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Basal cell carcinoma
The classical basal cell carcinoma is a well demarcated, translucent papular or nodule with evident telangiectasia. There may be central ulceration, the so-called "rodent ulcer". Basal cell carcinomas are multiple or single. Most commonly, they are in areas of significant actinic damage.
Nodular basal cell carcinomas can occur at sites of embryonal fusion planes such as the ocular canthi, periauricular skin, and paranasal skin.
Variants of the nodular basal cell carcinoma include the pigmented basal cell carcinoma, where numerous melanocytes are present, giving the lesion a gray to black color.
Sclerosing basal cell carcinoma, also called morpheic type basal cell carcinoma, is an expanding white plaque on the skin. Frequently quite large before recognized, this type of lesion is a significant cause of surgical morbidity. Its edges are frequently under-appreciated with a significant recurrent rate.
Multicentric basal cell carcinoma, is an expanding, very shallow BCC with an active, friable edge and central scarring. This type is common on the upper trunk.
Nevoid basal cell carcinoma syndrome is an autosomal dominant condition associated with bone cysts, palmar pits and other stigmata and in which innumerable basal cell carcinomas develop relatively early in life.
Treatment:
- Basal cell carcinoma of the nodular form can be treated with simple surgical excision or electrofulguration and curettage.
- Superficial variants respond to deep liquid nitrogen cryotherapy.
- Sclerosing basal cell carcinoma is best treated with micrographic surgery (Mohs' technique).
- Radiotherapy is an alternative in the older patient or where lesions are extensive and surgery would result in unwarranted morbidity.
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