Basal Cell Carcinoma Presented by: Bill V. Way, D.O. AOCD Board Certified Dermatologist Residency in...
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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
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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
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Diagnosis
• High index of suspicion
• Onset
• Prior treatment
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Types of BCC
• Supeficial BCC
• Nodular BCC
• Pigmented BCC
• Cystic BCC
• Sclerosing or Morpheaform BCC
• Recurrent BCC
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Biopsy
• Biopsy: Shave, Punch,Excision
• Specimen to reliable dermatopathologist or pathologist
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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
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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.
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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
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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
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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
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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
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Treatment of BCC
• Electrodesiccation and curettage
• Excision
• Cryosurgery
• Moh’s Surgery
• Radiation
• 5-Fluorouracil
• Aldara (Imiquimod)
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Electrodesiccation & Curettage
• Hyfrecator
• Curettes: 2mm, 3mm, 4mm
• EDC times 3
• Expect scar formation
• 85-90% cure rate
• Check for Pacemaker, Defribralator
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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
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Cryosurgery
Used only for superficial and small nodular BCC
Not indicated for deeper BCC
High morbidity, very painful
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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
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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
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5-Fluorouracil
• Should not be used today
• Can destroy surface without affecting deeper bcc cells
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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
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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
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Thank you
• We look forward to future lectures and having you each do rotations in dermatology if possible.