eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Pathology

Skin Cancer: Basal Cell Carcinoma: Differential Diagnoses & Workup

Author: M Abraham Kuriakose, MD, DDS, FRCS, Chairman, Head and Neck Institute, Amrita Institute of Medical Sciences
Contributor Information and Disclosures

Updated: Dec 11, 2006

Differential Diagnoses

Other Problems to Be Considered

Squamous cell carcinoma of the skin
Eczema
Psoriasis
Actinic keratitis

Workup

Imaging Studies

  • Perform diagnostic imaging studies for advanced tumors when there is question of invasion or involvement of underlying soft tissue or bone.
  • CT scanning with bone windows is the imaging study of choice. As incidence of nodal metastasis is very low, evaluation of the neck is not essential.
  • For early BCC, clinical examination suffices to determine extent of lesion.

Other Tests

  • Photo documentation

Procedures

  • Obtain a biopsy of the tumor to confirm the diagnosis and determine the histologic subtypes. Complete an incision or punch biopsy prior to definitive treatment.
    • Obtain the biopsy from the margins of the lesion to include both tumor and normal tissue.
    • A shave biopsy may be difficult to interpret because of tangential sectioning and should be avoided.

Histologic Findings

The basaloid appearance of the epithelial islands is the pathognomonic feature of BCC. The cells mimic germinative epithelium and have an increased nuclear cytoplasmic ratio. These cells show peripheral palisading, in which they are arranged perpendicular to the basement membrane. The tumor has a characteristic invasive pattern with the formation of large islands, cords, and teardrops. Cells within the center of the epithelial islands have nondiscrete cytoplasmic borders and mimic syncytium. The cells do not have prominent nucleoli and lack intercellular bridges. The stomas show varying amounts of collagen deposition with abundant mucin.

Staging

  • Primary tumor TX: Primary tumor cannot be assessed.
    • T0 - No evidence of primary tumor
    • T1 - Tumor 2 cm or less in greatest dimension
    • T2 - Tumor more than 2 cm but not more than 5 cm in greatest dimension
    • T3 - Tumor more than 5 cm in greatest dimension
    • T4 - Tumor invading deep extradermal structures
  • Regional lymph node NX: Regional lymph node cannot be assessed.
    • N0 - No regional lymph node metastasis
    • N1 - Regional lymph node metastasis
  • Distant metastasis MX: Presence of distant metastasis cannot be assessed.
    • M0 - No distant metastasis
    • M1 - Distant metastasis

More on Skin Cancer: Basal Cell Carcinoma

Overview: Skin Cancer: Basal Cell Carcinoma
Differential Diagnoses & Workup: Skin Cancer: Basal Cell Carcinoma
Treatment & Medication: Skin Cancer: Basal Cell Carcinoma
Follow-up: Skin Cancer: Basal Cell Carcinoma
Multimedia: Skin Cancer: Basal Cell Carcinoma
References
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References

  1. American Joint Committee on Cancer. Manual for Staging of Cancer. JB Lippincott;1992.

  2. Baker SR, Swanson NA, Grekin RC. An interdisciplinary approach to the management of basal cell carcinoma of the head and neck. J Dermatol Surg Oncol. Oct 1987;13(10):1095-106. [Medline].

  3. Gallagher RP, Hill GB, Bajdik CD, et al. Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer & Basal cell carcinoma. Archives of Dermatology. 1995;131:157-63.

  4. Geisse J, Caro I, Lindholm J. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from two phase III, randomized, vehicle-controlled studies. Journal of the American Academy of Dermatology. 2004;50:722-33. [Full Text].

  5. Miller SJ. Biology of basal cell carcinoma (Part I). J Am Acad Dermatol. Jan 1991;24(1):1-13. [Medline].

  6. Pascal RR, Hobby LW, Lattes R, Crikelair GF. Prognosis of "incompletely excised" versus "completely excised" basal cell carcinoma. Plast Reconstr Surg. Apr 1968;41(4):328-32. [Medline].

  7. Shumack S, Robinson J, Kossard S, et al. Efficacy of topical 5% imiquimod cream for the treatment of nodular basal cell carcinoma: comparison of dosing regimens. Archives of Dermatology. 2002;138:1165-71. [Medline]. [Full Text].

  8. Sober AJ. Diagnosis and management of skin cancer. Cancer. Jun 15 1983;51(12 Suppl):2448-52. [Medline].

  9. Swanson NA. Mohs surgery. Technique, indications, applications, and the future. Arch Dermatol. Sep 1983;119(9):761-73. [Medline].

  10. Swetter SM, Waddell BL, Vazquez MD. Increased effectiveness of targeted skin cancer screening in the Veterans Affairs population of northern California. Preventive medicine. 2003;36:164-71. [Medline]. [Full Text].

  11. Weber RS, Miller MJ, Goepfert H. Basal and Squamous Cell Skin Cancers of the Head and Neck. Baltimore:. Lippincott Williams & Wilkins;1996:9-33.

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Further Reading

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Keywords

basal cell carcinoma of the skin, BCC, basal cell epithelioma, rodent ulcer, squamous cell carcinoma, SCC, nodular basal cell carcinoma, noduloulcerative basal cell carcinoma, morpheaform basal cell carcinoma, sclerosing basal cell carcinoma, superficial basal cell carcinoma, basosquamous carcinoma, basisquamous carcinoma, basal squamous cell carcinoma, skin BCC

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Contributor Information and Disclosures

Author

M Abraham Kuriakose, MD, DDS, FRCS, Chairman, Head and Neck Institute, Amrita Institute of Medical Sciences
M Abraham Kuriakose, MD, DDS, FRCS is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, British Association of Oral and Maxillofacial Surgeons, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Medical Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

M Sherif Said, MD, PhD, Assistant Professor of Pathology, Director of Head and Neck Pathology, Department of Pathology, University of Colorado Health Sciences Center
M Sherif Said, MD, PhD is a member of the following medical societies: American Medical Association, American Society of Clinical Pathologists, American Society of Cytopathology, College of American Pathologists, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: UST Grant/research funds Consulting

 
 
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