Basal cell carcinoma (incl. subtypes)
Last Updated: 2021-11-19
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
- 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
- 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
- Arsenic exposure
- Tight scars
- Nevus sebaceus
- Epidermolysis bullosa simplex, Dowling-Meara
- Actinic keratoses (suggests ↑ UV exposure)
- Nicotine abuse
Vitamin B3 should be protective.
- Anamnesis (predisposing factors?)
- Clinical appearance.
- 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|
|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.
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