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Skin Cancer - Basal Cell Carcinoma: Differential Diagnoses & Workup
Updated: Jan 25, 2010
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
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 |
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Differential Diagnoses & Workup: Skin Cancer - Basal Cell Carcinoma |
| Treatment & Medication: Skin Cancer - Basal Cell Carcinoma |
| Follow-up: Skin Cancer - Basal Cell Carcinoma |
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References
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].
Wetzig T, Maschke J, Kendler M, Simon JC. Treatment of basal cell carcinoma. J Dtsch Dermatol Ges. Apr 24 2009;[Medline].
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].
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].
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].
American Joint Committee on Cancer. Manual for Staging of Cancer. JB Lippincott; 1992.
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].
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].
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].
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].
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].
Further Reading
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.
Differential Diagnoses & Workup: Skin Cancer - Basal Cell Carcinoma