Basal Cell Carcinoma

This is the commonest type of malignant skin tumour, also known as a rodent ulcer. It is a slow growing and locally destructive tumour. They do not heal and can damage skin structures near to them.
So a rodent ulcer can damage the nose, lip or eyelids if it is left. The name “rodent” ulcer refers to it gnawing into the skin like a rodent.

Written by Dr James Britton - Consultant Dermatologist 06/4/2020

This is the commonest type of skin cancer, also known as a rodent ulcer, but it is  slow growing and can take a year or so to get to the size above. It is a tumour that just damages the tissues around. They do not have "roots" that go down into deeper tissues, but they do not heal and can damage skin structures near to them. So this is more of a difficulty around the nose, lips and and eyes.
The name “rodent” ulcer refers to it gnawing into the skin like a rodent.

If they are taken out then they are cured.

Above is a characteristic basal cell carcinoma, just before an operation to remove it.

 

The known causes of a basal cell carcinoma or BCC are:

  • Prolonged UV exposure – working outside, living abroad in sunny climes.

  • Just having very fair skin and living in the UK without taking adequate suncare measures is enough to cause a rodent ulcer.

  • Arsenic ingestion (once present in many “tonics”)

  • X- irradiation – sometimes used to treat skin conditions

  • Chronic scarring – a wound that takes many years to heal with a scar can be prone to developing a BCC

  • Genetic predisposition (basal cell naevus syndrome- autosomal dominant) – a very rare condition with a predisposition to this condition.

  • People with fair skin are more prone - More often found in Caucasians with a fair “Celtic” skin, they are more common in males and more frequently found nearer the equator. They mainly occur in those over forty on light- exposed sites.

 

What you should look for:

  • Slow growing papule or nodule, which may go on to break down with necrosis and ulceration (as shown below).

  • Telangectasia (small blood vessels over the surface of the lesion or a skin coloured pearly edge may be associated.

  • A flat diffuse superficial form exists (“morphoeic”).

  • Pigmentation is a possibility in all types.

  • Typical sites are commonly around the nose, cheeks and the temple

Below is a basal cell carcinoma that ulcerated - surface broken down. This required surgical removal.

 

 

 

 

 

 

 

 

 


The example above does not have the pearled edge or the obvious telangiectasia.

 

If you are worried over a possible skin cancer you can check  with a UK trained consultant dermatologist at https://myhealthfile.me

There are many examples of basal cell carcinoma shown below:

Nodular (commonest)
Slow growing papule or nodule, which may go on to necrosis and ulceration.

Appearance:

  • skin coloured papule

  • fine telangectasia

  • glistening pearly edge becomes necrosed, ulcerated and crusty

 

Possible diagnosis:

  • naevus

  • molluscum contagiosum

  • keratoacanthoma

  • squamous cell carcinoma

  • sebaceous hyperplasia (benign proliferation of the sebaceous glands)

Below is a nodular basal cell carcinoma on the nose of an individual that required surgical removal.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



Morphoeic
Slow growing area of scarring on skin.

Appearance:

  • Scarring variant

  • Morphoea like plaque

  • White- yellow

 

Possible diagnosis:

  • Morphoea


Below is a BCC on the neck which required surgical removal after a biopsy confirmed the diagnosis.

 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you are worried over a possible skin cancer you can check  with a UK trained consultant dermatologist at https://myhealthfile.me


Cystic
Nodular but becoming translucent.

Appearance:

  • skin coloured papule

  • fine telangectasia

  • glistening pearly edge becomes necrosed, ulcerated and crusty

  • white- yellow becomes tense, more translucent and telangectatic

Possible diagnosis:

  • naevus

  • molluscum contagiosum

  • keratoacanthoma

  • squamous cell Ca

  • sebaceous hyperplasia (benign proliferation of the sebaceous glands)

 

This cystic basal cell carcinoma above is shown just after local anasethetic has been injected, causing the skin to raise up beneath it.
 

 

 

 

 

 

 

 

 

 

 

 

 

 




If you are worried over a possible skin cancer you can check  with a UK trained consultant dermatologist at https://myhealthfile.me

Multicentric
The appearance of the basal cell carcinoma may change over time.

Appearance:

  • Superficial i.e. not a deep tumour

  • Plaque like with rim- like edge

  • Often pigmented

  • Typically on the trunk

 

Possible diagnosis:

 

Below is a multicentric BCC that was successfully removed by an operation under local anaesthetic.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



These are the examples of basal cell carcinomata.

 

The management depends on a few factors:

  • The size of it

  • The site - where it is on the body

  • Type

  • Whether the patient will be able to undergo a minor operation



A punch biopsy can confirm the diagnosis:
Complete surgical excision, will allow histological assessment on adequacy of removal. The first step is to plan the surgery, making sure there is an adequate border:

The tumour can be removed by an ellipse excision as seen below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


If this is not possible, incisional biopsy (a small ellipse of skin taken from the ares to check) and radiotherapy may be used.

If the patient is old and infirm, curettage and cautery is sometimes used for lesions on the trunk and upper extremities and cryosurgery can be used for multiple superficial lesions.

Photodynamic therapy is also possible and topical application of chemotherapeutic drugs is also used.

Basal cell carcinomata do not metastasise - spread elsewhere.

Follow up:
Prognosis is excellent and common practise is not to follow up if the tumour is fully removed at operation.
If the patient has had many BCCs before then follow- up should be aimed at early detection of local recurrence.

Recurrence rate is 5% at 5 years for most forms of treatment.

 

Special types of surgery - Moh's surgery

If the basal cell carcinoma is in a sensitive area and the edges cannot be seen then they can be removed by a technique called "Moh's Surgery". This is where the dermatologist removes the tumour by cutting it out and as he/she goes along checks the specimen under the microscope so can take just the right amount of skin to remove and cure the tumour.

Moh's surgery was started by an American surgeon called Edwin Moh in 1938. It was developed by dermatologists in the USA and has over the last 20 years has been brought into dermatology centres in the United Kingdom under the enthusiastic group of dermatology consultants in the British Society of Dermatological Surgery (BSDS).

If you are worried over a possible skin cancer you can check  with a UK trained consultant dermatologist at https://myhealthfile.me

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