Basal cell carcinoma (incl. subtypes)

Last Updated: 2021-11-19

Author(s): Anzengruber, Navarini

Crompter 1900.

Basalioma, BCC, basalioma, basal cell carcinoma, basal cell epithelioma, basal cell epithelioma.

Most common non-benign epithelial neoplasia showing basaloid differentiation.

  • Incidence (Germany): 170/100000/year
  • Frequent skin cancer (Caucasians)
  • Frequent cancer in the USA and Australia
  • Average age: about 60 years
  • Incidence: men > women (30% higher in the USA)
  • In the USA, incidence has increased by 10% per year over the last 10 years
  • Lifetime risk: 30% (USA)
  • Aged 55- 75 years, compared to a 20 year old person, the risk of disease is increased 100-fold

Clinical/etiological classification:

  • Nodular basal cell carcinoma
  • Superficial basal cell carcinoma
  • Premalignant fibroepithelioma
  • Sclerodermiform basal cell carcinoma
  • Pigmented basal cell carcinoma
  • Destructive basal cell carcinoma (terebran ulcer)
  • Scarring basal cell carcinoma
  • Radiographic basal cell carcinoma
  • Polypoid basal cell carcinoma

Histological classification:

  • Solid basal cell carcinoma
  • Superficial basal cell carcinoma
  • Sclerodermiform basal cell carcinoma
  • Fibroepithelial basal cell carcinoma
  • Keratotic basal cell carcinoma
  • Cystic basal cell carcinoma
  • Metatypical basal cell carcinoma
  • Dimorphic basal cell carcinoma
  • BCCs arise from epidermal stem cells or undifferentiated cells of the hair follicle bulge or outer root sheath
  • BCCs arise de novo, not via precancerous lesions

 

Aetiologically important predisposing factors:

  • Genetics (p53 mutation)
  • Cumulative UVB exposure
  • Exposure to arsenic
  • Radiation therapy
  • Immune suppression
  • Medicinal UV sensitisation
  • Light skin type
  • Naevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome)
  • Rombo syndrome
  • Bazex-Dupré-Christol syndrome
  • Oculocutaneous albinism
  • Xeroderma pigmentosum
  • Albinism
  • Arsenic exposure
  • Tight scars
  • Nevus sebaceus
  • Epidermolysis bullosa simplex, Dowling-Meara
  • Actinic keratoses (suggests ↑ UV exposure)
  • Nicotine abuse
  • Coffee?
  • Eczema?
  • NSAIDs?

 

Vitamin B3 should be protective.

  • Anamnesis (predisposing factors?)
  • Clinical appearance.
  • Biopsy.
  • Chronic light-exposed skin areas (capillitium, face, neck, décolleté)
  • 80% of basal cell carcinomas occur in the head and neck region
  • 70% of basal cell carcinomas occur on the face
  • 15% of basal cell carcinomas occur on the trunk
  • Very rarely, basal cell carcinomas occur on the penis, vulva or perianally
  • Excellent, provided there has been no metastasis
  • Likelihood of recurrence:
    • Different authors put different figures on recurrence rates.

 

Years after initial diagnosis of a BCC Likelihood of recurrence of BCC
1 About 20%
2 About 50%
3 About 66%
5 About 40-80% (depending on data)

Source: Hauschild, A. (2016). Long version of the guideline "Basal cell carcinoma of the skin". Awmf.org. Retrieved 30 May 2016, from http://www.awmf.org/leitlinien/detail/ll/032-021.html

 

  • Patients who have already had basal cell carcinoma are 4 times more likely to develop basal cell carcinoma again
  • The risk decreases if the first basal cell carcinoma occurs after the 75th birthday.
  • If an upper extremity is the first affected site, this indicates a poorer prognosis.
  • 6-10% of patients with BCC develop SCC (3-fold higher risk than in the normal population).
  • The risk of subsequently developing malignant melanoma is 2-4-fold increased in BCC patients.
  • Control examinations should be performed every 6 months for the first year and 1x a year thereafter.

Surgery: surgery is the first line of treatment for all basal cell carcinomas.

 

For superficial basal cell carcinomas further options include:

  • Cryotherapie
  • Imiquimod
  • 5-fluorouracil
  • Photodynamic therapy
  • Radiation therapy
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