Basal cell carcinoma

Pt > 50 y/o with h/o smoking, significant UV-B exposure presents with suspicious appearing papule. Reports frequent tanning bed use in adolescence. Exam reveals pearly white, dome-shaped papule with prominent telangiectatic surface vessels on nose.

BCC Nodular type. Red, waxy nodule on the tip of the nose. Visible telangiectasias over the surface.

BCC Nodular type. Red, waxy nodule on the tip of the nose. Visible telangiectasias over the surface.

  • Shave biopsy performed and sent for histopathology; positive for BCC

  • Treatment

    • Nodular or superficial subtype < 3 mm in depth; treat with cryotherapy

    • Tumor diameter < 2 cm and not located on H region of face; refer for standard surgical excision

    • Refer for Mohs micrographic surgery for tumors

      • Located on H region of face

      • > 2 cm in diameter

      • With invasive histologic subtype and/or high risk of recurrence

  • Pt counseled about risk of recurrence and importance of monitoring for future lesions

  • Schedule f/u yearly s/p tumor removal

Notes

  • Epidemiology

    • BCCs comprise 80% of non-melanotic skin cancers and rarely metastasize

    • Tanning bed use is associated with 1.5-fold increase in BCC risk

  • Histologic subtypes

    • Nodular (21%)

    • Superficial (17% and may resemble eczema or psoriasis)

    • Invasive subtypes

      • Micronodular (15%)

      • Infiltrative (7%)

      • Morpheaform (1%)

  • Presentation

    • 85% occur on patients face with 25-30% occurring on the nose

    • Pigmented BCC may be confused with melanoma

  • Diagnosis: Shave or 2-4 mm punch biopsy may be performed

  • Risk of recurrence

    • Determined by lesion location, size, border definition, and status as primary or recurrent

    • Overall: 35% at 3 years and 50% at 5 years