BASAL CELL CARCINOMA (RODENT ULCER) the most common skin cancer (and the most common of all cancers)...
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![Page 1: BASAL CELL CARCINOMA (RODENT ULCER) the most common skin cancer (and the most common of all cancers) a locally invasive, slowly spreading primary epithelial.](https://reader036.fdocuments.in/reader036/viewer/2022070404/56649f345503460f94c51fcd/html5/thumbnails/1.jpg)
BASAL CELL CARCINOMA (RODENT ULCER)
the most common skin cancer (and the most common of all cancers)
a locally invasive, slowly spreading primary epithelial malignancy
Origin: arises from the basal cell layer of the skin and its appendages
85% are found on the skin of the head and neck
)
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Clinical Featuresa disease of adult whites
some lesions are detected as early as the second decade of life, particularly in patients with red hair and blue eyes.
nodular (noduloulcerative)BCC: The most common form
clinicopathologic varieties
Pigmented BCC
Sclerosing (morpheaform) BCC
superficial BCC
associated with the nevoid basal cell carcinoma syndrome
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begins as a firm, painless papule that slowly enlarges and gradually develops a central depression
One or more telangiectatic blood vessels ………..over the rolled border surrounding the central depression
Expanding ulceration often develops in the central depressed area
nodular (noduloulcerative)BCC
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Pigmented BCCThe melanin production imparts a tan, brown, black, or even bluish color to the lesion
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an insidious lesion that often mimics scar tissue
Sclerosing (morpheaform) basal cell carcinoma
pale and atrophic overlying skin
the lesion is firm to palpation
poorly demarcated borders
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superficial BCC may be mistaken clinically for psoriasis
occurs primarily on the skin of the trunk
Often, lesions are multiple
well-demarcated, erythematous, scaly patches
A fine, elevated, "threadlike" border is seen at the margins.
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usually do not produce a significant degree of tissue destruction.
BCC associated with the nevoid basal cell carcinoma syndrome
in both sun-exposed and protected areas of the skin
may number in the hundreds on a single patient
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Histopathologic Features
The noduloulcerative, pigmented, and syndrome-related BCCs are comprised of:
uniform ovoid, darkstaining basaloid cells with moderate-sized nuclei and relatively little cytoplasm
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Solid tumor Nested tumor
well-demarcated islands and strands
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appear to arise from the basal cell layer of the overlying epidermis and invade into the underlying dermal connective tissue
well-demarcated islands and strands
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Epithelial islands typically demonstrate palisading of the peripheral cells
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frequently, a clear zone of artifactual retraction is seen between the epithelial islands and the connective tissue.
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Although most of these neoplasms show no differentiation,some exhibit areas of keratin production, sebaceous differentiation, or interlacing strands of lesional cells that resemble duct formation ("adenoid")
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interlacing strands of lesional cells that resemble duct formation ("adenoid")
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Necrosis of epithelial islands may produce a cystic appearance.
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Basal cell carcinoma + an independent primary squamous cell carcinoma of the skin.
Some authorities consider the basosquamous carcinoma to be a simple basal cell carcinoma with abundant squamous metaplasia.
Basosquamous carcinoma"collision" tumor
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Treatment and Prognosis
Radical surgical excision radiation therapy
size site of the lesiondepends on
Small lesions (< 1 cm)………
•routine surgical excision•laser ablation•electrodesiccation •curettage
with 5 mm margins
a cure rate of 95% to 98%
for large or aggressive lesions
For sclerosing type lesionsrecurrent lesionslesions situated near embryonic planes of fusion
Mohs micrographic surgery(with frozen-section evaluation)
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Recurrence …………… uncommon
Metastasis …………..exceptionally rare
death ……………..in patients with uncontrollable disease………… local invasion into . . vital structures.
chance of a second lesion …………..30%............3 years of the treatment of the initial tumor.
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