Basal cell carcinoma overview: Difference between revisions

	Basal cell carcinoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Basal Cell Carcinoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
Staging
History and Symptoms
Physical Examination
Laboratory Findings
CT scan
MRI
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Basal cell carcinoma overview On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Basal cell carcinoma overview All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Basal cell carcinoma overview
CDC on Basal cell carcinoma overview
Basal cell carcinoma overview in the news
Blogs on Basal cell carcinoma overview
Directions to Hospitals Treating Basal cell carcinoma
Risk calculators and risk factors for Basal cell carcinoma overview

VisualWikitext

Latest revision as of 03:54, 14 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2] Saarah T. Alkhairy, M.D.,

Overview

Basal cell carcinoma is one of the most common skin cancers. It is commonly known as rodent ulcer. In 1827, Jacob Arthur, reported the "rodent ulcer". In 1900, Edmund Krompecher, identified the histological features as an epithelial carcinoma. The annual incidence of basal cell carcinoma in the United States is approximately 2.8 million which increases with increasing age. Men and white skinned people are affected relatively more, especially in states closer to the equator.There is no well established classification for basal cell carcinoma, however there are few clinical variants which are nodular, cystic, sclerodermiform, infiltrated, micronodular, superficial, and pigment basal cell carcinoma and fibroepithelioma of Pinkus.Although the exact causes were unknown, the following are some of the factors that have been associated with the development of basal cell carcinoma: radiation exposure, gene mutations, xeroderma pigmentosa, epidermodysplastic verruciformis, nevoid basal cell carcinoma syndrome, bazex syndrome, rombo syndrome etc. Environmental and genetic risk factors that may predispose to basal cell carcinoma include radiation exposure, physical characteristics, gender, albinism, xeroderma pigmentosum, epidermodysplastic verruciformis, nevoid basal cell carcinoma syndrome, bazex syndrome, rombo syndrome etc. Its morphology is characterized by pearly pink nodules with telangiectasias, rolled borders, and central crusting with or without an ulcerating lesion. The most common cause for the development of the basal cell carcinoma involves radiation exposure and mutations that involve many genes including sonic hedgehog gene, PTCH1 gene, and other gain-of-function mutations which further depend on the subtypes such as nodular, superficial, Infundibulocystic, fibroepithelial, morpheaform, infiltrative, micronodular, and basosquamous basal cell carcinomas. The U.S. Preventive Services Task Force has found no evidence to recommend for or against screening. It is a slow-growing locally invasive lesion with an unlikely risk of metastasis. Most patients are often asymptomatic. The major complication is its recurrence and involvement of surrounding structures. With appropriate treatment, the prognosis is usually excellent. The history and symptoms of basal cell carcinoma include skin growths on sun-exposed skin, mainly in the form of patches that are shiny, pearly bumps, raised edges with central ulceration. They are fragile and may bleed easily. Skin examination usually show papules, plaques, central ulceration with rolled borders, telangiectasias. Skin biopsy is the diagnostic study of choice for basal cell carcinoma. After the suspicious lesion is evaluated, the medical therapy is divided based on low-risk and high-risk basal cell carcinoma patients. Medical therapy consists of topical and systemic therapy. Among topical therapy imiquimod, photodynamic therapy, 5-fluorouracil are included. Systemic therapy consists of sonic hedgehog pathway inhibitors like vismodegib, sonidegib. 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 like using sunscreen lotions, protective clothing, avoid tanning beds etc. 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

There is no well established classification for basal cell carcinoma, however there are few clinical variants which are nodular, cystic, sclerodermiform, infiltrated, micronodular, superficial, and pigment basal cell carcinoma and fibroepithelioma of Pinkus.

Pathophysiology

Basal cell carcinoma is one of the most common skin cancers. It is commonly known as rodent ulcer due to its distinct morphology characterized by pearly pink nodules with telangiectasias, rolled borders, and central crusting with or without an ulcerating lesion. The most common cause for the development of the basal cell carcinoma involves radiation exposure and mutations that involve many genes including sonic hedgehog gene, PTCH1 gene, and other gain-of-function mutations which further depend on the subtypes such as nodular, superficial, Infundibulocystic, fibroepithelial, morpheaform, infiltrative, micronodular, and basosquamous basal cell carcinomas.

Causes

Although the exact causes were unknown, the following are some of the factors that have been associated with the development of basal cell carcinoma: radiation exposure, gene mutations, xeroderma pigmentosa, epidermodysplastic verruciformis, nevoid basal cell carcinoma syndrome, bazex syndrome, rombo syndrome etc.

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

The annual incidence of basal cell carcinoma in the United States is approximately 2.8 million which increases with increasing age. Men and white skinned people are affected relatively more, especially in states closer to the equator.

Risk Factors

Environmental and genetic risk factors that may predispose to basal cell carcinoma include radiation exposure, physical characteristics, gender, albinism, xeroderma pigmentosum, epidermodysplastic verruciformis, nevoid basal cell carcinoma syndrome, bazex syndrome, rombo syndrome etc.

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

It is a slow-growing locally invasive lesion with an unlikely risk of metastasis. Most patients are often asymptomatic. The major complication is its recurrence and involvement of surrounding structures. With appropriate treatment, the prognosis is usually excellent.

Diagnosis

Diagnostic Study Of Choice

Skin biopsy is the diagnostic study of choice for basal cell carcinoma.

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, mainly in the form of patches that are shiny, pearly bumps, raised edges with central ulceration. They are fragile and may bleed easily.

Physical Examination

Patients with basal cell carcinoma usually have normal general appearance. Skin examination usually show papules, plaques, central ulceration with rolled borders, telangiectasias.

Laboratory Findings

There are no laboratory tests available to diagnose basal cell carcinoma.

CT Scan

CT scan is mainly used for the staging of the basal cell carcinoma rather than diagnosing the tumor. CT scan images usually shows hypoattenuating or isoattenuating lesions when compared to adjacent musculature

MRI

MRI is useful when the tumor has any adjacent bony or perineural invasion. On T1- it appears as an enhancing isointense lesion. On T2- it appears as an hyperintense lesion.

Other Diagnostic Studies

There are various other techniques for diagnosing basal cell carcinoma, which include Reflectance Confocal Microscopy, Dermatoscopy

Medical Therapy

After the suspicious lesion is evaluated, the medical therapy is divided based on low-risk and high-risk basal cell carcinoma patients. Medical therapy consists of topical and systemic therapy. Among topical therapy imiquimod, photodynamic therapy, 5-fluorouracil are included. Systemic therapy consists of sonic hedgehog pathway inhibitors like vismodegib, sonidegib.

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 like using sunscreen lotions, protective clothing, avoid tanning beds etc

Secondary Prevention

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

References

Template:WikiDoc Sources

@@ Line 1: / Line 1: @@
+{{Basal cell carcinoma}}
+{{CMG}} {{AE}}{{M.N}} Saarah T. Alkhairy, M.D.,
+==Overview==
+Basal cell carcinoma is one of the most common [[skin cancers]]. It is commonly known as [[rodent ulcer]]. In 1827, Jacob Arthur, reported the "[[rodent ulcer]]". In 1900, Edmund Krompecher, identified the [[histological]] features as an [[epithelial]] [[carcinoma]]. The annual [[Incidence (epidemiology)|incidence]] of basal cell carcinoma in the United States is approximately 2.8 million which increases with increasing [[age]]. [[Men]] and white skinned people are affected relatively more, especially in states closer to the equator.There is no well established [[classification]] for basal cell carcinoma, however there are few [[clinical]] variants which are  [[nodular]], [[cystic]], sclerodermiform, infiltrated, micronodular, [[superficial]], and pigment basal cell carcinoma and fibroepithelioma of Pinkus.Although the exact [[causes]] were unknown, the following are some of the factors that have been associated with the [[development]] of basal cell carcinoma:  [[radiation exposure]], [[gene]] [[mutations]], [[xeroderma pigmentosa]], epidermodysplastic verruciformis, [[nevoid basal cell carcinoma syndrome]], [[bazex syndrome]], rombo syndrome etc. [[Environmental Health Perspectives|Environmental]] and [[genetic]] [[risk factors]] that may predispose to basal cell carcinoma include [[radiation exposure]], physical characteristics, gender, [[albinism]], [[xeroderma pigmentosum]], epidermodysplastic verruciformis, [[nevoid basal cell carcinoma syndrome]], [[bazex syndrome]], rombo syndrome etc. Its [[Morphology (biology)|morphology]] is characterized by pearly pink [[nodules]] with [[telangiectasias]], rolled borders, and central crusting with or without an [[Ulceration|ulcerating]] [[lesion]]. The most common [[Causes|cause]] for the [[development]] of the basal cell carcinoma involves [[radiation exposure]] and [[mutations]] that involve many [[genes]] including sonic [[Hedgehog (cell signaling)|hedgehog]] [[gene]], [[PTCH1]] [[gene]], and other [[Gain-of-function mutation|gain-of-function mutations]] which further depend on the subtypes such as [[nodular]], [[superficial]], Infundibulocystic, fibroepithelial, morpheaform, infiltrative, micronodular, and basosquamous basal cell carcinomas. The U.S. Preventive Services Task Force has found no evidence to recommend for or against [[screening]]. It is a slow-growing [[Local|locally]] [[invasive]] [[lesion]] with an unlikely risk of [[metastasis]]. Most [[patients]] are often [[asymptomatic]]. The major [[complication]] is its recurrence and involvement of surrounding structures. With appropriate treatment, the [[prognosis]] is usually excellent. The history and [[symptoms]] of basal cell carcinoma include [[skin]] growths on [[Sun exposure|sun-exposed]] [[skin]], mainly in the form of patches that are shiny, pearly [[Bumps on skin|bumps]], raised edges with [[central]] [[ulceration]]. They are fragile and may [[bleed]] easily. [[Skin]] [[examination]] usually show [[papules]], [[plaques]], [[central]] [[ulceration]] with rolled borders, [[telangiectasias]]. [[Skin biopsy]] is the [[diagnostic study of choice]] for basal cell carcinoma. After the suspicious [[lesion]] is evaluated, the [[medical]] [[therapy]] is divided based on low-risk and high-risk basal cell carcinoma [[patients]]. [[Medical]] [[therapy]] consists of [[topical]] and [[systemic therapy]]. Among [[topical]] [[therapy]] [[imiquimod]], [[photodynamic therapy]], [[5-fluorouracil]] are included. [[Systemic therapy]] consists of [[Sonic hedgehog|sonic hedgehog pathway]] inhibitors like [[vismodegib]], [[sonidegib]]. 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 like using [[Sunscreens|sunscreen lotions]], [[Protective finishing coat|protective clothing]], avoid [[Tanning booths|tanning beds]] etc. 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==
+There is no well established [[classification]] for basal cell carcinoma, however there are few [[clinical]] variants which are  [[nodular]], [[cystic]], sclerodermiform, infiltrated, micronodular, [[superficial]], and pigment basal cell carcinoma and fibroepithelioma of Pinkus.
+==Pathophysiology==
+Basal cell carcinoma is one of the most common [[skin cancers]]. It is commonly known as [[rodent ulcer]] due to its distinct [[Morphology (biology)|morphology]] characterized by pearly pink [[nodules]] with [[telangiectasias]], rolled borders, and central crusting with or without an [[Ulceration|ulcerating]] [[lesion]]. The most common [[Causes|cause]] for the [[development]] of the basal cell carcinoma involves [[radiation exposure]] and [[mutations]] that involve many [[genes]] including sonic [[Hedgehog (cell signaling)|hedgehog]] [[gene]], [[PTCH1]] [[gene]], and other [[Gain-of-function mutation|gain-of-function mutations]] which further depend on the subtypes such as [[nodular]], [[superficial]], Infundibulocystic, fibroepithelial, morpheaform, infiltrative, micronodular, and basosquamous basal cell carcinomas.
+==Causes==
+Although the exact [[causes]] were unknown, the following are some of the factors that have been associated with the [[development]] of basal cell carcinoma:  [[radiation exposure]], [[gene]] [[mutations]], [[xeroderma pigmentosa]], epidermodysplastic verruciformis, [[nevoid basal cell carcinoma syndrome]], [[bazex syndrome]], rombo syndrome etc.
+==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==
+The annual [[Incidence (epidemiology)|incidence]] of basal cell carcinoma in the United States is approximately 2.8 million which increases with increasing [[age]]. [[Men]] and white skinned people are affected relatively more, especially in states closer to the equator.
+==Risk Factors==
+Environmental and [[genetic]] [[risk factors]] that may predispose to basal cell carcinoma include [[radiation exposure]], physical characteristics, gender, [[albinism]], [[xeroderma pigmentosum]], epidermodysplastic verruciformis, [[nevoid basal cell carcinoma syndrome]], [[bazex syndrome]], rombo syndrome etc.
+==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==
+It is a slow-growing [[Local|locally]] [[invasive]] [[lesion]] with an unlikely risk of [[metastasis]]. Most [[patients]] are often [[asymptomatic]]. The major [[complication]] is its recurrence and involvement of surrounding structures. With appropriate treatment, the [[prognosis]] is usually excellent.
+== Diagnosis ==
+===Diagnostic Study Of Choice===
+[[Skin biopsy]] is the [[diagnostic study of choice]] for basal cell carcinoma.
+===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.
-{{Basal cell carcinoma}}
+===History and Symptoms===
-{{CMG}}
+The history and [[symptoms]] of basal cell carcinoma include [[skin]] growths on [[Sun exposure|sun-exposed]] [[skin]], mainly in the form of patches that are shiny, pearly [[Bumps on skin|bumps]], raised edges with [[central]] [[ulceration]]. They are fragile and may [[bleed]] easily.
+===Physical Examination===
+[[Patients]] with basal cell carcinoma usually have normal general appearance. [[Skin]] [[examination]] usually show [[papules]], [[plaques]], [[central]] [[ulceration]] with rolled borders, [[telangiectasias]].
-==Overview==
+===Laboratory Findings===
-'''Basal cell carcinoma''' ('''BCC''') is the most common form of [[skin cancer]]. It can be destructive and disfiguring. The risk of developing BCC is increased for individuals with a family history of the disease and with a high cumulative exposure to[[Ultraviolet]] light via sunlight or, in the past, were exposed to carcinogenic  chemicals especially [[arsenic]]. Treatment is with [[surgery]], topical [[chemotherapy]], x-ray, [[cryosurgery]], [[photodynamic therapy]]. It is rarely life-threatening but if left untreated can be disfiguring, cause bleeding and produce local destruction (eg., eye, ear, nose, lip).
+There are no [[laboratory]] tests available to [[diagnose]] basal cell carcinoma.
-It is a malignant epithelial cell tumor that begins as a papule (a small, circumscribed, solid elevation of the skin) and enlarges peripherally, developing into a crater that erodes, crusts and bleeds. Metastasis is rare, but local invasion destroys underlying and adjacent tissue. In 90 percent of all cases, the lesion is seen between the hairline and the upper lip. It can be destructive and disfiguring.
+=== CT Scan ===
+[[CT scan]] is mainly used for the [[Staging (pathology)|staging]] of the basal cell carcinoma rather than [[Diagnose|diagnosing]] the [[tumor]]. [[CT scan]] images usually shows hypoattenuating or isoattenuating [[lesions]] when compared to adjacent [[musculature]]
-The risk of skin cancer is related to the amount of sun exposure and pigmentation in the skin. The longer the exposure to the sun and the lighter the skin, the greater the risk of skin cancer.
+=== MRI ===
+[[MRI]] is useful when the [[tumor]] has any adjacent [[Bone or cartilage mass|bony]] or perineural [[invasion]]. On [[T1]]- it appears as an enhancing isointense [[lesion]]. On [[MRI|T2]]- it appears as an hyperintense [[lesion]].
-'''There are three types of BCC:'''
+===Other Diagnostic Studies===
+There are various other techniques for [[Diagnose|diagnosing]] basal cell carcinoma, which include [[Reflectance]] [[Confocal Microscopy]], [[Dermatoscopy]]
-The most common type of basal cell carcinoma is nodular basal cell carcinoma, a flesh-colored (cream to pink), round or oval translucent nodule with overlying small blood vessels and a pearly-appearing rolled border.
+==Medical Therapy==
+After the suspicious [[lesion]] is evaluated, the [[medical]] [[therapy]] is divided based on low-risk and high-risk basal cell carcinoma [[patients]]. [[Medical]] [[therapy]] consists of [[topical]] and [[systemic therapy]]. Among [[topical]] [[therapy]] [[imiquimod]], [[photodynamic therapy]], [[5-fluorouracil]] are included. [[Systemic therapy]] consists of [[Sonic hedgehog|sonic hedgehog pathway]] inhibitors like [[vismodegib]], [[sonidegib]].
-The second type of BCC is the pigmented lesion. This is darker than the nodular type, appearing blue, brown or black. It may be similar in appearance to the very aggressive malignant melanoma tumor. It is very important to distinguish between malignant melanomas and pigmented BCC.
+==Surgery==
+Types of [[surgery]] for basal cell carcinoma involve electrodesiccation and [[curettage]], surgical [[excision]], [[mohs micrographic surgery]], and [[cryosurgery]].
-A third type of BCC is the superficial type, which appears as red, and often scaly, localized plaque. It is frequently confused with psoriasis or eczema.
+==Primary Prevention==
+The [[primary prevention]] of basal cell carcinoma involves avoidance and protection from the sun like using [[Sunscreens|sunscreen lotions]], [[Protective finishing coat|protective clothing]], avoid [[Tanning booths|tanning beds]] etc
-Basal cell skin cancer almost never spreads; however, large and longstanding tumours may metastasize into regional lymph nodes and surrounding areas such as nearby tissues and bone.<ref>{{MedlinePlus|000824|Basal cell carcinoma}}</ref><ref>{{cite web|url=http://www.healthscout.com/ency/1/199/main.html |title=Basal Cell Carcinoma - Symptoms, Treatment and Prevention |format=|work= |accessdate=}}</ref>
+==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}}
-{{reflist|2}}
-{{Epithelial neoplasms}}
-{{Diseases of the skin and appendages by morphology}}
-{{Tumors of bone, cartilage, skin, connective, and soft tissue}}
-{{SIB}}
-<br>
-[[de:Basaliom]]
-[[nl:Basaalcelcarcinoom]]
-[[pl:Rak podstawnokomórkowy skóry]]
-[[pt:Carcinoma basocelular]]
-[[fi:Basaliooma]]
 {{WikiDoc Help Menu}}
 {{WikiDoc Sources}}
+[[Category:Up-To-Date]]
-[[Category:Disease]]
+[[Category:Oncology]]
+[[Category:Medicine]]
 [[Category:Dermatology]]
-[[Category:Types of cancer]]
+[[Category:Surgery]]
-[[Category:Pathology]]
-[[Category:Oncology]]