eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Pathology

Skin Cancer - Basal Cell Carcinoma: Differential Diagnoses & Workup

Author: Ali Sajjadian, MD, FACS, Director of University of Pittsburgh Medical Center Aesthetic Plastic Surgery Satellite Centers; Private Practice, Orange County, California
Coauthor(s): Michael Barakat, California Surgical Institute; Negar Sajjadian, MD, Assistant Professor of Pediatrics, Tehran University of Medical Sciences, Shariati Hospital; Rana Rofagha, MD,, Clinical Instructor, Department of Dermatology, University of California-Irvine, School of Medicine
Contributor Information and Disclosures

Updated: Jan 25, 2010

Differential Diagnoses

Other Problems to Be Considered

Squamous cell carcinoma of the skin
Eczema
Psoriasis
Actinic keratitis

Workup

Imaging Studies

  • For early basal cell carcinoma (BCC), clinical examination suffices to determine extent of lesion.
  • 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.

Other Tests

  • Photo documentation

Procedures

  • Obtain a biopsy of the tumor to confirm the diagnosis and determine the histological 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.6
    • 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.6
    • N0 - No regional lymph node metastasis
    • N1 - Regional lymph node metastasis
  • Distant metastasis MX: Presence of distant metastasis cannot be assessed.6
    • 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. Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg. Aug 2007;33(8):957-64; discussion 965. [Medline].

  2. Wetzig T, Maschke J, Kendler M, Simon JC. Treatment of basal cell carcinoma. J Dtsch Dermatol Ges. Apr 24 2009;[Medline].

  3. Walling HW, Fosko SW, Geraminejad PA, Whitaker DC, Arpey CJ. Aggressive basal cell carcinoma: presentation, pathogenesis, and management. Cancer Metastasis Rev. Aug-Dec 2004;23(3-4):389-402. [Medline].

  4. Brasseur R, Lagesse Ch. [Contribution of psychometry of clinical evaluation of the therapeutic effect of "Solcoseryl" in states of intellectual weakness connected with chronic cerebral circulatory insufficiency (author's transl)]. Schweiz Rundsch Med Prax. Mar 8 1977;66(10):312-7. [Medline]. [Full Text].

  5. Leffell DJ, Headington JT, Wong DS, Swanson NA. Aggressive-growth basal cell carcinoma in young adults. Arch Dermatol. Nov 1991;127(11):1663-7. [Medline].

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

  7. Ceilley RI, Del Rosso JQ. Current modalities and new advances in the treatment of basal cell carcinoma. Int J Dermatol. May 2006;45(5):489-98. [Medline].

  8. Batra RS, Kelley LC. Predictors of extensive subclinical spread in nonmelanoma skin cancer treated with Mohs micrographic surgery. Arch Dermatol. Aug 2002;138(8):1043-51. [Medline].

  9. Ezughah FI, Affleck AG, Evans A, Ibbotson SH, Fleming CJ. Confirmation of histological clearance of superficial basal cell carcinoma with multiple serial sectioning and Mohs' micrographic surgery following treatment with imiquimod 5% cream. J Dermatolog Treat. 2008;19(3):156-8. [Medline].

  10. Neville JA, Williford PM, Jorizzo JL. Pilot study using topical imiquimod 5% cream in the treatment of nodular basal cell carcinoma after initial treatment with curettage. J Drugs Dermatol. Sep 2007;6(9):910-4. [Medline].

  11. Prior SL, Griffiths AP, Lewis PD. A study of mitochondrial DNA D-loop mutations and p53 status in nonmelanoma skin cancer. Br J Dermatol. Nov 2009;161(5):1067-71. [Medline].

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Further Reading

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Keywords

basal cell carcinoma of the skin, skin cancer, BCC, basal cell epithelioma, rodent ulcer, nodular basal cell carcinoma, noduloulcerative basal cell carcinoma, skin BCC.

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Contributor Information and Disclosures

Author

Ali Sajjadian, MD, FACS, Director of University of Pittsburgh Medical Center Aesthetic Plastic Surgery Satellite Centers; Private Practice, Orange County, California
Ali Sajjadian, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, California Medical Association, Northeastern Society of Plastic Surgeons, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Barakat, California Surgical Institute
Disclosure: Nothing to disclose.

Negar Sajjadian, MD, Assistant Professor of Pediatrics, Tehran University of Medical Sciences, Shariati Hospital
Disclosure: Nothing to disclose.

Rana Rofagha, MD,, Clinical Instructor, Department of Dermatology, University of California-Irvine, School of Medicine
Rana Rofagha, MD, is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and American Society for MOHS Surgery
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 College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Allergan Honoraria Consulting

Pharmacy Editor

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

Managing Editor

M Sherif Said, MD, PhD, FCAP, Associate Professor of Pathology, Director of Head and Neck Pathology, Department of Pathology, University of Colorado, Denver
M Sherif Said, MD, PhD, FCAP is a member of the following medical societies: American Society for Clinical Pathology and College of American Pathologists
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: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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