Summary
Definition
BCC of the skin is a common neoplasm, related to exposure to sunlight.[1][2][Figure caption and citation for the preceding image starts]: Nodular basal cell carcinoma on the cheek, on background of diffuse solar damage with marked solar elastosisFrom the collection of Prof. Robert A. Schwartz [Citation ends].
BCC can be locally aggressive, but rarely metastasises. While certain factors can result in higher-grade behaviour, in most cases early detection and treatment have made extensive local invasion and destruction from this neoplasm a thing of the past.[3]
History and exam
Key diagnostic factors
- presence of risk factors
- papules with associated telangiectasias
- plaques, nodules, and tumours with rolled borders
- small crusts and non-healing wounds
- non-healing scabs
- pearly papules and/or plaques
Other diagnostic factors
- metastases associated with large or neglected BCC
- local destruction with advanced lesion
Risk factors
- Ultraviolet (UV) radiation
- sun exposure
- x-ray exposure
- arsenic exposure
- aberrant hedgehog signalling pathway
- xeroderma pigmentosum
- nevoid basal cell carcinoma (Gorlin-Goltz) syndrome
- history of non-melanona skin cancer
- childhood cancer survivors
- transplant recipient
Diagnostic investigations
Treatment algorithm
Contributors
Authors
Robert A. Schwartz, MD, MPH, DSc (Hon), MAE, FAAD, FRCP (Edin)
Professor & Head
Dermatology
Rutgers University New Jersey Medical School
Newark
NJ
Disclosures
RAS declares that he has no competing interests. RAS is an author of a number of references cited in this topic.
Acknowledgements
Professor Robert A. Schwartz would like to gratefully acknowledge Dr James R. DeBloom and Dr Drazen Jukic, the previous contributors to this topic.
Disclosures
JRD and DJ declare that they have no competing interests.
Peer reviewers
Richard Bull, BMBCh
Consultant Dermatologist
Homerton University Hospital NHS Foundation Trust
London
UK
Disclosures
RB declares that he has no competing interests.
David Cassarino, MD, PhD
Assistant Professor
Department of Pathology and Laboratory Medicine
University of California
Los Angeles
CA
Disclosures
DC declares that he has no competing interests.
References
Key articles
Nasr I, McGrath EJ, Harwood CA, et al; British Association of Dermatologists' Clinical Standards Unit. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol. 2021 Nov;185(5):899-920.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: basal cell skin cancer [internet publication].Full text
Kim JYS, Kozlow JH, Mittal B, et al; Work Group, Invited Reviewers. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018 Mar;78(3):540-59.Full text Abstract
Thomson J, Hogan S, Leonardi-Bee J, et al. Interventions for basal cell carcinoma of the skin. Cochrane Database Syst Rev. 2020 Nov 17;(11):CD003412.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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