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 clinicopathologic varieties
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. BCC associated 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-related BCCs 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. Recurrence …………… uncommon Metastasis …………..exceptionally rare
death ……………..in patients with uncontrollable disease………… local invasion into vital structures.
Recurrence …………… uncommon
Metastasis …………..exceptionally rare
chance of a second lesion
…………..30% years of the treatment of the initial tumor.