BASAL CELL CARCINOMA

Basal cell carcinoma (BCC) is the most frequently occurring form of all cancers. It arises from basal cells (small, round cells found in the lower layer of the epidermis). 

The prognosis of BCC is excellent: BCC almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases it may spread to other parts of the body.

Causes/ Risk factors

• UV radiation: About two thirds of basal-cell carcinomas occur on sun-exposed areas of the body, especially in white skin phototype.
• Gene mutations (p53)
• Arsenic exposure
• Immunosuppression
• Others: Epidermodysplastic verruciformis, Nevoid basal cell carcinoma syndrome, Bazex syndrome…

 Clinical features

The sun-exposed areas of the head and neck are the most commonly involved sites. BCC usually may have one of the following characteristics:

• Pearly papules with central depression
• Erosion or ulceration: Often central and pigmented
• Bleeding: Especially when traumatized
• Telangiectases over the surface
• It grows slowly (0.5 cm in 1-2 years) 

There are several types of basal cell carcinoma: nodular, superficial, pigmented, Morphoeic…

Investigations

Investigation  is primarily by visual exam,  dermoscopic inspection and a skin biopsy.

Management:

A number of treatments are available for basal cell carcinoma:

• Surgery: In nearly all cases of BCC, surgery is the recommended treatment modality.  Excision; Curetage; Cryotherapy/cryosurgery; Mohs micrographic surgery
• Radiation therapy
• Pharmacologic therapy (PDT)
• Drugs: Topical treatments ( imiquimod; fluorouracil); Medication for advanced cancer (vismodegib; sonidegib) .

Prevention+++

• Education on sun avoidance:
• Avoid UV exposure in susceptible individuals
• Use high-factor sunscreens
• Wear wide-brimmed hats, long-sleeved shirts and trousers.
• Education of patients to seek early assessment if further lesions develop.

Hind Benhiba, MD
Dermatologist
Rabat- Morocco

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