1 / 61

Basal Cell Carcinoma

Basal Cell Carcinoma. Presented by: Bill V. Way, D.O. AOCD Board Certified Dermatologist Residency in US Army at Walter Reed Consultant for Charlton Methodist Hosp for past 19 years. Epidemiology and Etiology. Incidence US 500-1000 per 100,000 >400,000 new patients annually

walker
Download Presentation

Basal Cell Carcinoma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Basal Cell Carcinoma • Presented by: • Bill V. Way, D.O. • AOCD Board Certified Dermatologist • Residency in US Army at Walter Reed • Consultant for Charlton Methodist Hosp for past 19 years

  2. Epidemiology and Etiology • Incidence US 500-1000 per 100,000 • >400,000 new patients annually • Age usually over age 40 • Sex Males >Females • Race rare in brown and black skinned pt

  3. Diagnosis • High index of suspicion • Onset • Prior treatment

  4. Types of BCC • Supeficial BCC • Nodular BCC • Pigmented BCC • Cystic BCC • Sclerosing or Morpheaform BCC • Recurrent BCC

  5. Biopsy • Biopsy: Shave, Punch,Excision • Specimen to reliable dermatopathologist or pathologist

  6. What to Biopsy • Select a good representation of the lesion for biopsy • If small lesion, biopsy the entire lesion • Final treatment code is dependent on actual size of lesion at time of biopsy • Get exact measurements of lesion, digital photo if possible

  7. When should you do a biopsy? • If you are unsure of diagnosis of lesion and have in the differential a skin cancer, basal cell carcinoma, squamous cell carcinoma or melanoma, then do a biopsy • List your differential in the order which you think the lesion is. Learn from your errors.

  8. Methods of Biopsy • Shave Biopsy: easiest and fastest • Punch Biopsy: depth of lesion • Excisional Biopsy: > time, > expense, complete removal of tumor • Incisional Biopsy: partial removal of tumor, >time, > expense

  9. Shave Biopsy • Xylocaine 2% with epi • 1cc tuberculin syringe, 30g needle • Non-sterile gloves • #15 sterile blade Bard Parker • Specimen bottle, labeled correctly • Drysol solution • Bacitracin Ointment, Bandaid

  10. Punch Biopsy • Xylocaine 2% with epi • 1cc tuberculin syringe, 30g needle • Sterile gloves • Punch : 2mm, 3mm, 4mm, 6mm • Minor surgery tray, suture size for area • Specimen bottle labeled correctly • Bacitracin Ointment and bandaid

  11. Excision or Incisional Biopsy • Xylocaine 2% with epi • 3-5cc syringe, 30g needle, sterile gloves • #15 or #11 sterile blade, surgery tray • Suture for area, absorbable, non-absorbable • Specimen bottle labeled correctly • Bacitracin Ointment and sterile dressing

  12. Treatment of BCC • Electrodesiccation and curettage • Excision • Cryosurgery • Moh’s Surgery • Radiation • 5-Fluorouracil • Aldara (Imiquimod)

  13. Electrodesiccation & Curettage • Hyfrecator • Curettes: 2mm, 3mm, 4mm • EDC times 3 • Expect scar formation • 85-90% cure rate • Check for Pacemaker, Defribralator

  14. Excision • Adequate outline of tumor margin • Adequate margins 3-5mm • Surgery Tray, Hyfrecator • Suture: absorbable, non-absorbable • Tag tip, specimen labeled correctly • Pressure dressing, antibiotic ointment

  15. Cryosurgery Used only for superficial and small nodular BCC Not indicated for deeper BCC High morbidity, very painful

  16. Moh’s Surgery • Can be used on all BCC • Difficult lesions: sclerosing or recurrent, poorly defined borders, tumors of nose, eyelids • Recurrent lesions • Lesions over 25mm dia • 98% cure rate • Expensive, > time • Few Moh’s Surgeons, Dermatologist

More Related