-
| '''Physical features'''||Red/blonde hair, blue/green eyes, freckling, and skin types I and II (skin that always burns and never/only sometimes tans)<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-
| '''Albinism'''||[[Albinism]] is associated with an increased risk for basal cell carcinoma<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-
| '''Gender'''||The male gender is associated with an increased risk for basal cell carcinoma<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-
| '''Xeroderma pigmentosum'''||This an [[autosomal recessive]] disorder; it results in the inability to repair ultraviolet-induced DNA damage; pigmentary changes are seen early in life, followed by the development of basal cell carcinoma, [[squamous cell carcinoma]], and [[malignant melanoma]]; other features include corneal opacities, eventual blindness, and neurological deficits<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-

| '''Epidermodysplastic verruciformis'''||Epidermodysplastic verruciformis is an autosomal recessive disorder characterized by the development of basal cell carcinoma and squamous cell carcinoma from warts ([[human papillomavirus]] infection)<ref name="pmid15149508">{{cite journal| author=Harwood CA, Surentheran T, Sasieni P, Proby CM, Bordea C, Leigh IM et al.| title=Increased risk of skin cancer associated with the presence of epidermodysplasia verruciformis human papillomavirus types in normal skin. | journal=Br J Dermatol | year= 2004 | volume= 150 | issue= 5 | pages= 949-57 | pmid=15149508 | doi=10.1111/j.1365-2133.2004.05847.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15149508 }} </ref>

|-

| '''Nevoid basal cell carcinoma syndrome'''||This is an [[autosomal dominant]] disorder that can result in basal cell carcinomas, multiple odontogenic keratocysts, palmoplantar pitting, [[intracranial calcification]], and rib anomalies<ref name="pmid10355946">{{cite journal| author=Cohen MM| title=Nevoid basal cell carcinoma syndrome: molecular biology and new hypotheses. | journal=Int J Oral Maxillofac Surg | year= 1999 | volume= 28 | issue= 3 | pages= 216-23 | pmid=10355946 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10355946}}</ref>

|-

| '''Bazex Syndrome'''||The features of Bazex syndrome include follicular atrophoderma, multiple basal cell carcinomas, and local [[anhidrosis]]<ref>Centers for Disease Control and Prevention (CDC). Sunburn prevalence among adults--United States, 1999, 2003, and 2004. MMWR Morb Mortal Wkly Rep. 2007 Jun 1. 56(21):524-8</ref>

|-

| '''Rombo syndrome'''||Rombo syndrome is an [[autosomal dominant]] condition distinguished by basal cell carcinoma and atrophoderma vermiculatum, trichoepitheliomas, [[hypotrichosis]] milia, and peripheral [[vasodilation]] with [[cyanosis]]<ref name="pmid6177160">{{cite journal| author=Michaëlsson G, Olsson E, Westermark P| title=The Rombo syndrome: a familial disorder with vermiculate atrophoderma, milia, hypotrichosis, trichoepitheliomas, basal cell carcinomas and peripheral vasodilation with cyanosis. | journal=Acta Derm Venereol | year= 1981 | volume= 61 | issue= 6 | pages= 497-503 | pmid=6177160 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6177160 }} </ref>

|}

Other risk factors for the development of basal cell carcinoma are the following<ref>http://www.cancercare.on.ca/pdf/pebc15-1s.pdf</ref>:
*Current immunosuppressive therapy after organ transplantation
*Personal history of skin cancer
*Two or more first-degree relatives with [[melanoma]]
*Total of 100 nevi or at least five atypical (dysplastic) [[nevi]]
*More than 250 treatments with psoralen plus ultraviolet A (UVA) therapy for [[psoriasis]]
*Radiation therapy for cancer as a child

==References==

{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma risk factors

2015-07-28T19:30:06Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
There are many causes associated with basal cell carcinoma such as sunlight, gene mutations, and other conditions, for example, xeroderma pigmentosum.

==Basal Cell Carcinoma Risk Factors==
There are some environmental and genetic risk factors that may predispose to basal cell carcinoma.

The following table summarizes the causes of basal cell carcinoma (BCC):
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Risk Factor'''

| align="center" style="background:#f0f0f0;"|'''Description'''

|-

| '''Radiation exposure'''||Sunlight (UV light), tanning beds, and x-rays exposure are associated with basal cell carcinoma formation<ref name="pmid15737190">{{cite journal| author=Lim JL, Stern RS| title=High levels of ultraviolet B exposure increase the risk of non-melanoma skin cancer in psoralen and ultraviolet A-treated patients. | journal=J Invest Dermatol | year= 2005 | volume= 124 | issue= 3 | pages= 505-13 | pmid=15737190 | doi=10.1111/j.0022-202X.2005.23618.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15737190}}</ref>

|-

| '''Gene mutations'''||TP53 gene mutations and the inappropriate activation of the [[hedgehog signaling pathway]] (loss-of-function mutations in tumor-suppressor protein patched homologue 1 ([[PTCH1]]) and gain-of-function mutations in sonic hedgehog (SHH), smoothened (SMO), and Gli) are associated with basal cell carcinoma<ref name="pmid20546211">{{cite journal| author=de Zwaan SE, Haass NK| title=Genetics of basal cell carcinoma. | journal=Australas J Dermatol | year= 2010 | volume= 51 | issue= 2 | pages= 81-92; quiz 93-4 | pmid=20546211 | doi=10.1111/j.1440-0960.2009.00579.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20546211 }} </ref>

|-
| '''Physical features'''||Red/blonde hair, blue/green eyes, freckling, and skin types I and II (skin that always burns and never/only sometimes tans)<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-
| '''Albinism'''||[[Albinism]] is associated with an increased risk for basal cell carcinoma<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-
| '''Gender'''||The male gender is associated with an increased risk for basal cell carcinoma<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-
| '''Xeroderma pigmentosum'''||This an [[autosomal recessive]] disorder; it results in the inability to repair ultraviolet-induced DNA damage; pigmentary changes are seen early in life, followed by the development of basal cell carcinoma, [[squamous cell carcinoma]], and [[malignant melanoma]]; other features include corneal opacities, eventual blindness, and neurological deficits<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-

| '''Epidermodysplastic verruciformis'''||Epidermodysplastic verruciformis is an autosomal recessive disorder characterized by the development of basal cell carcinoma and squamous cell carcinoma from warts ([[human papillomavirus]] infection)<ref name="pmid15149508">{{cite journal| author=Harwood CA, Surentheran T, Sasieni P, Proby CM, Bordea C, Leigh IM et al.| title=Increased risk of skin cancer associated with the presence of epidermodysplasia verruciformis human papillomavirus types in normal skin. | journal=Br J Dermatol | year= 2004 | volume= 150 | issue= 5 | pages= 949-57 | pmid=15149508 | doi=10.1111/j.1365-2133.2004.05847.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15149508 }} </ref>

|-

| '''Nevoid basal cell carcinoma syndrome'''||This is an [[autosomal dominant]] disorder that can result in basal cell carcinomas, multiple odontogenic keratocysts, palmoplantar pitting, [[intracranial calcification]], and rib anomalies<ref name="pmid10355946">{{cite journal| author=Cohen MM| title=Nevoid basal cell carcinoma syndrome: molecular biology and new hypotheses. | journal=Int J Oral Maxillofac Surg | year= 1999 | volume= 28 | issue= 3 | pages= 216-23 | pmid=10355946 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10355946}}</ref>

|-

| '''Bazex Syndrome'''||The features of Bazex syndrome include follicular atrophoderma, multiple basal cell carcinomas, and local [[anhidrosis]]<ref>Centers for Disease Control and Prevention (CDC). Sunburn prevalence among adults--United States, 1999, 2003, and 2004. MMWR Morb Mortal Wkly Rep. 2007 Jun 1. 56(21):524-8</ref>

|-

| '''Rombo syndrome'''||Rombo syndrome is an [[autosomal dominant]] condition distinguished by basal cell carcinoma and atrophoderma vermiculatum, trichoepitheliomas, [[hypotrichosis]] milia, and peripheral [[vasodilation]] with [[cyanosis]]<ref name="pmid6177160">{{cite journal| author=Michaëlsson G, Olsson E, Westermark P| title=The Rombo syndrome: a familial disorder with vermiculate atrophoderma, milia, hypotrichosis, trichoepitheliomas, basal cell carcinomas and peripheral vasodilation with cyanosis. | journal=Acta Derm Venereol | year= 1981 | volume= 61 | issue= 6 | pages= 497-503 | pmid=6177160 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6177160 }} </ref>

|}

Other risk factors for the development of basal cell carcinoma are the following<ref>http://www.cancercare.on.ca/pdf/pebc15-1s.pdf</ref>:
*Current immunosuppressive therapy after organ transplantation
*Personal history of skin cancer
*Two or more first-degree relatives with melanoma
*Total of 100 nevi or at least five atypical (dysplastic) nevi
*More than 250 treatments with psoralen plus ultraviolet A (UVA) therapy for [[psoriasis]]
*Radiation therapy for cancer as a child

==References==

{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma differential diagnosis

2015-07-28T19:26:22Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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]].

==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>:
{| {{table}}

| align="center" style="background:#f0f0f0;"|'''Disease or Condition'''

| align="center" style="background:#f0f0f0;"|'''Differentiating Signs and Symptoms'''

| align="center" style="background:#f0f0f0;"|'''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)<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>

|-

| '''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

|-

| '''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

|-

| '''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}}
| align="center" style="background:#f0f0f0;"|'''Clinical Variant'''

| align="center" style="background:#f0f0f0;"|'''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==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma differential diagnosis

2015-07-28T19:25:19Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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]].

==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>:
{| {{table}}

| align="center" style="background:#f0f0f0;"|'''Disease or Condition'''

| align="center" style="background:#f0f0f0;"|'''Differentiating Signs and Symptoms'''

| align="center" style="background:#f0f0f0;"|'''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)<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>

|-

| '''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

|-

| '''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

|-

| '''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}}
| align="center" style="background:#f0f0f0;"|'''Clinical Variant'''

| align="center" style="background:#f0f0f0;"|'''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==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma causes

2015-07-28T19:22:51Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
There are many causes associated with basal cell carcinoma such as sunlight, gene mutations, and other conditions, for example, [[xeroderma pigmentosum]].

==Basal Cell Carcinoma Causes==
Although the exact cause is unknown, there are some environmental and genetic factors that may predispose to basal cell carcinoma.

The following table summarizes the causes of basal cell carcinoma (BCC):
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Cause'''

| align="center" style="background:#f0f0f0;"|'''Description'''

|-

| '''Radiation exposure'''||Sunlight (UV light), tanning beds, and x-rays exposure are associated with basal cell carcinoma formation<ref name="pmid15737190">{{cite journal| author=Lim JL, Stern RS| title=High levels of ultraviolet B exposure increase the risk of non-melanoma skin cancer in psoralen and ultraviolet A-treated patients. | journal=J Invest Dermatol | year= 2005 | volume= 124 | issue= 3 | pages= 505-13 | pmid=15737190 | doi=10.1111/j.0022-202X.2005.23618.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15737190}}</ref>

|-

| '''Gene mutations'''||TP53 gene mutations and the inappropriate activation of the [[hedgehog signaling pathway]] (loss-of-function mutations in tumor-suppressor protein patched homologue 1 ([[PTCH1]]) and gain-of-function mutations in sonic hedgehog (SHH), smoothened (SMO), and Gli) are associated with basal cell carcinoma<ref name="pmid20546211">{{cite journal| author=de Zwaan SE, Haass NK| title=Genetics of basal cell carcinoma. | journal=Australas J Dermatol | year= 2010 | volume= 51 | issue= 2 | pages= 81-92; quiz 93-4 | pmid=20546211 | doi=10.1111/j.1440-0960.2009.00579.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20546211 }} </ref>

|-

| '''Xeroderma pigmentosum'''||This an autosomal recessive disorder; it results in the inability to repair ultraviolet-induced DNA damage; pigmentary changes are seen early in life, followed by the development of basal cell carcinoma, [[squamous cell carcinoma]], and [[malignant melanoma]]; other features include corneal opacities, eventual blindness, and neurological deficits<ref name="LearSmith1997">{{cite journal|last1=Lear|first1=J. T.|last2=Smith|first2=A. G.|title=Basal cell carcinoma.|journal=Postgraduate Medical Journal|volume=73|issue=863|year=1997|pages=538–542|issn=0032-5473|doi=10.1136/pgmj.73.863.538}}</ref>

|-

| '''Epidermodysplastic verruciformis'''||Epidermodysplastic verruciformis is an [[autosomal recessive]] disorder characterized by the development of basal cell carcinoma and [[squamous cell carcinoma]] from warts ([[human papillomavirus]] infection)<ref name="pmid15149508">{{cite journal| author=Harwood CA, Surentheran T, Sasieni P, Proby CM, Bordea C, Leigh IM et al.| title=Increased risk of skin cancer associated with the presence of epidermodysplasia verruciformis human papillomavirus types in normal skin. | journal=Br J Dermatol | year= 2004 | volume= 150 | issue= 5 | pages= 949-57 | pmid=15149508 | doi=10.1111/j.1365-2133.2004.05847.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15149508 }} </ref>

|-

| '''Nevoid basal cell carcinoma syndrome'''||This is an [[autosomal dominant]] disorder that can result in basal cell carcinomas, multiple odontogenic keratocysts, palmoplantar pitting, intracranial calcification, and rib anomalies<ref name="pmid10355946">{{cite journal| author=Cohen MM| title=Nevoid basal cell carcinoma syndrome: molecular biology and new hypotheses. | journal=Int J Oral Maxillofac Surg | year= 1999 | volume= 28 | issue= 3 | pages= 216-23 | pmid=10355946 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10355946}}</ref>

|-

| '''Bazex Syndrome'''||The features of Bazex syndrome include follicular atrophoderma, multiple basal cell carcinomas, and local [[anhidrosis]]<ref>Centers for Disease Control and Prevention (CDC). Sunburn prevalence among adults--United States, 1999, 2003, and 2004. MMWR Morb Mortal Wkly Rep. 2007 Jun 1. 56(21):524-8</ref>

|-

| '''Rombo syndrome'''||Rombo syndrome is an [[autosomal dominant]] condition distinguished by basal cell carcinoma and atrophoderma vermiculatum, trichoepitheliomas, hypotrichosis milia, and peripheral [[vasodilation]] with [[cyanosis]]<ref name="pmid6177160">{{cite journal| author=Michaëlsson G, Olsson E, Westermark P| title=The Rombo syndrome: a familial disorder with vermiculate atrophoderma, milia, hypotrichosis, trichoepitheliomas, basal cell carcinomas and peripheral vasodilation with cyanosis. | journal=Acta Derm Venereol | year= 1981 | volume= 61 | issue= 6 | pages= 497-503 | pmid=6177160 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6177160 }} </ref>

|}

==References==

{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma pathophysiology

2015-07-28T19:19:59Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}};{{AE}}{{SM}}

==Overview==
Basal cell carcinomas develop in the [[basal cell layer]] of the [[skin]]. Cumulative DNA damage leads to [[mutation]]s, after sunlight exposure.

==Pathophysiology==
Basal cell carcinomas develop in the [[basal cell layer]] of the [[skin]]. Sunlight exposure leads to the formation of [[thymine dimer]]s, a form of DNA damage.

While [[DNA repair]] removes most UV-induced damage, not all crosslinks are excised. There is, therefore, cumulative DNA damage leading to [[mutation]]s. Apart from the mutagenesis, sunlight depresses the local [[immune system]], possibly decreasing immune surveillance for new tumor cells.

Basal-cell carcinoma also develops as a result of basal-cell nevus syndrome, or Gorlin's syndrome, which is also characterized by odontogenic keratocysts of the jaw, palmar or plantar (sole of the foot) pits, calcification of the [[falx cerebri]] (in the center line of the brain) and rib abnormalities.

The cause of the syndrome is a mutation in the [[PTCH1]] tumor-suppressor gene at chromosome 9q22.3, which inhibits the [[hedgehog signaling pathway]]. A mutation in the [[smoothened|SMO]] gene, which is also on the hedgehog pathway, also causes basal-cell carcinoma.<ref>{{cite journal |author=Epstein EH, Shepard JA, Flotte TJ |title=Case records of the Massachusetts General Hospital. Case 3-2008. An 80-year-old woman with cutaneous basal-cell carcinomas and cysts of the jaws |journal=N Engl J Med |volume=358 |issue=4 |pages=393–401 |year=2008 |month=Jan |pmid=18216361 |doi=10.1056/NEJMcpc0707893 |url=}}</ref>
===Gross Pathology===
Basal cell carcinoma in a 75 year old male.

[[Image:Basalioma.jpg‎|200px]]

===Microscopic Pathology===
Shown below is a classic micrograph of basal cell carcinoma(H&E stain).The features seen are:
*Peripheral palisading
*Myxoid stroma
*Artefactual clefting
[[Image:Basal_cell_carcinoma_-_2_-_intermed_mag.jpg‎|center|200px]]

Shown below is the image of nodular variant of Basal cell carcinoma
[[Image:basal cell carcinoma pathology.jpg|center|200px]]

===Video===
{{#ev:youtube|JnJXrFnvOKs}}

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma classification

2015-07-28T19:15:01Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
The classification of basal cell carcinoma (BCC) is divided into many clinical variants.

==Basal Cell Carcinoma Classification==
The following table summarizes the classification of the clinical variants of basal cell carcinoma (BCC)<ref name="DourmishevRusinova2013">{{cite journal|last1=Dourmishev|first1=LyubomirA|last2=Rusinova|first2=Darena|last3=Botev|first3=Ivan|title=Clinical variants, stages, and management of basal cell carcinoma|journal=Indian Dermatology Online Journal|volume=4|issue=1|year=2013|pages=12|issn=2229-5178|doi=10.4103/2229-5178.105456}}</ref>:
{| {{table}}

| align="center" style="background:#f0f0f0;"|'''Clinical Variants'''

| align="center" style="background:#f0f0f0;"|'''Description'''

|-

| '''Nodular BCC'''||Comprises about 60-80% of cases; most commonly found on the skin of the head; clinically: elevated, exophytic pearl-shaped nodules with [[telangiectasias]] on the surface and periphery; histologically: nest-like infiltration from basaloid cells

|-

| '''Cystic BCC'''||≥ 1 cystic node with different sizes located peripherally to the centrally placed [[tumor]] nests

|-

| '''Sclerodermiform (morpheiform) BCC'''||The tumor cells are surrounded by fibrotic stroma; clinically: infiltrated plaque with a slightly shining surface and not well-defined borders; immunochemistry: expression of smooth muscle alpha-actin

|-

| '''Infiltrated BCC'''||Most common found on the upper part of the trunk or face; clinically: whitish, compact, not well-defined plaque; histologically: thin, nest-like bundles of basaloid cells infiltrating in the dermal [[collagenous]] fibers

|-

| '''Micronodular BCC'''||Most commonly found on the skin of the back; clinically: may be flat or elevated; yellow-whitish color when flat, clear outlines and thick at palpation; histologically: small rounded nodules of basaloid cells and minimal palisading

|-

| '''Superficial BCC'''||Comprises about 10-30% of cases; clinically: erythematous squamous plaque with clear borders, pearl-shape edge, superficial erosion, without tendencies for invasive growth; histologically: nests of basaloid cells located subepidermally, connection with the basal layer of the epidermis and no infiltration of tumor cells in the reticular dermis

|-

| '''Pigment BCC'''||The color varies from dark brown to black; clinically: nodular, micronodular, multifocal, supercial; histologically: nests of basaloid cells, melanocytes and melanophages, moderate [[inflammatory]] infiltrate

|-

| '''Fibroepithelioma of Pinkus'''||Most commonly on the skin of the back; affects women especially; clinically: elevated pink or [[erythematous]] nodules; histologically: trabecular, elongated, and branched thin strands of basaloid cells

|}

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma historical perspective

2015-07-28T19:11:34Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
In 1827, Jacob Arthur, reported the "rodent ulcer". In 1900, Edmund Krompecher, identified the histological features as an [[epithelial]] [[carcinoma]].

==Basal Cell Carcinoma Historical Perspective==
*In 1827, Jacob Arthur, an Irish [[ophthalmologist]], reported a difficult-to-eradicate lesion. He coined the term "rodent ulcer". Rodent ulcer's are also known as an ulcerating basal cell carcinoma<ref name="NetscherSpira2004">{{cite journal|last1=Netscher|first1=David T.|last2=Spira|first2=Melvin|title=Basal Cell Carcinoma: An Overview of Tumor Biology and Treatment|journal=Plastic and Reconstructive Surgery|volume=113|issue=5|year=2004|pages=74e–94e|issn=0032-1052|doi=10.1097/01.PRS.0000113025.69154.D1}}</ref>.
*In 1900, Edmund Krompecher, a German physician, identified the features of the rodent ulcer as an [[epithelial]] [[carcinoma]]<ref name="NetscherSpira2004">{{cite journal|last1=Netscher|first1=David T.|last2=Spira|first2=Melvin|title=Basal Cell Carcinoma: An Overview of Tumor Biology and Treatment|journal=Plastic and Reconstructive Surgery|volume=113|issue=5|year=2004|pages=74e–94e|issn=0032-1052|doi=10.1097/01.PRS.0000113025.69154.D1}}</ref>.
*The number of cases of basal cell carcinoma doubled between 1970 and 1986<ref name="NetscherSpira2004">{{cite journal|last1=Netscher|first1=David T.|last2=Spira|first2=Melvin|title=Basal Cell Carcinoma: An Overview of Tumor Biology and Treatment|journal=Plastic and Reconstructive Surgery|volume=113|issue=5|year=2004|pages=74e–94e|issn=0032-1052|doi=10.1097/01.PRS.0000113025.69154.D1}}</ref>.

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma medical therapy

2015-07-28T19:01:21Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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.

==Basal Cell Carcinoma Medical Therapy==
After the suspicious lesion is evaluated, the medical therapy is divided into low-risk and high-risk basal cell carcinoma patients.

The table below summarizes the characteristics in low-risk and high-risk lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''H&P'''

| align="center" style="background:#f0f0f0;"|'''Low Risk'''

| align="center" style="background:#f0f0f0;"|'''High Risk'''

|-

| '''Location/size'''||Area L <20 mm; Area M <10 mm; Area H <6 mm||Area L ≥20 mm; Area M ≥10 mm; Area H ≥6 mm

|-

| '''Borders'''||Well defined||Poorly defined

|-

| '''Primary vs. recurrent'''||Primary||Recurrent

|-

| '''Immunosuppression'''||(-)||(+)

|-

| '''Site of prior radiation therapy'''||(-)||(+)

|-

| '''Subtype'''||Nodular, superficial||Aggressive growth pattern

|-

| '''Perineural involvement'''||(-)||(+)

|}

'''Area H''' = “mask areas” of face (central face, eyelids, eyebrows, periorbital, nose, lips [cutaneous and vermilion], chin, mandible, preauricular and postauricular skin/sulci, temple, ear), genitalia, hands, and feet

'''Area M''' = cheeks, forehead, scalp, neck, and pre tibia

'''Area L''' = trunk and extremities (excluding pretibia, hands, feet, nail units, and ankles)

The algorithm below demonstrates a treatment protocol for '''low-risk''' lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Low Risk Basal Cell.jpg|800px]]

The algorithm below demonstrates a treatment protocol for '''high-risk''' lesions<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Low Risk Basal Cell.jpg|800px]]

After the primary treatment, a follow-up is performed to evaluate for recurrence of the tumor.

The algorithm below demonstrates a follow-up protocol<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.

[[Image:Followup Basal Cell.jpg|800px]]

Other medical therapy techniques include the following:
*'''Oral vismodegib''' - was approved by the FDA in January 2012 for adult patients with locally advanced basal cell carcinoma who are not candidates for surgery or radiation
*'''Radiotherapy''' - used in elderly patients with extensive lesions when surgery is inappropriate
*'''Topical photodynamic therapy''' - particularly for the management of superficial BCC that involves the application of a topical emulsion-based 5-aminolaevulinic acid
*'''Fluorouracil''' - particularly for the management of multiple superficial BCC on the trunk and limbs
*'''Imiquimod''' - particularly for the management of superficial BCC

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma laboratory tests

2015-07-27T20:55:53Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
The laboratory tests of basal cell carcinoma consist of a biopsy and visualization of its histological findings.

==Basal cell Carcinoma Laboratory Tests==

===Biopsy===
A skin biopsy can prove the diagnosis of basal cell carcinoma. An excisional or punch biopsy can visualize the depth of the tumor.

The algorithm below demonstrates a biopsy protocol for patients with a suspected lesion<ref>http://www.aafp.org/afp/2004/1015/p1481.html</ref>.
[[Image:Biopsy BCC.jpg|800px]]

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma secondary prevention

2015-07-27T20:53:38Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
A skin biopsy and chemotherapeutic agents such as 5-Fluorouracil or Imiquimod may prevent the further development of basal cell carcinoma.

==Basal Cell Carcinoma Secondary Prevention==
*Skin biopsy
To view the biopsy algorithm of a suspected lesion , click [[Basal cell carcinoma laboratory tests|'''here''']] 
*Chemotherapeutic agents such as 5-Fluorouracil or Imiquimod
:*It is usually recommended to individuals with extensive sun damage, history of multiple skin cancers, or precancerous growths
:*It is often repeated every 2 to 3 years

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma secondary prevention

2015-07-27T20:52:40Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
A skin biopsy and chemotherapeutic agents such as 5-Fluorouracil or Imiquimod may prevent the further development of basal cell carcinoma.

==Basal Cell Carcinoma Secondary Prevention==
*Skin biopsy
To view the biopsy algorithm of a suspected lesion , click [[Basal cell carcinoma laboratory findings|'''here''']] 
*Chemotherapeutic agents such as 5-Fluorouracil or Imiquimod
:*It is usually recommended to individuals with extensive sun damage, history of multiple skin cancers, or precancerous growths
:*It is often repeated every 2 to 3 years

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma laboratory tests

2015-07-27T20:49:41Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
The laboratory tests of basal cell carcinoma consist of a biopsy and its histological findings.

==Basal cell Carcinoma Laboratory Tests==

===Biopsy===
A skin biopsy can prove the diagnosis of basal cell carcinoma. An excisional or punch biopsy can visualize the depth of the tumor.

The algorithm below demonstrates a biopsy protocol for patients with a suspected lesion<ref>http://www.aafp.org/afp/2004/1015/p1481.html</ref>.
[[Image:Biopsy BCC.jpg|800px]]

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

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Basal cell carcinoma secondary prevention

2015-07-27T20:49:00Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
A skin biopsy and chemotherapeutic agents such as 5-Fluorouracil or Imiquimod may prevent the further development of basal cell carcinoma.

==Basal Cell Carcinoma Secondary Prevention==
*Skin biopsy
*Chemotherapeutic agents such as 5-Fluorouracil or Imiquimod
:*It is usually recommended to individuals with extensive sun damage, history of multiple skin cancers, or precancerous growths
:*It is often repeated every 2 to 3 years

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma surgery

2015-07-27T20:43:46Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and cryosurgery.

==Basal Cell Carcinoma Surgery==
Types of surgery for basal cell carcinoma involve electrodesiccation and curettage, surgical excision, mohs micrographic surgery, and cryosurgery.

===Electrodesiccation and Curettage===
A curette is used to remove the tumor away from adjacent normal skin. Curetting is often followed by electrodesiccation, and the entire process may be repeated 1-2 more times. lectrodesiccation and curettage is a brief procedure and is effective in treating primary nodular and superficial basal cell carcinoma. The disadvantage of this procedure is it leaves a white, atrophic scar<ref name="pmid1820764">{{cite journal| author=Silverman MK, Kopf AW, Grin CM, Bart RS, Levenstein MJ|title=Recurrence rates of treated basal cell carcinomas. Part 2: Curettage-electrodesiccation. | journal=J Dermatol Surg Oncol | year= 1991 | volume= 17 | issue= 9 | pages= 720-6 | pmid=1820764 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1820764 }} </ref>.

===Surgical Excision===
Surgical excision is performed to remove and examine the specimen under a microscope. The larger mount of skin that is removed, the higher the cure rate. Normally, 3-4 mm margins of normal skin are removed. Although surgical excision is more time-consuming and costly compared to curettage, it produces cure rates as high as 95%<ref name="pmid9723063">{{cite journal| author=Grabski WJ, Salasche SJ| title=Positive surgical excision margins of a basal cell carcinoma. |journal=Dermatol Surg | year= 1998 | volume= 24 | issue= 8 | pages= 921-4 | pmid=9723063 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9723063 }} </ref>.

===Mohs Micrographic Surgery===
Mohs surgery involves removal of the tumor and a thin rim of normal-appearing skin<ref name="pmid15270883">{{cite journal| author=Smeets NW, Kuijpers DI, Nelemans P, Ostertag JU, Verhaegh ME, Krekels GA et al.| title=Mohs' micrographic surgery for treatment of basal cell carcinoma of the face--results of a retrospective study and review of the literature. | journal=Br J Dermatol | year= 2004 | volume= 151 | issue= 1 | pages= 141-7 | pmid=15270883 | doi=10.1111/j.1365-2133.2004.06047.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15270883 }} </ref>. Mohs micrographic surgery is indicated for the following:
*Tumors with poorly defined clinical borders
*Tumors with diameters > 1 cm located anywhere on the face
*Tumors with diameters > 2 cm located in areas other than the face
*Tumors with infiltrative or morpheaform/sclerotic histopathologic patterns
*Tumors arising in regions where a good cosmetic outcome is important

===Cryosurgery===
Cryosurgery may be considered for small, clinically well-defined primary tumors. This procedure is especially useful for patients who are debilitated with medical conditions. Liquid nitrogen is applied to the tumor, the treatment stops when the temperature reaches -60°C<ref name="pmid17642878">{{cite journal| author=Kaur S, Thami GP, Kanwar AJ| title=Basal cell carcinoma--treatment with cryosurgery. | journal=Indian J Dermatol Venereol Leprol | year= 2003 | volume= 69 | issue= 2 |pages= 188-90 | pmid=17642878 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17642878 }} </ref>.

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

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]

Basal cell carcinoma screening

2015-07-27T20:34:29Z

Saarah Alkhairy:

__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
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 Carcinoma Screening==
*The U.S. Preventive Services Task Force has found no evidence to recommend for or against screening<ref>{{cite journal|title=Screening for Skin Cancer: U.S. Preventive Services Task Force Recommendation Statement|journal=Annals of Internal Medicine|volume=150|issue=3|year=2009|pages=188|issn=0003-4819|doi=10.7326/0003-4819-150-3-200902030-00008}}</ref>.
*Nevertheless, the Task Force members state that “clinicians should remain alert for skin lesions with malignant features noted in the context of physical examinations performed for other purposes,” and recognize that “even without formal screening programs, mortality from basal cell and squamous cell carcinoma is low compared with mortality from melanoma, but early detection and treatment may reduce morbidity and disfigurement from these cancers.”<ref>http://www.aafp.org/afp/2004/1015/p1481.html#afp20041015p1481-b22</ref>
*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

==References==

{{Reflist|2}}

[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Pathology]]
[[Category:Oncology]]