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group of malignant cutaneous tumors characterized by the presence of lobules, columns, bands or cords of basaloid cells (germinative cells).
EPIDEMIOLOGY
Most
AETIOLOGY
radiation
ultraviolet
acute episodes of intense burning sun exposure are a greater risk factor than cumulative lifetime sun exposure
Nodular
Morpheic
Types
Ulcerated
Superficial
Pigmented
Nodular
Ulcerated
Superficial
Morpheic
Pigmented
may be multiple
Sites
Majority
Morphoeic
on face. Superficial type - mainly on the trunk. Palms and soles - rarely affected
Characteristic Features
Translucency Ulceration Telangiectasias Rolled
border
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commonly on the sun-exposed areas of the head and neck translucent papule or nodule usually telangiectasias often a rolled border
Differential diagnosis traumatized dermal nevus Amelanotic melanoma
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BCC (Ulcerated)
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BCC (SUPERFICIAL)
Erythematous patch (often well demarcated) that resembles eczema Usually found on the trunk May be multiple D/D Usually have typical Eczema beaded edge
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BCC (MORPHOEIC) or
sclerodermiform
Ivory White or waxy Always on face Presents as a spontaneous scar Margins are usually much wider than what is clinically visible
dense fibrosis of the stroma produces a thickened plaque rather than a tumour palpation reveals a firm skin texture that extends irregularly beyond the visible changes
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D/D morphoea
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BCC
(PIGMENTED)
exhibits increased melanization hyperpigmented, translucent papule may also be eroded D/D- nodular melanoma.
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FIBROEPITHELIOMA OF PINKUS
Clinically, the lesion is a benign-appearing, pedunculated, pink tumor that may resemble an acrochordon
BCC (Multifocal)
Bowenoid
usually found on lower legs of women with sun damaged skin. Diagnosis by biopsy
Poorly
differentiated
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Naevoid basal cell carcinoma Basal cell naevus syndrome syndrome Gorlins syndrome
Skin
multiple
skeletal malformations
(mandibular keratocysts),
Characteristic
Frontal
facies
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palmar pits
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ice-pick marks, enlarged follicular ostia on the dorsa of hands,elbows, feet and face
Hypotrichosis Hypohidrosis
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H/P Of BCC
Basaloid
tumor cells
Palisading of nuclei
Peripheral
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A solid group of atypical basaloid cells is present at the dermo-epidermal junction showing peripheral palisading and cleft formation between tumour nest and dermis
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BCC
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typical nodular basal cell carcinoma with the additional feature of melanin pigmentation of the tumour nests
BCC
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that on pathological study appear to have features of both BCC and SCC Significantly higher incidence of metastatic spread small aggregates of cells lacking classic palisading
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Course BCC
slow progressive course
of peripheral extension, which producing thread-like margin doubling time is estimated to be between 6 months and 1 year
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Spread
Local
Periorbital tissues; bones of the face, skull ,meninges Perineural Invasion - Uncommon most often in histologically aggressive or recurrent lesions
Dissemination
- Rare
Inhalation ulceration involves the airway inhaled and become implanted in the lungs bloodstream metastasis
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deposits
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TREATMENT
Destructive
therapies Surgical excision Mohs micrographic surgery Photodynamic therapy Radiation therapy Topical therapy
Imiquimod 5-FU
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Destructive therapies
INDICATION
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Surgical excision
3
4 mm margin
Tumor less than 2 cm in diameter
5-mm
margin
morphoeic
BCC large BCCs (more than2 cm in diameter) smaller nodular BCCs with poorly defined clinical margins recurrent BCCs
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Mohs surgery
offers
superior histologic analysis of tumor margins while permitting maximal conservation of tissue compared with standard excisional surgery Usually reserved for high risk lesions eyelids, nose, lips, ears
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Repeated
cycles of surgery and intraoperative microscopic examination of the entire surgical margin of the excised tissues allows accurate and dependable identification and removal of all residual invasive tumour
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superior to the rate for other modalities excision curettage and desiccation XRT cryotherapy (10 percent) (7.7percent) (8.7 percent) (7.5 percent)
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Radiation Therapy
Advantages
minimal
patient discomfort avoidance of an invasive procedure for a patient unwilling or unable to undergo surgery
Disadvantages
lack
of histologic verification of tumor removal prolonged treatment course cosmetic result that may worsen over time predisposition to aggressive and extensive recurrences
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a Toll-like receptor 7 agonist believed to induce interferon- and other cytokines to boost T helper 1 type immunity.
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Photodynamic Therapy
involves
the activation of a photosensitizing drug (-aminolevulinic acid) by visible light to produce activated oxygen species that destroy the constituent cancer cells
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FOLLOW UP
Counseling
about sun
A patient who has had one BCC should undergo periodic full-body skin examinations for :
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