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Non melanoma Skin cancer Basal Cell Canrcinom - Coggle Diagram
Non melanoma Skin cancer
Basal Cell Canrcinom
Non Melanoma Skin Cancer
Most frequently observed in Caucasian
75-80% Basal Cell Carcinoma
25% SCC Squamous Cell Carcinoma
Merkel cell tumour , rare adnexal tumours, cutaneous lymphomas
Epidemiology
M>F
White
Increasing incidence with age
Incidence in under 40s increasing - in women especially
Most common cancer
BCC more common than SCC
Risk Factors
Environmental
UV radiation
2.Occupation expsoure - outiside
Tanning beds
Phototherapy
Photosensitizing agents - tetrayclines / thiazide diuretics
Chroni aresenic exposure
Ionizing radiation
Fitzpatrick Type 1
Personal hx skin cancer
Fhx skin cancer
Light
Inherited disorders
Gorlins syndrome
Xeroderma pigmentosum
Immunosuppression
SCC
Solid organ transplants
Kidney transplants
More aggressive, higher mortality
HIV
Allogenic stem cell transplant
CLL
Axothiozine, ciclopsporin
Basal Cell Carcinoma
Epi
Most common type of skin cancer
Older people
Grows sloly
Path
Low metstatic potential
Locally aggressive / Destrucive to skin and strucures
Often begins as red / pale and pealy in colou
Basal layer of epidermis in the stratum
Lesion
Nodular lesions
Telangiectasia
Ulceration
Red
Pearly
https://d1z8zkw1yi6kd7.cloudfront.net/uploads/ckeditor/pictures/data/000/002/139//content/clinical_features_of_bcc.jpg
Pathogenesis
UV radioation induced carinogenesis
Hedgehog pathway
PTCH1 mutation
SMO mutation
P53 mutation
Nodular BCCPResentation
Sun exposed sights
70% head and neck
15% trunk
Shiny pearly
Rolleg egdes
Ulcerated centre
Blood vessels - arborising vessles
Not tender
Bleed easily
Can be pigmented
Superficial Spreading BCC
Most common BCC in younger adults
Most common in trunk and extremities but can be head and neck
well circumscribed erythematous patches
Focal areas of erosion
Slight edge
Treated diff to nodular
Morpheaform BCC
Waxy scar like plaque
Indistinct borders
Can infiltrate cutaneous nerves
Diagnosis
Clinical
Hc exam
Dermoscopic exam
Ulceration!!
Vessles
Biopsy to confirm / subtype
DDx
Dermal naevi - beauty spot
SCC
⭐
Melanoma
Epidermal inclusion cyst
Sebaceous hyperplasia
Keratoacanthoma
Dermal metastasis
Eczema
Psoriasis
Scarring
High risk Tumours
Trunk or extremities >2cm
Mask area of face
Face >10cm
GEnitals
Poorly defined borders
Recurrent
Immunusupresion
Site of prior radiotherapy
Infiltrative and morph
Management
Patient considerations
Clinical considerations
MDT
Surgical
Curetteage and cautery
Excision
4mm neg margins
Mohs Micrographic surgery
Complete tumour removal
highest cure rate 98-99%
96% for recurrent BCC
Tissue saving - smaller margins
https://www.researchgate.net/publication/350347357/figure/fig2/AS:1033650632134656@1623452923895/Wide-local-excision-A-Elliptical-excision-with-a-wide-surgical-margin-around-the.jpg
2mm margin
https://www.ncbi.nlm.nih.gov/books/NBK441833/bin/Mohs__Surgery__Diagram.jpg
Indications
Critical sights - mask area
Large tumour
Ill defined
Young
REcurrent
Incomplete exision
Good cosmetic outcome
Radiotherapy
Non surgical
Topical - Imiquimod and 5FU
Phototherapy
Cryotherapy
Vismodgegib
Oral tx
Indx
Metastatic disease
Locally advanced that has recurred after suregery
Neoadjuvant therapy pre- excision
Response rate
45% local disease
30% mets
Neoadjuvant use - 34% defect size reduction
Superficial disease
Gorlins Syndrome
Rare genetic syndrome
AKA basal cell nevus syndrome
Early onset of BCC <20y/o
Odontogenic keratocysts usually mandible
Palmer pits
Medulloblastoma in 5%
Other cancers fibromas, rhabdomyosarcoma
