What Is Aggressive Basal Cell Carcinoma

The Difference Of Angiogenic Agent Expression In Basal Cell Carcinoma Related To Its Aggressiveness

Prasetyadi Mawardi

Department of Dermatology and Venereology, Faculty of Medicine, Sebelas Maret University, Dr. Moewardi General Hospital, Surakarta-Jawa Tengah, Indonesia

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Indah Julianto

Department of Dermatology and Venereology, Faculty of Medicine, Sebelas Maret University, Dr. Moewardi General Hospital, Surakarta-Jawa Tengah, Indonesia

Nugrohoaji Dharmawan

Department of Dermatology and Venereology, Faculty of Medicine, Sebelas Maret University, Dr. Moewardi General Hospital, Surakarta-Jawa Tengah, Indonesia

Synthia Sari Toh

Department of Dermatology and Venereology, Faculty of Medicine, Sebelas Maret University, Dr. Moewardi General Hospital, Surakarta-Jawa Tengah, Indonesia

Eka Putra Wirawan

Department of Dermatology and Venereology, Faculty of Medicine, Sebelas Maret University, Dr. Moewardi General Hospital, Surakarta-Jawa Tengah, Indonesia

Isaak Effendy

Department of Dermatology and Allergology, University Hospital of Bielefeld, Germany

DOI: 10.15761/GOD.1000230

Figures & Data

Infiltrated Basal Cell Carcinoma

This version of basal cell carcinoma is presented as thin bundles of basaloid cells with nest-like configuration located between the collagenous fibers on the dermis and infiltrating in the depth. Clinically, it is a whitish, compact, not-well defined plaque . The most common localization is in the upper part of the trunk or the face. Seldom had the paresthesia or hyperesthesia as a symbol of perineural infiltration appeared, especially when the tumor is localized on face. This clinical version is often underestimated when the borders of surgical excision are estimated. Histologically this variant is presented as thin, nest-like bundles of basaloid cells infiltrating in the dermal collagenous fibers .

Infiltrated basal cell carcinoma. Thin bundles of basaloid cells invade the dermis

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Symptoms Of Basal Cell Carcinoma

There are several types of basal cell carcinomas.

The nodular type of basal cell carcinoma usually begins as small, shiny, firm, almost clear to pink in color, raised growth. After a few months or years, visible dilated blood vessels may appear on the surface, and the center may break open and form a scab. The border of the cancer is sometimes thickened and pearly white. The cancer may alternately bleed and form a scab and heal, leading a person to falsely think that it is a sore rather than a cancer.

Other types of basal cell carcinomas vary greatly in appearance. For example, the superficial type appears as flat thin red or pink patches, and the morpheaform type appears as thicker flesh-colored or light red patches that look somewhat like scars.

Is It Time For Your Annual Skin Check

One of the best ways to prevent basal cell carcinoma is to take steps to protect your skin from the sun, including daily sunscreen, protective clothing, and seeking shade whenever possible. If you have a high risk of developing skin cancer, then make sure that you dont miss your yearly skin check-up with your dermatologist.

Are you experiencing any symptoms that concern you? Schedule an appointment with the dermatologists at the Center for Surgical Dermatology. Were now accepting patients for telemedical appointments!

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When To Seek Medical Care

If you have developed a new bump on sun-exposed skin, or if you have a spot that bleeds easily or does not seem to be healing, then you should make an appointment with your primary care physician or with a dermatologist.Try to remember to tell your doctor when you first noticed the lesion and what symptoms, if any, it may have . Also, be sure to ask your parents, siblings, and adult children whether or not they have ever been diagnosed with a skin cancer, and relay this information to your physician.

What This Form Of Skin Cancer Can Look Like

Basal cell carcinoma is the most common form of skin cancer. It originates in basal cells, which are located in the epidermis, which is the outermost layer of the skin, that are responsible for producing new skin cells and pushing them to the surface. Due to the location of these cells, BCC typically develops on areas of skin that are regularly exposed to sunlight and other forms of ultraviolet radiation.

BCC tends to grow slowly and develop on sun-exposed areas such as the face, ears, neck, scalp, chest, shoulders, and back. The lesions commonly appear as painless, raised nodules, often shiny with tiny blood vessels running through them.

Even so, BCC can vary in its size and appearance and may develop on parts of the body that are not sun-exposed. By recognizing the different manifestations of BCC, you may be able to spot them early and seek immediate treatment.

The early diagnosis and treatment of BCC is associated with a disease-free cure rate of between 85 and 95%.

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SkarmoutsosV / Wikimedia Commons

Nodular basal cell carcinoma is one of the three main subtypes of BCC. It appears as a small, dome-shaped nodule populated by tiny branch-like blood vessels .

This photo contains content that some people may find graphic or disturbing.

Skin Cancer Doctor Discussion Guide

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What Are The Possible Complications Of Superficial Basal Cell Carcinoma Of Skin

The complications of Superficial Basal Cell Carcinoma of Skin could include:

• If the tumor becomes big, or ulcerates, it can get secondarily infected with bacteria or fungus
• If left untreated, Superficial Basal Cell Carcinomas can become invasive
• Superficial BCC of Skin can cause cosmetic issues
• Recurrence of the tumor after a period of time recurrences are frequently noted with large tumors
• Effects of surgical or topical treatments, which involve scarring, redness, or secondary infection

How Is Basal Cell Carcinoma Diagnosed

BCC is diagnosed clinically by the presence of a slowly enlarging skin lesion with typical appearance. The diagnosis and histological subtype is usually confirmed pathologically by a diagnostic biopsy or following excision.

Some typical superficial BCCs on trunk and limbs are clinically diagnosed and have non-surgical treatment without histology.

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Who Gets Infiltrating Basal Cell Carcinoma Of Skin

• Infiltrating Basal Cell Carcinoma of Skin is an uncommon skin cancer that generally affects elderly or older adults some cases rarely develop in children too
• It can occur in both males and females however
• Among the older age group, males are affected more than females
• In the younger age group, females are affected more than males, which may be attributed to their tendency to acquire sun-tanned bodies or visit skin tanning parlors more

How Is Basal Cell Carcinoma Treated

After examining your health and the pathology report findings, your doctor will determine an effective treatment plan. There are several treatment options for basal cell carcinoma, and determining the optimal treatment option depends on the microscopic pattern of the cancer, the location on the body, the size of the skin cancer, and factors specific to each patient.

From the least invasive to the most aggressive, here are the treatment options for basal cell carcinoma:

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Additional And Relevant Useful Information For Superficial Basal Cell Carcinoma Of Skin:

There are multiple types of Basal Cell Carcinoma of Skin:

• Superficial Basal Cell Carcinoma of Skin
• Nodular Basal Cell Carcinoma of Skin
• Infiltrating Basal Cell Carcinoma of Skin
• Micronodular Basal Cell Carcinoma of Skin
• Fibroepithelial Basal Cell Carcinoma of Skin
• Basal Cell Carcinoma of Skin with Adnexal Differentiation
• Basosquamous Carcinoma of Skin
• Keratotic Basal Cell Carcinoma of Skin

Exposure To Ionizing Radiation

Ionizing radiation is any electromagnetic wave capable of detaching atoms from molecules. We are exposed to ionizing radiation all the time, coming from the planets own electromagnetic field or from space, but there are artificial sources that can make a difference. For example, X-ray machines use ionizing radiation to obtain your images.

Using the X-ray machine once is not enough to cause cancer, but people who work with the device need to wear protection such as lead aprons, as prolonged and daily exposure for years of work can be harmful.

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How Is Basal Cell Cancer Of The Head And Neck Diagnosed

Diagnosis is made by clinical exam and a biopsy. Basal cell cancers are staged by size and extent of growth. These cancers rarely metastasize to lymph nodes or other organs, but they can grow quite large and invade small nerves and local structures.

Biopsy can help determine if the basal cell cancer is a low-risk tumor or a high-risk tumor that requires more aggressive treatment. Low-risk tumors are often nodular and do not have nerve involvement. High-risk tumors in the head and neck are those that involve the central face, nose and eye area, as well as those tumors that are greater than or equal to 10 millimeters on the cheeks, scalp and neck tumors that are recurrent or arising from previously radiated tissue and tumors arising in patients who are immunosuppressed. An aggressive growth pattern on the pathology evaluation and perineural invasion are also features of high-risk basal cell cancers.

What Is The Treatment For Advanced Or Metastatic Basal Cell Carcinoma

Locally advanced primary, recurrent or metastatic BCC requires multidisciplinary consultation. Often a combination of treatments is used.

• Radiotherapy
• Targeted therapy

Targeted therapy refers to the hedgehog signalling pathway inhibitors, vismodegib and sonidegib. These drugs have some important risks and side effects.

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Additional And Relevant Useful Information For Infiltrating Basal Cell Carcinoma Of Skin:

There are multiple types of Basal Cell Carcinoma of Skin:

• Superficial Basal Cell Carcinoma of Skin
• Nodular Basal Cell Carcinoma of Skin
• Infiltrating Basal Cell Carcinoma of Skin
• Micronodular Basal Cell Carcinoma of Skin
• Fibroepithelial Basal Cell Carcinoma of Skin
• Basal Cell Carcinoma of Skin with Adnexal Differentiation
• Basosquamous Carcinoma
• Keratotic Basal Cell Carcinoma of Skin

What Is The Prognosis Of Superficial Basal Cell Carcinoma Of Skin

• In general, the prognosis of Superficial Basal Cell Carcinoma of Skin is excellent, if it is detected and treated early.
• Stage of tumor: With this lower-stage tumor, the prognosis is usually excellent with appropriate therapy
• The surgical resectability of the tumor
• Overall health of the individual: Individuals with overall excellent health have better prognosis compared to those with poor health
• Age of the individual: Older individuals generally have poorer prognosis than younger individuals
• Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have a poorer prognosis compared to tumors that do not recur

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Who Gets Basal Cell Carcinoma

Risk factors for BCC include:

• Age and sex: BCCs are particularly prevalent in elderly males. However, they also affect females and younger adults
• Repeated prior episodes of sunburn
• Fair skin, blue eyes and blond or red hairnote BCC can also affect darker skin types
• Previous cutaneous injury, thermal burn, disease
• Inherited syndromes: BCC is a particular problem for families with basal cell naevus syndrome , Bazex-Dupré-Christol syndrome, Rombo syndrome, Oley syndrome and xeroderma pigmentosum
• Other risk factors include ionising radiation, exposure to arsenic, and immune suppression due to disease or medicines

Who Gets Superficial Basal Cell Carcinoma Of Skin

• Superficial Basal Cell Carcinoma of Skin generally affects elderly adults some cases rarely develop in children and young adults too
• Superficial BCC of Skin constitutes approximately 15% of all Basal Cell Carcinoma of Skin types. It is the second most common type of BCC of Skin
• It can occur in both males and females however
• Among the older age group, males are affected more than females
• In the younger age group, females are affected more than males, which may be attributed to their tendency to acquire sun-tanned bodies or visit skin tanning parlors more

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Prognosis Of Basal Cell Carcinoma

Treatment of basal cell carcinoma is nearly always successful, and the cancer is rarely fatal. However, almost 25% of people with a history of basal cell carcinoma develop a new basal cell cancer within 5 years of the first one. Thus, anyone with one basal cell carcinoma should have a yearly skin examination.

More Information About Basal Cell Carcinoma

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

See the following sites for comprehensive information about basal cell carcinoma, including detection, prevention, treatment options, and other resources:

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What Is Infiltrating Basal Cell Carcinoma Of Skin

• Basal Cell Carcinoma of Skin is a malignant cancer affecting the skin. It is a slow-growing tumor generally observed in older individuals, in both men and women
• This malignant carcinoma, which may be present as a lesion on the sun-exposed areas of the body, has the potential to metastasize to the lymph nodes
• Infiltrating Basal Cell Carcinoma of Skin occurs as an irregular plaque and has the tendency to infiltrate deep into the body tissue, making them difficult to treat. It is an uncommon subtype of BCC of Skin
• Some lesions may grow to large sizes and ulcerate. They can also infiltrate into the adjoining soft tissues and nerves. Larger tumors also have a greater tendency to recur after treatment
• The cause of Infiltrating Basal Cell Carcinoma of Skin is unknown, but factors such as chronic sun exposure, smoking, and ionizing radiation, etc., are known to contribute towards its development. Also, fair-skinned Caucasians have a greater risk than dark-skinned Africans and Asians
• Any combination of chemotherapy, radiation therapy, and invasive procedures are used to treat Infiltrating Basal Cell Carcinoma of Skin. Small-sized tumors and tumors that have not metastasized can be cured through appropriate skin surgery
• The prognosis for metastatic tumors depends upon many factors including the stage of the tumor, health status of the individual, and treatment response. The prognosis may be guarded

Surgical Options And Eligibility

Surgical techniques for BCC include ED& C, cryosurgery, excision with postoperative assessment of margins, and MMS.3 When performed by highly skilled surgeons, these techniques have 5-year cure rates of approximately 95% or higher .3 MMS has been associated with 5-year cure rates of 95% to 99% .3

Migden emphasized that a surgeons skill and selection of appropriate techniques are critical. Unless you have a very small superficial tumor, I think that ED& C is especially operator dependent, he noted. I see a lot of people that have lot of rapid ED& Cs in a very high-paced kind of clinic where its going through the motions, but it wouldnt be the same as me doing one. I do cryo and curettage instead of ED& C, but Im extremely thorough in going up over the lip of the clinical lesion onto the normal skin and really being meticulous about it.

Nathalie C. Zeitouni, MD, a Mohs surgeon in private practice in Phoenix, Arizona, cautioned about the potential discordance between the pathology on biopsy and specimens obtained from MMS, particularly in tumors with mixed histology. She estimated that up to one-third of histology on biopsy is discordant with the histology of the specimen. Many people may be thinking theyre doing an ED& C on a superficial BCC, which actually is probably nodular or nodular infiltrative, she said.

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Treatments Your Physician May Prescribe

If your physician suspects a basal cell carcinoma, he or she will first want to establish the correct diagnosis by performing a biopsy of the lesion. The procedure involves:

Nodular basal cell carcinomas:Infiltrating or morpheaform basal cell carcinomas:

• Excision â The basal cell carcinoma is cut out with a scalpel, and sutures are usually placed to bring the wound edges together.
• Mohs micrographic surgery â In this technique, the physician takes tiny slivers of skin from the cancer site until it is completely removed. This technique is particularly useful for basal cell carcinomas located on the nose, the ears, and the lips.
• Radiation treatment â X-ray therapy is often useful for patients who are not good surgical candidates because of other health issues.

Superficial basal cell carcinomas: