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Basal Cell Carcinoma

Basal cell cancer (BCC) is the most common malignant cutaneous neoplasm in humans. The most common presenting complaint is a bleeding or scabbing sore that heals and recurs. The tumor rarely metastasizes. BCC advances by direct extension and destroys normal tissue. Untreated, the cancer can destroy the whole side of the face or penetrate subcutaneous tissue.

Risk factors for basal cell cancer.

Fair skin and the degree of sun exposure are important risk factors. Outdoor workers and people who live in southern latitudes with higher levels of ambient ultraviolet B radiation are at greater risk. Men have a significantly higher incidence than basal cell cancer, basal cell carcinoma, basal cancer, basel, canser Tanning salons with equipment that emits ultraviolet A or B radiation.

Location.

Eighty-five percent of all BCCs appear on the head and neck region; 25% to 30% occur on the nose alone, the most common site. BCC is rarely found on the backs of the hands, although this site receives a significant amount of solar radiation.

Incidence.

The tumor may occur at any age, but the incidence of BCC increases markedly after age 40.

PATHOPHYSIOLOGY

BCCs arise from basal keratinocytes of the epidermis and adnexal structures (hair follicles, eccrine sweat ducts). Ultraviolet B (UVB) radiation (sunburn spectrum, 290 to 320 nm) is important for the induction of BCC. UVB radiation damages DNA and its repair system.

Basal cell cancer grows by direct extension and appears to require the surrounding stroma to support its growth. This may explain why the cells are not capable of metastasizing through blood vessels or lymphatics. The course of BCC is unpredictable.

BCC occurs at the site of previous trauma, such as scars, thermal burns, and injury. BCC occurs years later at sites treated with ionizing

Nodular BCC.

Nodular BCC is the most common form. The lesion begins as a pearly white or pink, dome-shaped papule resembling a molluscum contagiosum or dermal nevus. The mass extends peripherally. The lesion may remain flat. Traction on the surrounding skin

Ulcerated areas heal with scarring, and patients often assume their conditions are improving. This cycle of growth, ulceration, and healing continues as the mass extends peripherally and deeper; masses of enormous size may be attained.

Pigmented BCC.

BCCs may contain melanin that imparts a brown, black, or blue color through all or part of the lesion.

Management and risk of recurrence

There are several factors to consider before choosing the best treatment modality. The most important are clinical presentation, cell type, tumor size, and location.

Clinical type.

Nodular and superficial BCCs are the least aggressive and can be completely removed by electrodesiccation and curettage.

Mohs' micrographic surgery.

Mohs' surgery is a microscopically controlled technique that may be used for all types and sizes of BCCs.

 

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