Basal Cell Carcinoma

• Presented by:

• Bill V. Way, D.O.

• AOCD Board Certified Dermatologist

• Residency in US Army at Walter Reed

• Consultant for Charlton Methodist Hosp for past 19 years

Epidemiology and Etiology

• Incidence US 500-1000 per 100,000

• >400,000 new patients annually

• Age usually over age 40

• Sex Males >Females

• Race rare in brown and black skinned pt

Diagnosis

• High index of suspicion

• Onset

• Prior treatment

Types of BCC

• Supeficial BCC

• Nodular BCC

• Pigmented BCC

• Cystic BCC

• Sclerosing or Morpheaform BCC

• Recurrent BCC

Biopsy

• Biopsy: Shave, Punch,Excision

• Specimen to reliable dermatopathologist or pathologist

What to Biopsy

• Select a good representation of the lesion for biopsy

• If small lesion, biopsy the entire lesion

• Final treatment code is dependent on actual size of lesion at time of biopsy

• Get exact measurements of lesion, digital photo if possible

When should you do a biopsy?

• If you are unsure of diagnosis of lesion and have in the differential a skin cancer, basal cell carcinoma, squamous cell carcinoma or melanoma, then do a biopsy

• List your differential in the order which you think the lesion is. Learn from your errors.

Methods of Biopsy

• Shave Biopsy: easiest and fastest

• Punch Biopsy: depth of lesion

• Excisional Biopsy: > time, > expense, complete removal of tumor

• Incisional Biopsy: partial removal of tumor, >time, > expense

Shave Biopsy

• Xylocaine 2% with epi

• 1cc tuberculin syringe, 30g needle

• Non-sterile gloves

• #15 sterile blade Bard Parker

• Specimen bottle, labeled correctly

• Drysol solution

• Bacitracin Ointment, Bandaid

Punch Biopsy

• Xylocaine 2% with epi

• 1cc tuberculin syringe, 30g needle

• Sterile gloves

• Punch : 2mm, 3mm, 4mm, 6mm

• Minor surgery tray, suture size for area

• Specimen bottle labeled correctly

• Bacitracin Ointment and bandaid

Excision or Incisional Biopsy

• Xylocaine 2% with epi

• 3-5cc syringe, 30g needle, sterile gloves

• #15 or #11 sterile blade, surgery tray

• Suture for area, absorbable, non-absorbable

• Specimen bottle labeled correctly

• Bacitracin Ointment and sterile dressing

Treatment of BCC

• Electrodesiccation and curettage

• Excision

• Cryosurgery

• Moh’s Surgery

• Radiation

• 5-Fluorouracil

• Aldara (Imiquimod)

Electrodesiccation & Curettage

• Hyfrecator

• Curettes: 2mm, 3mm, 4mm

• EDC times 3

• Expect scar formation

• 85-90% cure rate

• Check for Pacemaker, Defribralator

Excision

• Adequate outline of tumor margin

• Adequate margins 3-5mm

• Surgery Tray, Hyfrecator

• Suture: absorbable, non-absorbable

• Tag tip, specimen labeled correctly

• Pressure dressing, antibiotic ointment

Cryosurgery

Used only for superficial and small nodular BCC

Not indicated for deeper BCC

High morbidity, very painful

Moh’s Surgery

• Can be used on all BCC• Difficult lesions: sclerosing or recurrent, poorly

defined borders, tumors of nose, eyelids• Recurrent lesions• Lesions over 25mm dia• 98% cure rate• Expensive, > time• Few Moh’s Surgeons, Dermatologist

Radiation therapy

• For elderly pt who can not tolerate surgery

• Useful for eyelids and lips

• Requires several outpt visits

• If used in young pt can lead to development of SCC or recurrent BCC later in life at same site

5-Fluorouracil

• Should not be used today

• Can destroy surface without affecting deeper bcc cells

Prevention

• Frequent skin examination q 3 months

• Yearly by PCP or Dermatologist

• Sunscreens SPF 15 or higher

• Protective clothing, hats, sunglasses

• Team approach: Patient, Family, Doctor

Remember

• Look at all the patient’s skin, especially the sun exposed skin.

• Biopsy ?? Lesions• Treat if trained and comfortable• Otherwise refer to a more qualified

physician: Dermatologist, Moh’s Surgeon, Plastic Surgeon

• Follow patients frequently

Thank you

• We look forward to future lectures and having you each do rotations in dermatology if possible.