BASAL CELL CARCINOMA ( RODENT ULCER)

1. BASAL CELL CARCINOMA (RODENT ULCER) the most common skin cancer (and the most common of all cancers) a locally invasive, slowly spreading primary epithelial malignancy Origin: arises from the basal cell layer of the skin and its appendages ) 85% are found on the skin of the head and neck

2. Clinical Features a disease of adult whites some lesions are detected as early as the second decade of life, particularly in patients with red hair and blue eyes. clinicopathologic varieties nodular (noduloulcerative)BCC: The most common form Pigmented BCC Sclerosing (morpheaform) BCC superficial BCC associated with the nevoid basal cell carcinoma syndrome

3. nodular (noduloulcerative)BCC begins as a firm, painless papule that slowly enlarges and gradually develops a central depression One or more telangiectatic blood vessels ………..over the rolled border surrounding the central depression Expanding ulceration often develops in the central depressed area

4. Pigmented BCC The melanin production imparts a tan, brown, black, or even bluish color to the lesion

5. Sclerosing (morpheaform) basal cell carcinoma an insidious lesion that often mimics scar tissue pale and atrophic overlying skin the lesion is firm to palpation poorly demarcated borders

6. superficial BCC may be mistaken clinically for psoriasis occurs primarily on the skin of the trunk Often, lesions are multiple well-demarcated, erythematous, scaly patches A fine, elevated, "threadlike" border is seen at the margins.

7. BCCassociated with the nevoid basal cell carcinoma syndrome in both sun-exposed and protected areas of the skin may number in the hundreds on a single patient usually do not produce a significant degree of tissue destruction.

8. Histopathologic Features The noduloulcerative, pigmented, and syndrome-relatedBCCs are comprised of: uniform ovoid,darkstaining basaloid cells with moderate-sized nuclei and relatively little cytoplasm

9. Nested tumor Solid tumor well-demarcated islands and strands

10. well-demarcated islands and strands appear to arise from the basal cell layer of the overlying epidermis and invade into the underlying dermal connective tissue

11. Epithelial islands typically demonstrate palisading of the peripheral cells

12. frequently, a clear zone of artifactual retraction is seen between the epithelial islands and the connective tissue.

13. Although most of these neoplasms show no differentiation, some exhibit areas of keratin production, sebaceous differentiation, or interlacing strands of lesional cells that resemble duct formation ("adenoid")

14. interlacing strands of lesional cells that resemble duct formation ("adenoid")

15. Necrosis of epithelial islands may produce a cystic appearance.

16. Basosquamous carcinoma "collision" tumor Basal cell carcinoma +an independent primary squamous cell carcinoma of the skin. Some authorities consider the basosquamous carcinoma to be a simple basal cell carcinoma with abundant squamous metaplasia.

17. Treatment and Prognosis size site of the lesion depends on • routine surgical excision • laser ablation • electrodesiccation • curettage Small lesions (< 1 cm)……… with 5 mm margins a cure rate of 95% to 98% • Radical surgical excision • radiation therapy for large or aggressive lesions For sclerosing type lesions recurrent lesions lesions situated near embryonic planes of fusion Mohs micrographic surgery (with frozen-section evaluation)

18. death ……………..in patients with uncontrollable disease………… local invasion into . . vital structures. Recurrence …………… uncommon Metastasis …………..exceptionally rare chance of a second lesion …………..30%............3 years of the treatment of the initial tumor.