A basal-cell carcinoma (BCC) is a slow-growing, locally invasive, malignant epidermal (basal layer) skin tumour.
Typically, a slow-growing skin lesion (over months / years) which commonly occurs on sun-exposed areas of the body. Eighty percent of BCCs occur on the head and neck. It is the commonest form of skin cancer. It is 4-5x more common than squamous cell carcinoma (SCC).
They generally affect middle-aged/elderly individuals, unless there is a genetic susceptibility (e.g. Gorlin's syndrome - see below). BCCs are locally invasive and rarely metastasize.
BCC on the face. Image courtesy of Wikipedia Commons
Gorlin-Goltz syndrome or nevoid basal cell carcinoma syndrome (NBCCS) is a genetic condition which greatly increases the risk of developing BCCs.
A rare autosomal dominant condition that occurs as a result of gene mutation, specifically the PTCH1 gene. Individuals with Gorlin syndrome typically begin to develop BCCs during adolescence or early adulthood.
Other clinical features include:
BCCs are often diagnosed clinically by the presence of a slowly enlarging skin lesion with a typical appearance.
Irregular skin lesion; typically on the face or neck. Clinical features can be remembered with the mnemonic 'TURP'.
Management may be surgical or non-surgical and based upon a clinical-suspicion (e.g. what the lesion looks like) or upon a biopsy result (tissue diagnosis).
Surgical treatment may be 'Excisional' or 'Destructive':
Lesions may be either high or low-risk.
A high-risk BCC is determined by ANY of the below:
Generally speaking, treatments that do not permit histological confirmation (tissue diagnosis) are only used for LOW RISK lesions.
Consider patient, tumour and practitioner factors:
Surgical excision margins are based upon the British Association of Dermatologists (BAD) guidelines for BCC.
Lesions should be excised down to subcutaneous fat to ensure that the entirely of skin (epidermis and dermis) has been included in the excision sample.
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