Infiltrating Basal cell carcinoma 	 Infiltrating Basal cell carcinoma
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Infiltrating Basal cell carcinoma Infiltrating Basal cell carcinoma

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Infiltrating Basal cell carcinoma Infiltrating Basal cell carcinoma Presentation Transcript

  • 1. Infiltrating Basal Cell Carcinoma Laura S. Gilmore, MD Department of Ophthalmology October 8, 2004 Discussant: Kenn Freedman, MD
  • 2. Case Presentation
    • CC: growth on right side of nose
    • HPI: 81 yo HF who first noted growth on right side of nose “last December”, progressively growing.
    • PMH: arthritis
    • SH: ½ ppd smoker X 25 years
    • ROS: denies F/C, significant weight loss
    • FH: non-contributory
  • 3. Physical Exam
    • General: AAO, VSS and good
    • VA: 20/80 OD, 20/50 OS
    • Pupils: 3mm OU, no APD
    • External: extensive ulcerative lesion from bridge of nose to RLL and R cheek, with almost complete destruction of RLL and nearly complete ptosis of RUL
    • IOP, CVF, DFE normal OS, unobtainable OD
  • 4.  
  • 5.  
  • 6. Differential Diagnosis
    • Malignant melanoma
    • Squamous cell carcinoma
    • Basal cell carcinoma, infiltrative
    • Infectious
  • 7. Basics of BCC
    • Background
      • Most common cutaneous malignancy (~80-90%)
      • Typically slow-growing, rarely metastasizes
      • Sun-exposed skin, m ostly face and scalp, esp nose, cheek, and periorbital regions (~80%)
    • Frequency
      • 900,000 Dx in US/year
      • estimated lifetime risk of 33-39% for
    • men and 23-28% for women
    • Sex
      • Men 2X over women
  • 8. Basics of BCC
    • Mortality/Morbidity
      • <0.1% metastasize
      • Very low mortality
      • Significant morbidity with direct invasion of adjacent tissues, especially when on face or near an eye
    • Age
      • Likelihood increases with age
      • Rare in <40 yo
    • Race
      • Most often in light-skinned, rare in dark-skinned races
  • 9. Variants of Basal Cell Carcinoma
    • Superficial
    • Nodular
    • Micronodular
    • Infiltrating (5%)
    • Sclerosing/ morpheaform (5%)
    • Metatypical
    • Infundibulocystic
    • Nodulocystic
    • Adenoid
    • Clear cell
    • Follicular
    • Sebaceous
    • Perineurally invasive
  • 10. Perineural Invasion
    • May be seen in 3% of pts with infiltrating and morpheaform types
      • Most often infiltrating type, which has highest rate of local recurrence
    • Requires CT scan for full work-up
    • Causes? inherently aggressive behavior vs inadequate early management?
  • 11. Treatment Options
    • Electrodessication and curettage
    • Curettage alone
    • Surgical excision
    • Mohs micrographically controlled surgery
    • Cryosurgery
    • Ionizing radiation
    • Surgical excision plus radiation
    • E xenteration
  • 12. Factors Considered in Treatment Planning
    • Pt preference to keep eye
    • Pt age
    • Surgical excision-considered definitive tx
    • “ Careful frozen section controlled excision of periocular BCCs yields cure rates comparable to Mohs micrographic surgery at 5-year follow-up”
      • 5 year recurrence of 2.2% in one study
      • Wong, et al. “Management of Periocular Basal Cell Carcinoma with Modified En Face Frozen Section Controlled Excision.” Ophthalmic and Plastic Reconstructive Surgery . 2002. Vol 18 (6): 430-435.
    • Therefore, avoiding exenteration was considered a good possibility
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  • 22. Conclusion
    • Basal cell carcinomas are not always as innocent as we tend to believe
    • In formulating treatment course:
      • Strong pt preference and
      • other pt factors
      • Current research