Basal cell carcinoma natural history: Difference between revisions

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


==Overview==
==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.
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.


==Natural History==
==Natural History==
*Patients with basal cell carcinoma are often asymptomatic.
*[[Patients]] with basal cell carcinoma are often [[asymptomatic]]<ref name="pmid14525881">{{cite journal |vauthors=Wong CS, Strange RC, Lear JT |title=Basal cell carcinoma |journal=BMJ |volume=327 |issue=7418 |pages=794–8 |date=October 2003 |pmid=14525881 |pmc=214105 |doi=10.1136/bmj.327.7418.794 |url=}}</ref>
 
*They often report a slowly enlarging [[lesion]] which does not [[Healing|heal]] and [[Bleed|bleeds]] when [[Trauma|traumatized]]
*Basal cell carcinoma is slow-growing and locally invasive.
*It is [[Local|locally]] [[invasive]] and destructive so the name [[Rodent ulcer|'''rodent cancer''']]
*The overall risk of [[metastases]] is estimated to be less than 0.1%.
*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).
*The risk of [[invasion]] and recurrence is based on size, duration, [[Location parameter|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.
*Even without a recurrence, a [[Personal, Social and Health Education|personal]] [[History and Physical examination|history]] of basal cell carcinoma increases the risk of [[Development|developing]] all types of [[skin cancers]]


==Complications==
==Complications==
Complications of basal cell carcinoma are the following:
*The main [[complication]] of basal cell carcinoma is recurrence.<ref name="WortsmanVergara2015">{{cite journal|last1=Wortsman|first1=X.|last2=Vergara|first2=P.|last3=Castro|first3=A.|last4=Saavedra|first4=D.|last5=Bobadilla|first5=F.|last6=Sazunic|first6=I.|last7=Zemelman|first7=V.|last8=Wortsman|first8=J.|title=Ultrasound as predictor of histologic subtypes linked to recurrence in basal cell carcinoma of the skin|journal=Journal of the European Academy of Dermatology and Venereology|volume=29|issue=4|year=2015|pages=702–707|issn=09269959|doi=10.1111/jdv.12660}}</ref><ref name="pmid22560426">{{cite journal |vauthors=Jebodhsingh KN, Calafati J, Farrokhyar F, Harvey JT |title=Recurrence rates of basal cell carcinoma of the periocular skin: what to do with patients who have positive margins after resection |journal=Can. J. Ophthalmol. |volume=47 |issue=2 |pages=181–4 |date=April 2012 |pmid=22560426 |doi=10.1016/j.jcjo.2012.01.024 |url=}}</ref>
*Reccurrence
*The following are the factors associated with increased risk of basal cell carcinoma recurrence:
*Development of other types of skin cancer
**[[Location parameter|Location]] and size
*[[Metastasis]]
***>/= 6 mm in [[diameter]] in high-risk areas (eg, central [[face]], [[nose]], [[lips]], [[eyelids]], [[eyebrows]], periorbital [[skin]], [[chin]], [[mandible]], [[ears]], preauricular and postauricular areas, [[temples]], [[hands]], [[feet]])
*[[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>
***10 mm in [[diameter]] in other areas of the [[head]] and [[neck]]
*[[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>  
***20 mm in [[diameter]] in all other areas (excluding [[hands]] and [[feet]])
*[[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>  
**Aggressive [[Pathological|pathologic]] variants
*[[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>
***Morpheaform, sclerosing, or mixed infiltrative
*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>
***Micronodular
***Basosquamous
**[[Lesions]] in sites of prior [[radiation therapy]] (RT)
**[[Lesions]] with poorly defined borders
**[[Lesions]] in [[immunocompromised]] [[patients]]
**Perineural [[invasion]]


==Prognosis==
==Prognosis==
*Prognosis of basal cell carcinoma is usually excellent.
*[[Prognosis]] of basal cell carcinoma is usually excellent.<ref name="Czarnecki1998">{{cite journal|last1=Czarnecki|first1=D.|title=The prognosis of patients with basal and squamous cell carcinoma of the skin|journal=International Journal of Dermatology|volume=37|issue=9|year=1998|pages=656–658|issn=00119059|doi=10.1046/j.1365-4362.1998.00559.x}}</ref><ref name="pmid26449265">{{cite journal |vauthors=Correia de Sá TR, Silva R, Lopes JM |title=Basal cell carcinoma of the skin (part 2): diagnosis, prognosis and management |journal=Future Oncol |volume=11 |issue=22 |pages=3023–38 |date=November 2015 |pmid=26449265 |doi=10.2217/fon.15.245 |url=}}</ref>
*Although basal cell carcinoma rarely [[metastasis|metastasizes]], it grows locally with invasion and destruction of local tissues, without stopping.
*These [[lesions]] are typically slow growing, and [[metastatic]] [[disease]] is a very [[rare]] event.  
*The cancer can impinge on vital structures and result in loss of extension or loss of function or rarely death.
*Basal cell carcinoma will cause considerable [[disfigurement]] by [[Local|locally]] destroying [[skin]], [[cartilage]], and even [[bone]].
*The vast majority of cases can be successfully treated before serious complications occur.
*Recurrence is a issue with basal cell carcinoma.
*Approximately 50% of recurrences are apparent within the first two years.


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


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Latest revision as of 14:36, 11 March 2019

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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

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.

Natural History

Complications

Prognosis

References

  1. Wong CS, Strange RC, Lear JT (October 2003). "Basal cell carcinoma". BMJ. 327 (7418): 794–8. doi:10.1136/bmj.327.7418.794. PMC 214105. PMID 14525881.
  2. Wortsman, X.; Vergara, P.; Castro, A.; Saavedra, D.; Bobadilla, F.; Sazunic, I.; Zemelman, V.; Wortsman, J. (2015). "Ultrasound as predictor of histologic subtypes linked to recurrence in basal cell carcinoma of the skin". Journal of the European Academy of Dermatology and Venereology. 29 (4): 702–707. doi:10.1111/jdv.12660. ISSN 0926-9959.
  3. Jebodhsingh KN, Calafati J, Farrokhyar F, Harvey JT (April 2012). "Recurrence rates of basal cell carcinoma of the periocular skin: what to do with patients who have positive margins after resection". Can. J. Ophthalmol. 47 (2): 181–4. doi:10.1016/j.jcjo.2012.01.024. PMID 22560426.
  4. Czarnecki, D. (1998). "The prognosis of patients with basal and squamous cell carcinoma of the skin". International Journal of Dermatology. 37 (9): 656–658. doi:10.1046/j.1365-4362.1998.00559.x. ISSN 0011-9059.
  5. Correia de Sá TR, Silva R, Lopes JM (November 2015). "Basal cell carcinoma of the skin (part 2): diagnosis, prognosis and management". Future Oncol. 11 (22): 3023–38. doi:10.2217/fon.15.245. PMID 26449265.


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