Basal Cell CarcinomaBasal Cell CarcinomaDan Ladd, D.O, Rick Lin, D.O., MPH Dan Ladd, D.O, Rick Lin, D.O., MPH

Bill V. Way, D.O.Bill V. Way, D.O.

BCC: What are they?BCC: What are they?

PEARLY PAPULES OR NODULES

ROLLED BORDER TELANGIECTASES CENTRAL ULCER CRUSTING BLEED EASILY

BCC: Where are they?BCC: Where are they?

HEAD, NECK 85% MC NOSE, 30% FOREHEAD EARS CHEEKS UPPER TRUNK

BCC: When?BCC: When?

OFTEN – 1/3 OF ALL CA IN USA.

Chronic UVB, Xray Immunosuppression Renal Transplant Genetics, ie. XP, NBCCS

BCC: Who?BCC: Who?

ELDERLY & MIDDLE AGED

Ages 40-79 ANGLO-SAXON

Blue Eyes, Fair Skin X-Ray Exposure, ie

Physicians, Dentists, Technicians, Workers

BCC: How?BCC: How?

Arise from immature pluripotential cells.Mutations in the HEDGEHOG pathway

(genes which controls cell growth)PATCHED (tumor suppressor) inactivated. HEDGEHOG and SMOOTHENED (cell

growth inhibitors) activated.P53 and RAS mutations also play a role.

BCC look-alikes: SGHBCC look-alikes: SGH

BCC look-alikes: KABCC look-alikes: KA

BCC Look alikes: SCCBCC Look alikes: SCC

BCC: VariantsBCC: Variants

SUPERFICIAL BCCMORPHEAFORM BCCPIGMENTED BCC CYSTIC BCCBASAL CELL NEVUS SYNDROME(GORLIN’S SYNDROME)

SUPERFICIAL BCCSUPERFICIAL BCC

PSORIASIFORM TRUNK LIMBS FLAT GROWTHS YOUNGER

PATIENTS ONGOING

STUDIES WITH ALDARA

MORPHEAFORM BCCMORPHEAFORM BCC

RESEMBLES LOCALIZED SCLERODERMA

ALMOST ALWAYS ON THE CHEEKS OR FOREHEAD

MOH’S SURGERY AGGRESSIVE

PIGMENTED BCCPIGMENTED BCC

DARK SKINNED PATIENTS

LATIN AMERICANS

JAPANESE NOT BLACKS ARSENIC

INGESTION 6% OF ALL BCC

BCC – CYSTIC/SOLIDBCC – CYSTIC/SOLID

DOME SHAPED BLUE GRAY CYSTIC NODULES 4-8% OF ALL BCCS

NEVOID BCC NEVOID BCC SYNDROMESYNDROME

JAW CYSTS PALMAR PITS SKELETAL

DEFECTS CALCIFICATION

OF FALX CEREBRI MOHS SURGERY

BCC TREATMENTBCC TREATMENT

EXCISIONFULGURATION AND CURETTAGEIONIZING RADIATIONCRYOSURGERYTOPICAL 5-FULASERMOHS’ MICROGRAPHIC 99% CURE

THE END