Overview
What is basal cell carcinoma (BCC)?
What are the signs and symptoms of basal cell carcinoma (BCC)?
Where is basal cell carcinoma (BCC) most commonly located?
What are the clinicopathologic types of basal cell carcinoma (BCC)?
What is the role of imaging studies in the diagnosis of basal cell carcinoma (BCC)?
How is a diagnosis of basal cell carcinoma (BCC) confirmed?
Which histology findings are characteristic of basal cell carcinoma (BCC)?
Which surgery techniques are performed in the treatment of basal cell carcinoma (BCC)?
What is the role of radiation therapy in the treatment of basal cell carcinoma (BCC)?
What is the role of photodynamic therapy in the treatment of basal cell carcinoma (BCC)?
What is the role of topical agents in the treatment of basal cell carcinoma (BCC)?
Which medications are FDA approved for the treatment of basal cell carcinoma (BCC)?
What is basal cell carcinoma (BCC)?
What are the most common sites for basal cell carcinoma (BCC) lesions?
How is the diagnosis of basal cell carcinoma (BCC) confirmed?
What is the recommended treatment for basal cell carcinoma (BCC)?
What are the treatment options for superficial basal cell carcinoma (BCC)?
What is the pathophysiology of basal cell carcinoma?
What is the role of radiation in the pathogenesis of basal cell carcinoma (BCC)?
What causes of basal cell carcinoma (BCC)?
What is the role of radiation exposure in the etiology of basal cell carcinoma (BCC)?
What is the role of genetics in the etiology of basal cell carcinoma (BCC)?
What is the role of arsenic ingestion to the etiology of basal cell carcinoma (BCC)?
How much does immunosuppression increase the risk for basal cell carcinoma (BCC)?
What is the role of xeroderma pigmentosum in the etiology of basal cell carcinoma (BCC)?
What is nevoid basal cell carcinoma syndrome?
What are the features of Bazex syndrome?
Which skin types are at higher risk for basal cell carcinoma (BCC)?
What is the link between alcohol consumption and the development of basal cell carcinoma (BCC)?
What is the role of hydrochlorothiazide (HCTZ) in the etiology of basal cell carcinoma (BCC)?
What is the prevalence of basal cell carcinoma (BCC) in the US?
What is the racial predilection of basal cell carcinoma (BCC)?
How does the incidence of basal cell carcinoma (BCC) vary by sex?
How does the incidence of basal cell carcinoma (BCC) vary by age?
What is the prognosis of basal cell carcinoma (BCC)?
What is the rate of recurrence for basal cell carcinoma (BCC)?
What are signs of recurrence of basal cell carcinoma (BCC)?
What is included in patient education about basal cell carcinoma (BCC)?
What is the role of sunscreen in the prevention of basal cell carcinoma (BCC)?
How should patients with basal cell carcinoma (BCC) be taught to perform self-exam for skin changes?
Presentation
What is the clinical history characteristic of basal cell carcinoma (BCC)?
How are nodular basal cell carcinoma characterized?
How is superficial basal cell carcinoma characterized?
How are basal cell carcinoma tumors characterized?
What are the most common sites for basal cell carcinoma?
Which physical findings are characteristic of basal cell carcinoma?
What are the clinicopathologic types of basal cell carcinoma (BCC)?
How are pigmented basal cell carcinoma characterized?
How is infiltrative basal cell carcinoma characterized?
How is micronodular basal cell carcinoma characterized?
How is morpheaform (sclerosing) basal cell carcinoma characterized?
Which physical findings are characteristic of basal cell nevus syndrome (Gorlin syndrome)?
What are the types of basal cell carcinoma (BCC)?
DDX
What are diagnostic considerations in basal cell carcinoma?
Which conditions should be included in the differential diagnoses of basal cell carcinoma (BCC)?
What are the differential diagnoses for Basal Cell Carcinoma?
Workup
What studies are included in the workup of basal cell carcinoma (BCC)?
What is the role of skin biopsy in the workup of basal cell carcinoma?
What is the role of cytology in the workup of basal cell carcinoma?
Which histologic findings are characteristic of basal cell carcinoma (BCC)?
Which histologic findings are characteristic of nodular basal cell carcinoma?
Which histologic findings are characteristic of micronodular basal cell carcinoma?
Which histologic findings are characteristic of pigmented basal cell carcinoma?
Which histologic findings are characteristic of adenoid basal cell carcinoma?
Which histologic findings are characteristic of morpheaform (sclerosing) basal cell carcinoma?
Which histologic findings are characteristic of infiltrative basal cell carcinoma?
Which histologic findings are characteristic of cystic basal cell carcinoma?
Which histologic findings are characteristic of superficial basal cell carcinoma?
Which histologic findings are characteristic of keratotic basal cell carcinoma?
Which histologic findings are characteristic of infundibulocystic basal cell carcinoma?
Which histologic findings are characteristic of metatypical basal cell carcinoma?
Which histologic findings are characteristic of basosquamous basal cell carcinoma?
Which histologic findings are characteristic of fibroepithelioma basal cell carcinoma?
What is the role of ultrasonography in the workup of basal cell carcinoma (BCC)?
What is the role of laser Doppler perfusion imaging in the workup of basal cell carcinoma (BCC)?
How is basal cell carcinoma staged?
What are types of high-risk basal cell carcinoma (BCC)?
Treatment
What are the treatment options for basal cell carcinoma (BCC)?
When are topical therapies indicated in the treatment of basal cell carcinoma (BCC)?
What is the role of Mohs micrographic surgery in the treatment of basal cell carcinoma (BCC)?
When is radiation therapy indicated in the treatment of basal cell carcinoma (BCC)?
What is the role of Hedgehog (Hh) pathway inhibitors in the treatment of basal cell carcinoma (BCC)?
What are the surgical options for the treatment of basal cell carcinoma (BCC)?
What is the role of topical creams in the treatment of basal cell carcinoma (BCC)?
What is the role of topical 5-fluorouracil 5% cream in the management of basal cell carcinoma (BCC)?
What is the role of interferon in the management of basal cell carcinoma (BCC)?
What is the role of imiquimod in the management of basal cell carcinoma (BCC)?
What is the role of tazarotene in the management of basal cell carcinoma (BCC)?
What is the role of radiation therapy for the management of basal cell carcinoma?
What are the contraindications for radiation therapy to treat basal cell carcinoma (BCC)?
What is the role of photodynamic therapy (PDT) in the management of basal cell carcinoma (BCC)?
When is photodynamic therapy (PDT) indicated in the treatment of basal cell carcinoma (BCC)?
What is the efficacy of photodynamic therapy (PDT) for the treatment for basal cell carcinoma (BCC)?
What is the role of retinoids in the management of basal cell carcinoma (BCC)?
What is the role of vismodegib in the management of basal cell carcinoma (BCC)?
What is the role of sonidegib in the management of basal cell carcinoma (BCC)?
What is the role of cemiplimab in the treatment of basal cell carcinoma?
What are the 5-year recurrence rates following treatment for basal cell carcinoma (BCC)?
How is basal cell carcinoma (BCC) prevented?
Which medical personnel provide consultation to patients with basal cell carcinoma (BCC)?
What is included in the long-term monitoring of basal cell carcinoma (BCC)?
Guidelines
What are the USPSTF guidelines for screening and early detection of basal cell carcinoma (BCC)?
Which organizations have issued treatment guidelines for basal cell carcinoma?
What are the AAD biopsy diagnostic guidelines for basal cell carcinoma (BCC)?
How are basal cell carcinoma classified in the NCCN and EDF guidelines?
What are histologically aggressive subtypes of basal cell carcinoma?
What are low-risk, non-aggressive subtypes of basal cell carcinoma?
What are the AAD treatment guidelines for basal cell carcinoma (BCC)?
What are the guidelines on the treatment of recurrent and metastatic basal cell carcinoma (BCC)?
Medications
Which medications are used for the treatment of basal cell carcinoma (BCC)?
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A pink, scaly lesion on the skin. Superficial basal cell carcinoma (BCC) is often misdiagnosed as eczematous dermatitis or guttate psoriasis and is often difficult to distinguish clinically from Bowen disease (squamous cell carcinoma in situ). Features that suggest the diagnosis of superficial BCC are the absence of significant white, adherent scale and a history of the lesion remaining unchanged for several months or years. Treatment options for this tumor include electrodesiccation and curettage, surgical excision, cryosurgery, 5-fluorouracil, 5% imiquimod cream, and superficial radiotherapy. Electrodesiccation and curettage is the modality most commonly used, with a cure rate of approximately 95%.
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Basal cell carcinoma.
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A 68-year-old patient presenting with an advanced basal cell carcinoma (BCC) of the right periorbital region, frontal view. Courtesy of M Abraham Kuriakose, DDS, MD.
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Lateral view of face showing extent of tumor. Courtesy of M Abraham Kuriakose, DDS, MD.
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Basal cell carcinoma of the right lower lid.
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Biopsy-proven basal cell carcinoma of the upper lid margin. Note the loss of cilia (madarosis) in the area of the tumor.
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Medial canthal/lower lid basal cell. Note the pearly nodular surface with characteristic telangiectatic vessels. Proximity to the lacrimal system will impact its treatment and reconstruction.
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Nodular basal cell carcinoma.
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Nodular basal cell carcinoma appearing as a waxy, translucent papule with central depression and a few small erosions.
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Scale, erythema, and a threadlike raised border are present in this superficial basal cell carcinoma on the trunk.
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Large, superficial basal cell carcinoma.
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Basal cell carcinoma. Courtesy of Hon Pak, MD.
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Pigmented basal cell carcinoma.
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Pigmented basal cell carcinoma.
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Pigmented basal cell carcinoma has features of nodular basal cell carcinoma with the addition of dark pigmentation from melanin deposition. The pigmentation often has the appearance of dark droplets in the lesion, as shown here.
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This infiltrating basal cell cancer has ill-defined borders and telangiectases.
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This translucent pink papule has telangiectases and a crusted erosion, characteristic of nodular basal cell carcinoma.
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Large, scarlike morpheaform basal cell cancer.
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Nodular basal cell carcinoma. Nodular aggregates of basalioma cells are present in the dermis and exhibit peripheral palisading and retraction artifact. Melanin is also present within the tumor and in the surrounding stroma, as seen in pigmented basal cell carcinoma.
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Histologic pattern of a well-differentiated basal cell carcinoma (original magnification X140). Courtesy of Prof Pantaleo Bufo, University of Foggia, Italy.
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Histologic pattern of a well-differentiated basal cell carcinoma (original magnification X250). Courtesy of Prof Pantaleo Bufo, University of Foggia, Italy.
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Micronodular basal cell carcinoma often has an absence of retraction artifact. The characteristic histology is small size and uniformity of the tumor nodules. Courtesy of Shang I Brian Jiang, MD.
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Infiltrative basal cell carcinoma. Tumor cells are arranged in narrow strands, and mucin-rich stroma is often present. Courtesy of Shang I Brian Jiang, MD.
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Keratotic basal cell carcinoma. Rare type characterized by keratocysts. Courtesy of Shang I Brian Jiang, MD.
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Basosquamous basal cell carcinoma. Foci of neoplastic cells with squamous differentiation are present. Courtesy of Shang I Brian Jiang, MD.
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Histology of superficial basal cell carcinoma. Nests of basaloid cells are seen budding from the undersurface of the epidermis. Courtesy of Michael L Ramsey, MD.