Basal cell carcinoma

Basal cell carcinoma 2

Basal cell carcinoma is a common skin tumor with pronounced local destructive growth, a tendency to recur, but generally no metastasis. It is localized to exposed areas of the skin, such as the face, neck, and scalp. The ICD-10 code for this condition is C44.9.

The disease is more common in people over the age of 50, but it can also develop at a younger age. It occurs with equal frequency in both women and men. The histogenesis of the tumor is still debated. Most researchers adhere to the dysontogenetic theory of origin, according to which basal cell carcinoma develops from multipotent epithelial cells. These cells can differentiate and form various structures. The development of basal cell carcinoma is also influenced by genetic factors, immune disorders, and adverse environmental exposures (such as intense sunlight and exposure to carcinogenic substances). The tumor can develop on visually unaltered skin as well as in the presence of various skin conditions (actinic keratosis, post-radiation dermatitis, lupus vulgaris, nevi, psoriasis, etc.).

Basal cell carcinoma can be classified into:
  1. Pigmented
  2. Nodular
  3. Superficial
  4. Ulcerative (ulcus terebrans): BCC can have destructive growth, penetrating deeper layers of the skin.
  5. Sclerodermiform (morphoeic)
  6. Fibroepithelial: BCC can have fibrous and epithelial components.

Nodular BCC

Basal cell carcinoma nodular ulc 1
The nodular-ulcerative form can appear as a single lesion, either a small node or a hemisphere-shaped nodule, usually with rounded edges, slightly elevated above the skin level and pink or grayish-red color. The surface of the tumor is smooth, with a small central depression covered by a thin, loosely adherent scale-crust. Underneath, there is usually an erosion. The border is thickened and consists of small nodular elements. In this state, the tumor can persist for years, slowly growing and occasionally becoming ulcerated.

Ulcerative BCC

Basal cell carcinoma ulc 1
In the ulcerative form (ulcus rodens), a centrally located ulceration is surrounded by a raised rim of pink color, with small nodular thickenings of a light gray color, known as "pearls."

Superficial BCC

Basal cell carcinoma pigmented 1
The superficial form manifests as single or multiple patches of pink and reddish-brown color with fine flaky scaling on the surface. It is characterized by slow peripheral growth.

Sclerodermiform BCC

Basal cell carcinoma sclerod 1
The sclerodermiform (morphoeic) form presents as a dense, sclerotic lesion resembling scar tissue, pale pink with a yellowish tint. Sometimes, an active growth zone covered by a crust can be observed at the periphery of the lesion.

Fibroepithelial BCC

Basal cell carcinoma fibroepithel pinkus 1
The fibroepithelial form commonly manifests as a solitary nodule, externally resembling a fibroepithelial polyp.

The diagnosis of basal cell carcinoma (BCC) is based on the clinical presentation and histological findings.

  • Nodular BCC: Benign tumors of sweat glands and hair follicles.
  • Ulcerative BCC: Squamous cell carcinoma, leishmaniasis.
  • Pigmented BCC: Lentigo and lentigo maligna.
  • Superficial BCC: Bowen's disease, chronic focal inflammatory dermatoses, actinic keratosis, discoid lupus erythematosus.
  • Sclerodermoid BCC: Scarring skin lesions.
  • Fibroepithelial BCC: Fibroepithelial polyp, solid trichoepithelioma, dermatofibroma.
Basal cell carcinoma tabl

Surgical excision, Mohs surgery, interferon therapy, local chemotherapy

Prognosis

Overall, the prognosis is favorable since BCC rarely metastasizes unless it transforms into a metatypical form. The recurrence rate is quite high, with some reports indicating rates of up to 17-20%.