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Infiltrating Basal Cell Carcinoma Laura S. Gilmore, MD Department of Ophthalmology October 8, 2004 Discussant: Kenn Freedm...
Case Presentation <ul><li>CC: growth on right side of nose </li></ul><ul><li>HPI: 81 yo HF who first noted growth on right...
Physical Exam <ul><li>General: AAO, VSS and good </li></ul><ul><li>VA: 20/80 OD, 20/50 OS </li></ul><ul><li>Pupils: 3mm OU...
 
 
Differential Diagnosis <ul><li>Malignant melanoma </li></ul><ul><li>Squamous cell carcinoma </li></ul><ul><li>Basal cell c...
Basics of BCC <ul><li>Background </li></ul><ul><ul><li>Most common cutaneous malignancy (~80-90%) </li></ul></ul><ul><ul><...
Basics of BCC <ul><li>Mortality/Morbidity </li></ul><ul><ul><li><0.1% metastasize </li></ul></ul><ul><ul><li>Very low mort...
Variants of Basal Cell Carcinoma <ul><li>Superficial </li></ul><ul><li>Nodular </li></ul><ul><li>Micronodular </li></ul><u...
Perineural Invasion <ul><li>May be seen in 3% of pts with infiltrating and morpheaform types </li></ul><ul><ul><li>Most of...
Treatment Options <ul><li>Electrodessication and curettage </li></ul><ul><li>Curettage alone </li></ul><ul><li>Surgical ex...
Factors Considered in Treatment Planning <ul><li>Pt preference to keep eye </li></ul><ul><li>Pt age </li></ul><ul><li>Surg...
 
 
 
 
 
 
 
 
 
Conclusion <ul><li>Basal cell carcinomas are not always as innocent as we tend to believe </li></ul><ul><li>In formulating...
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Infiltrating Basal cell carcinoma Infiltrating Basal cell carcinoma

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Infiltrating Basal cell carcinoma Infiltrating Basal cell carcinoma

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

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