eMedicine Specialties > Oncology > Carcinomas of the Skin

Basal Cell Carcinoma

Author: Robert S Bader, MD, Assistant Clinical Professor, Department of Dermatology, Drexel University College of Medicine; Dermatologist, Section of Dermatology, Department of Medicine, North Broward Medical Center
Coauthor(s): Luigi Santacroce, MD, Assistant Professor, Medical School, State University at Bari, Italy; Laura Diomede, University of Bari School of Medicine, Italy; Andrew Scott Kennedy, MD, Co-Medical Director, Wake Radiology Oncology
Contributor Information and Disclosures

Updated: Aug 31, 2009

Introduction

Background

Basal cell carcinoma (BCC) is the most common skin cancer in humans. Basal cell skin cancer tumors typically appear on sun-exposed skin, are slow growing, and rarely metastasize (0.028-0.55%). Neglected tumors can continue to grow and lead to significant local destruction and even disfigurement.


Basal cell carcinoma.

Basal cell carcinoma.

[ CLOSE WINDOW ]
Basal cell carcinoma.

Basal cell carcinoma.


Basal cell carcinoma is a nonmelanocytic skin cancer (ie, an epithelial tumor) that arises from basal cells, small round cells found in the lower layer of the epidermis. Tumor size can vary from a few millimeters to several centimeters in diameter. Basal cells invade the dermis but seldom invade other parts of the body.

Basal cell carcinomas have a typical body distribution: 70% on head (most frequently on face1 ), 25% on trunk,2 and 5% on penis,3 vulva,4,5 or perianal skin. Very rarely, other organs are affected.6 Basal cell carcinoma has a high frequency in older men who have a long history of unprotected exposure to ultraviolet (UV) light. Basal cell carcinoma can develop on unexposed areas; cases of basal cell carcinoma of the prostate have been reported. In a few patients, the contributing factors are contact with arsenic,5,7 tar, coal, paraffin,8 certain types of industrial oil, radiation exposure, scars (ie, burn complications),9 xeroderma pigmentosum,10 vaccinations, or even tattoos.

The DNA of certain genes is often damaged in patients with basal cell carcinoma; therefore, inheritance may be a factor. Most DNA alterations result from damage caused by exposure to sunlight.

Pathophysiology

Although the exact etiology of basal cell carcinoma is unknown, a well-established relationship exists between basal cell carcinoma and the pilosebaceous unit, as tumors are most often discovered on hair-bearing areas. Tumors are currently believed to arise from pluripotent cells (which have the capacity to form hair), sebaceous glands, and apocrine glands. Tumors usually arise from the epidermis or the outer root sheath of a hair follicle.

Patient geographical location affects the risk of developing skin cancer. Basal cell carcinoma is related to lifetime exposure to UV radiation and a history of sunburn. The damaging effects of the sun are cumulative. The skin can repair superficial damage, but the underlying damage remains, including DNA damage. The damage worsens with each successive sun exposure, causing a lifetime progression.11 This damage reduces the ability of DNA to control cell growth and division and, in some situations, this progression results in cancer.

Almost all forms of basal cell carcinoma have mutations in the gene encoding the Hedgehog (Hh) receptor molecule, a signaling pathway playing a pivotal role in cell differentiation. At least 3 forms of this protein are known: sonic HH (SHH), Indian HH (IHH), and desert HH (DHH).

Frequency

United States

Each year in the United States, 900,000 people are diagnosed with basal cell carcinoma (550,000 male, 350,000 female). The estimated lifetime risk of basal cell carcinoma in the white population is 33-39% for men and 23-28% for women.

The American Cancer Society reports skin cancer as the most common cancer in the United States, with over 1 million new cases diagnosed per year and accounting for over 10,000 deaths estimated yearly (ie, approximately 2% of all cancer deaths) in the United States.

Basal cell carcinoma incidence doubles every 25 years.

International

The highest rates of skin cancer occur in South Africa and Australia,12 areas that receive high amounts of UV radiation. Basal cell carcinoma accounts for 80% of all skin cancers but is the least likely cancer to behave in a malignant fashion and metastasize. Basal cell carcinoma differs from squamous cell carcinoma, which accounts for 16% of skin cancers, because squamous cell carcinoma is much less common and more life threatening.

Mortality/Morbidity

Although basal cell carcinoma is a malignant neoplasm, it rarely metastasizes. The incidence of metastatic basal cell carcinoma is estimated at less than 0.1%. The most common sites of metastasis are the lymph nodes, the lungs, and the bones.13 Typically, basal cell tumors enlarge slowly and relentlessly and tend to be locally destructive. Periorbital tumors can invade the orbit, leading to blindness, if diagnosis and treatment are delayed. Perineural invasion can occur, leading to loss of nerve function.

Race

Although basal cell carcinoma is observed in people of all races and skin types, it is most often found in light-skinned individuals (type 1 or type 2 skin); dark-skinned individuals are rarely affected.

  • Type 1 skin - Very fair skin, red or blond hair, freckles, always burn, never tan
  • Type 2 skin - Fair skin, burn easily, tan minimally

Sex

Historically, men are affected twice as often as women. The higher incidence in men is probably due to increased recreational and occupational exposure to the sun, although these differences are becoming less significant with changes in lifestyle. The current male-to-female ratio is approximately 2.1:1.

Age

The likelihood of developing basal cell carcinoma increases with age. With the exception of basal cell nevus syndrome, basal cell carcinoma is rarely found in patients younger than 40 years.

Patients 50-80 years old are affected most often (mean age, 55 y); however, basal cell carcinoma can develop in teenagers and now appears frequently in fair-skinned patients aged 30-50 years. Data indicate that the incidence of basal cell carcinoma is far higher (more than 100-fold) in persons 55-70 years old than in those 20 years of age or younger; however, the damaging effects of the sun begin at an early age. The results may not appear for 20-30 years.

Clinical

History

Patients often report a slowly enlarging lesion that does not heal and that bleeds when traumatized. As tumors most commonly occur on the face, patients often give a history of an acne bump that occasionally bleeds.

People who sunburn are more likely to develop skin cancer than those who do not; however, sunlight damages the skin with or without sunburn. Consider basal cell carcinoma in any patient with a history of a sore or skin anomaly that does not heal within 3-4 weeks and occurs on sun-exposed skin, especially if it is dimpled in the middle. These tumors may take many months or years to reach even 1 cm in diameter.

  • Patients often have a history of chronic sun exposure.
    • Recreational sun exposure (eg, sunbathing, outdoor sports, fishing, boating)
    • Occupational sun exposure (eg, farming, construction)
  • Occasionally, patients have a history of exposure to ionizing radiation. X-ray therapy for acne was commonly used until 1950.
  • Occasionally, patients have a history of arsenic intake; arsenic is found in well water in some parts of the United States.

Physical

Basal cell carcinoma occurs mostly on the face, head (scalp included), neck, and hands.14 It rarely develops on the palms and soles. Basal cell carcinoma usually appears as a flat, firm, pale area that is small, raised, pink or red, translucent, shiny, and waxy, and the area may bleed following minor injury. Basal cell carcinomas may have one or more visible and irregular blood vessels, an ulcerative area in the center that often is pigmented, and black-blue or brown areas. Large basal cell carcinomas may have oozing or crusted areas. The lesion grows slowly, is not painful, and does not itch.

Clinical presentation of basal cell carcinoma varies by type.

  • Nodular basal cell carcinoma
    • Nodular basal cell carcinoma is the most common type of basal cell carcinoma and usually presents as a round, pearly, flesh-colored papule with telangiectases. As it enlarges, it frequently ulcerates centrally, leaving a raised, pearly border with telangiectases, which aids in making the diagnosis.
    • Most tumors are observed on the face, although the trunk and extremities also are affected.

    • Nodular basal cell carcinoma.

      Nodular basal cell carcinoma.

      [ CLOSE WINDOW ]
      Nodular basal cell carcinoma.

      Nodular basal cell carcinoma.

  • Cystic basal cell carcinoma
    • An uncommon variant of nodular basal cell carcinoma, cystic basal cell carcinoma is often indistinguishable from nodular basal cell carcinoma clinically, although it might have a polypoid appearance.
    • Typically, a bluish-gray cyst-like lesion is observed. The cystic center of these tumors is filled with clear mucin that has a gelatin-like consistency.
  • Pigmented basal cell carcinoma
    • Pigmented basal cell carcinoma is an uncommon variant of nodular basal cell carcinoma that has brown-black macules in some or all areas, often making it difficult to differentiate from melanoma.
    • Typically, some areas of these tumors do not retain pigment; pearly, raised borders with telangiectases that are typical of a nodular basal cell carcinoma can be observed. This aids clinically in differentiating this tumor from a melanoma.

    • Pigmented basal cell carcinoma.

      Pigmented basal cell carcinoma.

      [ CLOSE WINDOW ]
      Pigmented basal cell carcinoma.

      Pigmented basal cell carcinoma.


    • Pigmented basal cell carcinoma.

      Pigmented basal cell carcinoma.

      [ CLOSE WINDOW ]
      Pigmented basal cell carcinoma.

      Pigmented basal cell carcinoma.

  • Morpheaform (sclerosing) basal cell carcinoma
    • Morpheaform basal cell carcinoma is an uncommon variant in which tumor cells induce a proliferation of fibroblasts within the dermis and an increased collagen deposition (sclerosis) that clinically resembles a scar. The tumor appears as a white or yellow, waxy, sclerotic plaque that rarely ulcerates. The morpheaform subtype is the most difficult subtype to diagnose.
    • Because the tumor infiltrates in thin strands between collagen fibers, treatment is difficult, and the clinical margins are difficult to distinguish. Mohs micrographic surgery is the treatment of choice for this type of basal cell carcinoma.
  • Superficial basal cell carcinoma
    • Superficial basal cell carcinoma is often multiple, most often developing on the upper trunk or shoulders. It grows slowly and appears clinically as an erythematous, well-circumscribed patch or plaque, often with a whitish scale. Occasionally, minute eschars may appear within the patch or plaque.
    • The tumor appears multicentric, with areas of clinically normal skin intervening among clinically involved areas.


Basal cell carcinoma is also a feature of basal cell nevus syndrome (ie, Gorlin syndrome),15 an autosomal dominant inherited condition. The lesions in these patients cannot be distinguished histologically from ordinary basal cell carcinomas. The gene responsible for this syndrome is located on chromosome arm 9q, and chromosome abnormalities develop in some patients. The number of basal cell carcinomas in patients with this syndrome may number from one to hundreds. Multiple basal cell carcinomas begin to appear after puberty on the face, trunk, and extremities. In many cases, the tumors are highly invasive and involve areas of the face, especially around the eyes and nose.16 Other features associated with Gorlin syndrome (fortunately uncommon) include the following:17
  • Mental retardation
  • Congenital agenesis of the corpus callosum and medulloblastoma
  • Odontogenic jaw cysts
  • Bifid ribs and pectus excavatum
  • Absent or undescended testes
  • Mesenteric lymphatic cysts
  • Palmar and plantar pits
  • Ectopic calcification (particularly of the falx cerebri)
  • Ocular and skeletal abnormalities (eg, hypertelorism, shortening of the fourth and fifth metacarpals)

Causes

The exact cause of basal cell carcinoma is unknown. Environmental and genetic factors that are believed to predispose patients to basal cell carcinoma skin cancer include the following:

  • Exposure to sunlight: Sunlight is the most frequent association, and risk is associated with the amount and nature of accumulated sun exposure over a lifetime, especially during childhood. UVB, 290-320 nm, which causes sunburn, is believed to play a greater role in the development of basal cell carcinoma than UVA.18
  • Gene mutations: Recent studies demonstrate a high incidence of p53 gene mutations in basal cell carcinoma. Researchers speculate that UV sunlight may play an important role in the genesis of this mutation; however, genetic involvement has been demonstrated on chromosome 9 only in patients with familial basal cell nevus syndrome (Gorlin syndrome). Such mutation involves the PTCH gene, a tumor suppressor gene.
  • Exposure to artificial ultraviolet light (eg, tanning booths, ultraviolet light therapy)
  • Ionizing radiation exposure (eg, x-ray therapy for acne)
  • Arsenic exposure through ingestion: Arsenic was used as a medicinal agent, predominantly Fowler's solution of potassium arsenite, which was used to treat many disorders, including asthma and psoriasis. A contaminated water source has been the most common source of arsenic ingestion.
  • Immunosuppression: A modest increase in the lifetime risk of basal cell carcinoma has been noted in chronically immunosuppressed patients, such as recipients of organ or stem cell transplants.
  • Xeroderma pigmentosum: This autosomal recessive disease results in the inability to repair UV-induced DNA damage. Pigmentary changes are seen early in life followed by the development of basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Other features include corneal opacities, eventual blindness, and neurological deficits.
  • Nevoid basal cell carcinoma syndrome (basal cell nevus syndrome, Gorlin syndrome): In addition to basal cell carcinoma, this autosomal dominant disorder can result in the early formation of multiple odontogenic keratocysts, palmoplantar pitting, intracranial calcification, and rib anomalies. Various tumors such as medulloblastomas, meningioma, fetal rhabdomyoma, and ameloblastoma also can occur.19
  • Bazex syndrome: Features include follicular atrophoderma ("ice pick" marks, especially on dorsal hands), multiple basal cell carcinomas, and local anhidrosis (decreased or absent sweating).
  • Personal and family history of previous nonmelanoma skin cancer (basal cell carcinoma or squamous cell carcinoma): Persons who have been diagnosed with one nonmelanoma skin cancer are at increased risk of developing additional tumors in the future. The risk of developing new nonmelanoma skin cancers is reported to be 35% at 3 years and 50% at 5 years after an initial skin cancer diagnosis.
  • Skin type (including albinism)

More on Basal Cell Carcinoma

Overview: Basal Cell Carcinoma
Differential Diagnoses & Workup: Basal Cell Carcinoma
Treatment & Medication: Basal Cell Carcinoma
Follow-up: Basal Cell Carcinoma
Multimedia: Basal Cell Carcinoma
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Erba P, Farhadi J, Wettstein R, Arnold A, Harr T, Pierer G. Morphoeic basal cell carcinoma of the face. Scand J Plast Reconstr Surg Hand Surg. 2007;41(4):184-8. [Medline].

  2. Fresini A, Rossiello L, Severino BU, Del Prete M, Satriano RA. Giant basal cell carcinoma. Skinmed. Jul-Aug 2007;6(4):204-5. [Medline].

  3. Shindel AW, Mann MW, Lev RY, Sengelmann R, Petersen J, Hruza GJ. Mohs micrographic surgery for penile cancer: management and long-term followup. J Urol. Nov 2007;178(5):1980-5. [Medline].

  4. Mulvany NJ, Allen DG. Differentiated intraepithelial neoplasia of the vulva. Int J Gynecol Pathol. Jan 2008;27(1):125-35. [Medline].

  5. Cabrera HN, Cuda G, Lopez M, Costa JA. [Basal cell epithelioma of the vulva in chronic endemic regional arsenic poisoning]. Med Cutan Ibero Lat Am. 1984;12(2):81-5. [Medline].

  6. Keyhani K, Ashenhurst M, Oryschak A. Periocular basal cell carcinoma arising in a site of previous trauma. Can J Ophthalmol. Jun 2007;42(3):467-8. [Medline].

  7. Cabrera HN, Gomez ML. Skin cancer induced by arsenic in the water. J Cutan Med Surg. Mar-Apr 2003;7(2):106-11. [Medline].

  8. Romao-Correa RF, Maria DA, Soma M, Sotto MN, Sanches JA Jr, Neto CF. Nucleolar organizer region staining patterns in paraffin-embedded tissue cells from human skin cancers. J Cutan Pathol. May 2005;32(5):323-8. [Medline].

  9. Ozyazgan I, Kontas O. Previous injuries or scars as risk factors for the development of basal cell carcinoma. Scand J Plast Reconstr Surg Hand Surg. 2004;38(1):11-5. [Medline].

  10. Mohanty P, Mohanty L, Devi BP. Multiple cutaneous malignancies in xeroderma pigmentosum. Indian J Dermatol Venereol Leprol. Mar-Apr 2001;67(2):96-7. [Medline].

  11. Centers for Disease Control and Prevention (CDC). Sunburn prevalence among adults--United States, 1999, 2003, and 2004. MMWR Morb Mortal Wkly Rep. Jun 1 2007;56(21):524-8. [Medline].

  12. Marks R, Jolley D, Dorevitch AP, Selwood TS. The incidence of non-melanocytic skin cancers in an Australian population: results of a five-year prospective study. Med J Aust. May 1 1989;150(9):475-8. [Medline].

  13. Akinci M, Aslan S, Markoc F, Cetin B, Cetin A. Metastatic basal cell carcinoma. Acta Chir Belg. Mar-Apr 2008;108(2):269-72. [Medline].

  14. Kumar N, Saxena YK. Two cases of rare presentation of basal cell and squamous cell carcinoma on the hand. Indian J Dermatol Venereol Leprol. Nov-Dec 2002;68(6):349-51. [Medline].

  15. Gorlin RJ. Nevoid basal cell carcinoma (Gorlin) syndrome: unanswered issues. J Lab Clin Med. Dec 1999;134(6):551-2. [Medline].

  16. Bernardini FP. Management of malignant and benign eyelid lesions. Curr Opin Ophthalmol. Oct 2006;17(5):480-4. [Medline].

  17. Ly JQ. Scintigraphic findings in Gorlin's syndrome. Clin Nucl Med. Dec 2002;27(12):913-4. [Medline].

  18. Lim JL, Stern RS. High levels of ultraviolet B exposure increase the risk of non-melanoma skin cancer in psoralen and ultraviolet A-treated patients. J Invest Dermatol. Mar 2005;124(3):505-13. [Medline].

  19. Cohen MM Jr. Nevoid basal cell carcinoma syndrome: molecular biology and new hypotheses. Int J Oral Maxillofac Surg. Jun 1999;28(3):216-23. [Medline].

  20. Orengo IF, Salasche SJ, Fewkes J, Khan J, Thornby J, Rubin F. Correlation of histologic subtypes of primary basal cell carcinoma and number of Mohs stages required to achieve a tumor-free plane. J Am Acad Dermatol. Sep 1997;37(3 Pt 1):395-7. [Medline].

  21. Young LC, Listgarten J, Trotter MJ, Andrew SE, Tron VA. Evidence that dysregulated DNA mismatch repair characterizes human nonmelanoma skin cancer. Br J Dermatol. Jan 2008;158(1):59-69. [Medline].

  22. Ackerman AB, Gottlieb GJ. Fibroepithelial tumor of pinkus is trichoblastic (Basal-cell) carcinoma. Am J Dermatopathol. Apr 2005;27(2):155-9. [Medline].

  23. Bowen AR, LeBoit PE. Fibroepithelioma of pinkus is a fenestrated trichoblastoma. Am J Dermatopathol. Apr 2005;27(2):149-54. [Medline].

  24. Strauss RM, Edwards S, Stables GI. Pigmented fibroepithelioma of Pinkus. Br J Dermatol. Jun 2004;150(6):1208-9. [Medline].

  25. Barry J, Oon SF, Watson R, Barnes L. The management of basal cell carcinomas. Ir Med J. Jun 2006;99(6):179-81. [Medline].

  26. Dandurand M, Petit T, Martel P, Guillot B,. Management of basal cell carcinoma in adults Clinical practice guidelines. Eur J Dermatol. Jul-Aug 2006;16(4):394-401. [Medline].

  27. Babilas P, Landthaler M, Szeimies RM. Photodynamic therapy in dermatology. Eur J Dermatol. Jul-Aug 2006;16(4):340-8. [Medline].

  28. Foley P. Clinical efficacy of methyl aminolaevulinate photodynamic therapy in basal cell carcinoma and solar keratosis. Australas J Dermatol. Feb 2005;46 Suppl 3:S8-10; discussion S23-5. [Medline].

  29. Zimmermann A, Walt H, Haller U, Baas P, Klein SD. Effects of chlorin-mediated photodynamic therapy combined with fluoropyrimidines in vitro and in a patient. Cancer Chemother Pharmacol. Feb 2003;51(2):147-54. [Medline].

  30. Miller BH, Shavin JS, Cognetta A, et al. Nonsurgical treatment of basal cell carcinomas with intralesional 5-fluorouracil/epinephrine injectable gel. J Am Acad Dermatol. Jan 1997;36(1):72-7. [Medline].

  31. Greenway HT, Cornell RC, Tanner DJ, Peets E, Bordin GM, Nagi C. Treatment of basal cell carcinoma with intralesional interferon. J Am Acad Dermatol. Sep 1986;15(3):437-43. [Medline].

  32. Geisse JK, Rich P, Pandya A, Gross K, Andres K, Ginkel A. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: a double-blind, randomized, vehicle-controlled study. J Am Acad Dermatol. Sep 2002;47(3):390-8. [Medline].

  33. [Best Evidence] Eigentler TK, Kamin A, Weide BM, et al. A phase III, randomized, open label study to evaluate the safety and efficacy of imiquimod 5% cream applied thrice weekly for 8 and 12 weeks in the treatment of low-risk nodular basal cell carcinoma. J Am Acad Dermatol. Oct 2007;57(4):616-21. [Medline]. [Full Text].

  34. Stockfleth E, Ulrich C, Hauschild A, Lischner S, Meyer T, Christophers E. Successful treatment of basal cell carcinomas in a nevoid basal cell carcinoma syndrome with topical 5% imiquimod. Eur J Dermatol. Nov-Dec 2002;12(6):569-72. [Medline].

  35. Berman B. Scientific rationale: combining imiquimod and surgical treatments for basal cell carcinomas. J Drugs Dermatol. Jan 2008;7(1 Suppl 1):s3-6. [Medline].

  36. Von Hoff DD, et al. "Efficacy data of GDC-0449, a systemic Hedgehog pathway antagonist, in a first-in-human, first-in-class phase I study with locally advanced, multifocal, or metastatic basal cell carcinoma patients". AACR Meeting. 2008;Abstract LB-138.

  37. Garber K. Hedgehog drugs begin to show results. J Natl Cancer Inst. May 21 2008;100(10):692-7. [Medline].

  38. Lewis JE. Keloidal basal cell carcinoma. Am J Dermatopathol. Oct 2007;29(5):485. [Medline].

  39. Kempf RA. Systemic therapy of skin carcinoma. Cancer Treat Res. 1995;78:137-62. [Medline].

  40. Brownell I. Nodular basal cell carcinoma: when in doubt, cut it out. J Drugs Dermatol. Dec 2007;6(12):1245-6. [Medline].

  41. Farhi D, Dupin N, Palangie A, Carlotti A, Avril MF. Incomplete excision of basal cell carcinoma: rate and associated factors among 362 consecutive cases. Dermatol Surg. Oct 2007;33(10):1207-14. [Medline].

  42. Mukamal KJ. Alcohol consumption and self-reported sunburn: a cross-sectional, population-based survey. J Am Acad Dermatol. Oct 2006;55(4):584-9. [Medline].

  43. Barlow JO, Zalla MJ, Kyle A, DiCaudo DJ, Lim KK, Yiannias JA. Treatment of basal cell carcinoma with curettage alone. J Am Acad Dermatol. Jun 2006;54(6):1039-45. [Medline].

  44. Grabski WJ, Salasche SJ. Positive surgical excision margins of a basal cell carcinoma. Dermatol Surg. Aug 1998;24(8):921-4. [Medline].

  45. Bostock-Ling N. Excising basal cell carcinoma in general practice. Aust Fam Physician. Jul 2006;35(7):558-60. [Medline].

  46. Lawrence CM. Mohs' micrographic surgery for basal cell carcinoma. Clin Exp Dermatol. Mar 1999;24(2):130-3. [Medline].

  47. Smeets NW, Krekels GA, Ostertag JU, Essers BA, Dirksen CD, Nieman FH. Surgical excision vs Mohs' micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. Lancet. Nov 13-19 2004;364(9447):1766-72. [Medline].

  48. Kaur S, Thami GP, Kanwar AJ. Basal cell carcinoma--treatment with cryosurgery. Indian J Dermatol Venereol Leprol. Mar-Apr 2003;69(2):188-90. [Medline].

  49. Aoki R, Pennington DG, Hyakusoku H. Flap-in-flap method for enhancing the advancement of a V-Y flap. J Plast Reconstr Aesthet Surg. 2006;59(6):653-7. [Medline].

  50. Horlock N, Grobbelaar AO, Gault DT. Can the carbon dioxide laser completely ablate basal cell carcinomas? A histological study. Br J Plast Surg. Jun 2000;53(4):286-93. [Medline].

  51. Humphreys TR, Malhotra R, Scharf MJ, Marcus SM, Starkus L, Calegari K. Treatment of superficial basal cell carcinoma and squamous cell carcinoma in situ with a high-energy pulsed carbon dioxide laser. Arch Dermatol. Oct 1998;134(10):1247-52. [Medline].

  52. Heal C, Buettner P, Browning S. Risk factors for wound infection after minor surgery in general practice. Med J Aust. Sep 4 2006;185(5):255-8. [Medline].

  53. Mc Loone NM, Tolland J, Walsh M, et al. Follow-up of basal cell carcinomas: an audit of current practice. J Eur Acad Dermatol Venereol. Jul 2006;20(6):698-701.

  54. Bruce AJ, Brodland DG. Overview of skin cancer detection and prevention for the primary care physician. Mayo Clin Proc. May 2000;75(5):491-500. [Medline].

  55. Cohen PR, Schulze KE, Nelson BR. Basal cell carcinoma with mixed histology: a possible pathogenesis for recurrent skin cancer. Dermatol Surg. Apr 2006;32(4):542-51. [Medline].

  56. De Palo G, Veronesi U, Marubini E, et al. Controlled clinical trials with fenretinide in breast cancer, basal cell carcinoma and oral leukoplakia. J Cell Biochem Suppl. 1995;22:11-7.

  57. Desai A, Krathen R, Orengo I, Medrano EE. The age of skin cancers. Sci Aging Knowledge Environ. May 15 2006;2006(9):pe13. [Medline].

  58. Drake LA, Ceilley RI, Cornelison RL, Dobes WA, Dorner W, Goltz RW, et al. Guidelines of care for basal cell carcinoma. The American Academy of Dermatology Committee on Guidelines of Care. J Am Acad Dermatol. Jan 1992;26(1):117-20. [Medline].

  59. Dzubou LM. Aggressive basal cell carcinoma. J Am Acad Dermatol. Aug 1986;15(2 Pt 1):297-9. [Medline].

  60. Etter L, Cook JL. Basal cell carcinoma of the umbilicus: a case report and literature review. Cutis. Feb 2003;71(2):123-6. [Medline].

  61. Geller AC, Annas GD. Epidemiology of melanoma and nonmelanoma skin cancer. Semin Oncol Nurs. Feb 2003;19(1):2-11. [Medline].

  62. Glass LF, Fenske NA, Jaroszeski M, et al. Bleomycin-mediated electrochemotherapy of basal cell carcinoma. J Am Acad Dermatol. Jan 1996;34(1):82-6. [Medline].

  63. Green CL, Khavari PA. Targets for molecular therapy of skin cancer. Semin Cancer Biol. Feb 2004;14(1):63-9. [Medline].

  64. Heinritz H, Benzel W, Hoffmann K, Iro H. [Imaging superficial skin tumors of the ENT area. High frequency ultrasound in comparison with computerized tomography and magnetic resonance tomography]. HNO. Jan 1995;43(1):6-11. [Medline].

  65. Hoban PR, Lear JT, Strange RC. Basal cell carcinoma: genetic homogeneity in a tumour type displaying phenotypic diversity. Eur J Hum Genet. Sep 2006;14(9):977-8. [Medline].

  66. Jones MS, Maloney ME, Billingsley EM. The heterogenous nature of in vivo basal cell carcinoma. Dermatol Surg. Aug 1998;24(8):881-4. [Medline].

  67. Lear JT, Tan BB, Smith AG, et al. Risk factors for basal cell carcinoma in the UK: case-control study in 806 patients. J R Soc Med. Jul 1997;90(7):371-4. [Medline].

  68. Lortscher DN, Sengelmann RD, Allen SB. Acrochordon-like basal cell carcinomas in patients with basal cell nevus syndrome. Dermatol Online J. 2007;13(2):21. [Medline].

  69. Mathews SS, Ninan S. Reconstruction of the conchal bowl and external auditory canal. Ear Nose Throat J. Jul 2006;85(7):425. [Medline].

  70. Mehta R. Malignant and premalignant skin conditions. Practitioner. Feb 2003;247(1643):104-7, 109, 112-4 passim. [Medline].

  71. Mogensen M, Jemec GB. Diagnosis of nonmelanoma skin cancer/keratinocyte carcinoma: a review of diagnostic accuracy of nonmelanoma skin cancer diagnostic tests and technologies. Dermatol Surg. Oct 2007;33(10):1158-74. [Medline].

  72. Mollenhauer J, Deichmann M, Helmke B, Muller H, Kollender G, Holmskov U. Frequent downregulation of DMBT1 and galectin-3 in epithelial skin cancer. Int J Cancer. Jun 10 2003;105(2):149-57. [Medline].

  73. Mumm CD, Draznin M. Melanocortin-1 receptor: loss of function mutations and skin cancer. Dermatol Online J. 2006;12(5):13. [Medline].

  74. Netscher DT, Spira M. Basal cell carcinoma: an overview of tumor biology and treatment. Plast Reconstr Surg. Apr 2004;113(5):74E-94E. [Medline].

  75. Oh CK, Kwon YW, Kim YS, Jang HS, Kwon KS. Expression of basic fibroblast growth factor, vascular endothelial growth factor, and thrombospondin-1 related to microvessel density in nonaggressive and aggressive basal cell carcinomas. J Dermatol. Apr 2003;30(4):306-13. [Medline].

  76. Oster-Schmidt C, Altmeyer P, Stücker M. Successful treatment of basal cell carcinoma on the face with imiquimod 5% cream. Acta Derm Venereol. 2002;82(6):477. [Medline].

  77. Pannone G, Nocini PF, Lo Muzio L, Procaccini M, Pannone G, Santacroce L. [Instability of micro-satellite sequences of DNA associated with genetic alterations in head and neck neoplasms. Review of the literature and preliminary results of a research plan]. Minerva Stomatol. Nov 1998;47(11):589-96. [Medline].

  78. Plumb SJ, Argenyi ZB, Stone MS, De Young BR. Cytokeratin 5/6 immunostaining in cutaneous adnexal neoplasms and metastatic adenocarcinoma. Am J Dermatopathol. Dec 2004;26(6):447-51. [Medline].

  79. Raasch B, Woolley T. Management of primary superficial basal cell carcinoma. Aust Fam Physician. Jun 2006;35(6):455-8. [Medline].

  80. Saldanha G, Fletcher A, Slater DN. Basal cell carcinoma: a dermatopathological and molecular biological update. Br J Dermatol. Feb 2003;148(2):195-202. [Medline].

  81. Sharquie KE, Al-Nuaimy AA, Al-Shimary FA. New intralesional therapy for basal cell carcinoma by 2% zinc sulphate solution. Saudi Med J. Feb 2005;26(2):359-61. [Medline].

  82. Smeets NW, Stavast-Kooy AJ, Krekels GA, Daemen MJ, Neumann HA. Adjuvant cytokeratin staining in Mohs micrographic surgery for basal cell carcinoma. Dermatol Surg. Apr 2003;29(4):375-7. [Medline].

  83. Spencer JM, Tannenbaum A, Sloan L, Amonette RA. Does inflammation contribute to the eradication of basal cell carcinoma following curettage and electrodesiccation?. Dermatol Surg. Aug 1997;23(8):625-30; discussion 630-1. [Medline].

  84. Strayer SM, Reynolds PL. Diagnosing skin malignancy: assessment of predictive clinical criteria and risk factors. J Fam Pract. Mar 2003;52(3):210-8. [Medline].

  85. Usatine RP. Recognition for the diagnosis of skin cancer. J Fam Pract. Mar 2003;52(3):219-21. [Medline].

  86. Vun Y, Siller G. Use of 5% imiquimod cream in the treatment of facial basal cell carcinoma: a 3-year retrospective follow-up study. Australas J Dermatol. Aug 2006;47(3):169-71. [Medline].

[ CLOSE WINDOW ]

Keywords

basal cell carcinoma, basal cell cancer, basal cell skin cancer, BCC, basal cell epithelioma, BCE, basalioma, skin cancer diagnosis, skin cancer treatment, skin cancer pictures, basal cell carcinoma diagnosis, basal cell carcinoma treatment, basal cell carcinoma pictures, skin tumor rodent ulcer, nodular basal cell carcinoma, noduloulcerative cystic basal cell carcinoma, pigmented basal cell carcinoma, morpheaform basal cell carcinoma, sclerosing basal cell carcinoma, superficial basal cell carcinoma, keratotic basal cell carcinoma, adenoid basal cell carcinoma, infiltrative basal cell carcinoma, Mohs micrographic surgery, Mohs surgery, cutaneous malignancy, skin malignancy, cutaneous cancer, basaloma, basalioma, basal cell nevus syndrome, Gorlin-Goltz syndrome, nevoid basal cell carcinoma syndrome, NBCCS, trichoblastic carcinoma, trichoblastoma, fibroepithelioma of Pinkus, epithelial tumor

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert S Bader, MD, Assistant Clinical Professor, Department of Dermatology, Drexel University College of Medicine; Dermatologist, Section of Dermatology, Department of Medicine, North Broward Medical Center
Robert S Bader, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and Florida Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Luigi Santacroce, MD, Assistant Professor, Medical School, State University at Bari, Italy
Disclosure: Nothing to disclose.

Laura Diomede, University of Bari School of Medicine, Italy
Disclosure: Nothing to disclose.

Andrew Scott Kennedy, MD, Co-Medical Director, Wake Radiology Oncology
Andrew Scott Kennedy, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Hepato-Pancreato-Biliary Association, American Society for Therapeutic Radiology and Oncology, American Society of Clinical Oncology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Sanjiv S Agarwala, MD, Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Associate Professor of Cancer Biology, University of Pennsylvania
Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Head and Neck Surgery, Eastern Cooperative Oncology Group, and European Society for Medical Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.