Basal cell carcinoma (incl. subtypes)

Last Updated: 2021-11-19

Author(s): Anzengruber F., Navarini A.

ICD11: 2C32.Z

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.

  1. Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up. Journal of the American Academy of Dermatology 2005;53:452-7.
  2. Peris K, Campione E, Micantonio T, Marulli GC, Fargnoli MC, Chimenti S. Imiquimod Treatment of Superficial and Nodular Basal Cell Carcinoma. Dermatologic Surgery 2005;31:318-23.
  3. Epstein EH. Basal cell carcinomas: attack of the hedgehog. Nature Reviews Cancer 2008;8:743-54.
  4. Geist DE, Garcia-Moliner M, Fitzek MM, Cho H, Rogers GS. Perineural Invasion of Cutaneous Squamous Cell Carcinoma and Basal Cell Carcinoma: Raising Awareness and Optimizing Management. Dermatologic Surgery 2008;34:1642-51.
  5. Gudbjartsson DF, Sulem P, Stacey SN, et al. ASIP and TYR pigmentation variants associate with cutaneous melanoma and basal cell carcinoma. Nature Genetics 2008;40:886-91.
  6. Pincus LB, McCalmont TH, Neuhaus IM, Kasper R, Oh DH. Basal cell carcinomas arising within multiple trichoepitheliomas. Journal of Cutaneous Pathology 2008;35:59-64.
  7. Redondo P, Marquina M, Pretel M, Aguado L, Iglesias ME. Methyl-ALA–Induced Fluorescence in Photodynamic Diagnosis of Basal Cell Carcinoma Prior to Mohs Micrographic Surgery. Arch Dermatol 2008;144.
  8. Szeimies RM, Ibbotson S, Murrell DF, et al. A clinical study comparing methyl aminolevulinate photodynamic therapy and surgery in small superficial basal cell carcinoma (8-20 mm), with a 12-month follow-up. Journal of the European Academy of Dermatology and Venereology 2008;22:1302-11.
  9. Telfer NR, Colver GB, Morton CA. Guidelines for the management of basal cell carcinoma. Br J Dermatol 2008;159:35-48.
  10. Love WE, Bernhard JD, Bordeaux JS. Topical Imiquimod or Fluorouracil Therapy for Basal and Squamous Cell Carcinoma. Arch Dermatol 2009;145.
  11. Muller FM, Dawe RS, Moseley H, Fleming CJ. Randomized Comparison of Mohs Micrographic Surgery and Surgical Excision for Small Nodular Basal Cell Carcinoma. Dermatologic Surgery 2009;35:1349-54.
  12. Swanson EL, Amdur RJ, Mendenhall WM, Morris CG, Kirwan JM, Flowers F. Radiotherapy for basal cell carcinoma of the medial canthus region. The Laryngoscope 2009;119:2366-8.
  13. Basset-Seguin N. Topical photodynamic therapy for superficial and nodular basal cell carcinoma. Expert Review of Dermatology 2010;5:61-6.
  14. Saran A. Basal cell carcinoma and the carcinogenic role of aberrant Hedgehog signaling. Future Oncology 2010;6:1003-14.
  15. Youssef KK, Van Keymeulen A, Lapouge G, et al. Identification of the cell lineage at the origin of basal cell carcinoma. Nature Cell Biology 2010.
  16. Sekulic A, Migden MR, Oro AE, et al. Efficacy and Safety of Vismodegib in Advanced Basal-Cell Carcinoma. New England Journal of Medicine 2012;366:2171-9.
  17. Sezer E, Erkek E, Sahin S. A Case Report of Syringocystadenoma Papilliferum Mimicking Basal Cell Carcinoma on the Face. Turkish Journal of Dermatology / Türk Dermatoloji Dergisi 2012;6:21-3.
  18. Dreier J, Felderer L, Barysch M, Rozati S, Dummer R. Basal cell carcinoma: a paradigm for targeted therapies. Expert Opinion on Pharmacotherapy 2013;14:1307-18.
  19. Harms KL, Dlugosz AA. Harnessing Hedgehog for the Treatment of Basal Cell Carcinoma. JAMA Dermatol 2013;149:607.
  20. Iarrobino A, Messina JL, Kudchadkar R, Sondak VK. Emergence of a squamous cell carcinoma phenotype following treatment of metastatic basal cell carcinoma with vismodegib. Journal of the American Academy of Dermatology 2013;69:e33-e4.
  21. Sekulic A, Mangold AR, Northfelt DW, LoRusso PM. Advanced basal cell carcinoma of the skin. Current Opinion in Oncology 2013:1.
  22. McCusker M, Basset-Seguin N, Dummer R, et al. Metastatic basal cell carcinoma: Prognosis dependent on anatomic site and spread of disease. European Journal of Cancer 2014;50:774-83.
  23. Majores M, Bierhoff E. [Actinic keratosis, Bowen's disease, keratoacanthoma and squamous cell carcinoma of the skin]. Pathologe 2015;36:16-29.
  24. Hauschild, A. (2016). Langfassung der Leitlinie "Basalzellkarzinom der Haut". Awmf.org. Retrieved 30 May 2016, from http://www.awmf.org/leitlinien/detail/ll/032-021.html
  25. Lebwohl, Mark. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Elsevier, 2014. Print.
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