Basal cell carcinoma is the most common type of skin cancer. It typically appears as a slow-growing bump or lesion on areas frequently exposed to sunlight, such as the face and scalp. While basal cell carcinoma rarely spreads to other parts of the body, it can cause significant tissue damage if left untreated. Treatment options depend on the size, depth and location of the cancer, and may include surgical excision, electrodesiccation, cryotherapy, topical medications, or Mohs surgery for cancers on the face. With early detection and treatment, basal cell carcinoma has an excellent prognosis.

1. Basal cell carcinoma
Dr. firas kassab
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2. Basal cell carcinoma is a slow-growing
form of skin cancer.
Skin cancer falls into two major groups:
Nonmelanoma and melanoma.
Basal cell carcinoma is a type of nonmelanoma skin
cancer
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3. Basics of BCC
 Background
 Most common cutaneous malignancy (~80-90%)
 Typically slow-growing, rarely metastasizes
 Sun-exposed skin, mostly 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
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4. 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
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5. Classification
according to
 Appearance
 Histological
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6. Appearance
we can divide basal-cell carcinoma into 3 groups, based on location and
difficulty of therapy:
1. . Superficial basal-cell carcinoma :is very responsive to
topical chemotherapy such as .It is the only type that can be
effectively treated with topical chemotherapy.
2. Infiltrative basal-cell carcinoma: which often encompasses
morpheaform and micronodular basal-cell cance. More difficult to
treat with conservative treatment methods such as
electrodessiccation and curettage, or with curettage alone.
3. Nodular basal-cell carcinoma: which essentially includes most
of the remaining categories of basal-cell cancer. It is not unusual to
encounter morphologic features of several variants of basal-cell
cancer in the same tumor.
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7. Histological
Basal-cell carcinomas may be divided into the following types:
 Nodular basal-cell carcinoma is a subtype of basal-cell carcinoma, most
commonly occurring on the sun-exposed areas of the head and neck.[
 Cystic basal-cell carcinoma is characterized by dome-shaped, blue-gray
cystic nodules.
 Cicatricial basal-cell carcinoma is an aggressive variant with a distinct
clinical and histologic appearance.
 Infiltrative basal-cell carcinoma is an aggressive type of basal-cell
carcinoma characterized by deep infiltration.
 Micronodular basal-cell carcinoma is characterized by a micronodular
growth pattern.
 Superficial basal-cell carcinoma that occurs most commonly on the trunk
and appears as an erythematous patch.
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8.  Pigmented basal-cell carcinoma that exhibits increased
melanization.About 80% of all basal cell carcinoma in chinese are
pigmented while this subtype is uncommon in white people.
 Rodent ulcer is a large skin lesionof nodular basal cell carcinoma
with central necrosis
 Fibroepithelioma of pinkus most commonly occurring on the lower
back.
 Polypoid basal-cell carcinoma is characterized by exophytic
nodules (polyp-like structures) on the head and neck.
 Pore-like basal-cell carcinoma is characterized by a basal-cell
carcinoma that resembles an enlarged pore or stellate pit.
 Aberrant basal-cell carcinoma is characterized by the formation of
basal-cell carcinoma in the absence of any apparent carcinogenic
factor, occurring in odd sites such as scrotum, vulva, perineum,
nipple, and axilla.
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9. See also:
 Nevoid basal cell carcinoma syndrom
 Cystic basal-cell carcinoma
 Micronodular basal cell carcinoma
 Superficial basal cell carcinoma
 Micrograph of a fibroepithelioma of Pinkus.
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10. Variants of Basal Cell Carcinoma
 Superficial
 Nodular
 Micronodular
 Infiltrating (5%)
 Sclerosing/ morpheaform (5%)
 Metatypical
 Infundibulocystic
 Nodulocystic
 Adenoid
 Clear cell
 Follicular
 Sebaceous
 Perineurally invasive
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11. Nodular
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12. Superficial
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13. Morpheaform
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14. Pigmented
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15. Infiltrating
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16. Differential Diagnosis
 Malignant melanoma
 Squamous cell carcinoma
 Basal cell carcinoma, infiltrative
 Infectious
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17. Causes, incidence, and risk factors:
Basal cell carcinoma starts in the top layer of the skin called the
epidermis. Most basal cell cancers occur on skin that is regularly
exposed to sunlight or other ultraviolet radiation. This includes
the top of your head, or scalp.
Basal cell skin cancer is most common in people over age 40.
However, it occurs in younger people, too.
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18. You are more likely to get basal cell skin cancer if you have:
 Light-colored or freckled skin
 Blue, green, or grey eyes
 Blond or red hair
 Overexposure to x-rays or other forms of radiation
 Many moles
 Close relatives who have or had skin cancer
 Many severe sunburns early in life
 Long-term daily sun exposure (such as the sun exposure people who
work outside receive)
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19. Sings and Symptoms:
Basal cell skin cancer grows slowly and is usually painless. It may
not look that different from normal skin.
patient may have a skin bump or growth that is:
 Pearly or waxy
 White or light pink
 Flesh-colored or brownIn
some cases the skin may be just slightly raised or even flat.
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20. patient may have:
 A skin sore that bleeds easily
 A sore that does not heal
 Oozing or crusting spots in a sore
 A scar-like sore without having injured the area
 Irregular blood vessels in or around the spot
 A sore with a depressed (sunken) area in the
middle
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21. Diagnosis:
 doctor should check the skin and look at the size,
shape, color, and texture of any suspicious areas.
 If the patient might has skin cancer, a piece of skin
will be removed and sent to a lab for examination
under a microscope. This is called a skin biopsy.
There are different types of skin biopsies.
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22. The most common method is a shave biopsy under locale
anesthesia.
Most nodular basal-cell cancers can be diagnosed clinically;
however, other variants can be very difficult to distinguish from
benign lesions such as:
 intradermal naevus
 sebaceomas
 Fibrous papules
 early acnes scars
 and hypertrophing scarring.
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23. Treatment Options
 Electrodessication and curettage
 Curettage alone
 Surgical excision
 Mohs micrographically controlled surgery
 Cryosurgery
 Ionizing radiation
 Surgical excision plus radiation
 Exenteration
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24. Treatment depends on the size
 depth
 location of the skin cancer
 overall health.
Treatment
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25. may involve:
Treatment
 Excision: Cutting out the skin cancer and stitching the skin
together
 Curettage and electrodesiccation: Scraping away cancer cells
and using electricity to kill any that remain
 Cryosurgery: Freezing the cancer cells, which kills them
 Medication: Skin creams containing imiquimod or 5-
fluorouracil for superficial (not very deep) basal cell cancer
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26. Treatment
 Mohs surgery: Removing a layer of skin and looking at it
immediately under a microscope, then removing many layers of
skin until there are no signs of the cancer; usually used for skin
cancers on the nose, ears, and other areas of the face.
 Photodynamic therapy: Treatment using light
 Radiation may be used if a basal cell cancer cannot be treated
with surgery
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27. Is excellent
prognosis
 How well a patient does depends on many things,
including how quickly the cancer was diagnosed.
Most of these cancers are cured when treated early.
 Some basal cell cancers may return. Smaller ones are
less likely to come back.
 Basal cell carcinoma almost never spreads to other
parts of the body ,Because basal-cell carcinoma
rarely metastasis, it grows locally with invasion and
destruction of local tissues
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28. Complications
Basal cell skin cancer almost never spreads. But, if left
untreated, it may grow into surrounding areas and
nearby tissues and bone. This is most worrisome
around the nose, eyes, and ears.
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29. Prevention
 The best way to prevent skin cancer is to reduce exposure to
sunlight.
 Ultraviolet light is most intense between 10 a.m. and 4 p.m., so
try to avoid sun exposure during these hours.
 Protect the skin by wearing hats, long-sleeved shirts, long skirts,
or pants.
 Always use sunscreen
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30. 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
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