Basal cell carcinoma or rodent ulcer

Basal cell carcinoma or rodent ulcer
Introduction
Basal cell carcinoma BCC is a malignant tumor or neoplasm which arise from the basal cell layer of the skin and is considered most common type of skin cancer which also known as rodent ulcer
It is locally malignant tumor that so it is never or very rare to spread or metastasize to other blood or lymph nodes or  organs and it is slowly growing which may take years it also called non melanoma skin cancer together with squamous cell carcinoma but malignant melanoma are called melanoma skin cancer
What are the site of basal cell carcinoma

BCC can be arise from any part of the skin including the anal margin but about 90% occur on the face above a line joining the angle of the mouth to the external auditory meatus or to the lobule of the ear (seborrheic area) they are especially common around the eye nasolabial folds and hairline of the scalp

They are more common in male the female common in old age

What are the causes of basal cell carcinoma
  • Exposure to sunlight
  • Exposure to X rays radiation
  • Exposure to arsenic
  • Basal cell naevus syndrome which it is dominantly inherited associated with multiple basal cell carcinoma
  • People with inherited defects such as albinism and xerodermia pigmentos
  • White skinned with prolonged exposure to sun
  • Immunocompremised patient
What are symptoms signs and pathology of basal cell carcinoma
Basal cell carcinoma  can be present  either with small nodule pearly white or blue translucent on the sun exposed area common on the face with dilated capillaries over it vessels within the tumor it the earliest lesion and called nodular or button type
   
Basal cell carcinoma can be present with ulcer which called rodent ulcer and this the commonest pictures of basal cell carcinoma

The rodent ulcer have the following criteria
  • Size can take any size either small moderate or large size
  • Shape either rounded or oval or irregular
  • Edge raised ,rolled in and beaded
  • Floor not raised red and granular or may be covered with scabs crusts and blood
  • Base indurated but not extended beyond the edge
  • Margin showing dilated blood vessels telangectasia
  • Discharge the ulcer may discharge blood or pus
Basal cell carcinoma can also present as scarring or cystic or pigmented lesion as pigmented basal cell carcinoma  but less common
Basal cell carcinoma can be as superficial type which found on the trunk and presents as red scaly patch and raised edge or present as turban tumor such as cylindroma over the scalp or flied fire type or multifocal which emerge from the epidermis and spread over several cms
What are the complications of basal cell carcinoma
Basal cell carcinoma can be direct spread to underlying structures such as the causing eroded the underlying skull and may destroy the face nose and eye
Basal cell carcinoma can causes bleeding from erosion of blood vessels
 Basal cell carcinoma can be changed into squamous cell or carcinoma or epitheliomatous transformation  called basosquamous carcinoma
 it may causes secondary infection meningitis and cavernous sinus thrombosis this due to it site on the face but this is rare
Investigations

Biopsy

Taken  a biopsy from the lesion either by incisional  by removal small part of the  lesion or excisional by removal the whole lesion then examined under microscope to detect cancer cells which appear as solid rounded mass with dark staining cells arising from the basal cell layers of the skin with no prickle cells no epithelial pearls which seen in squamous cell carcinoma 

Each mass consists of a palisade arrangement of columnar epithelium at the periphery and polyhedral cells at the center with no cell nests

Treatment of basal cell carcinoma

There are many ways to treated basal cell carcinoma which give good results and that is depend on the site of the lesion age of the patient the size of the lesion  if there contraindication for operation or the patient refuse
the aim of this treatment is to destroyed  or to remove the tumor completely to avoid it is recurrence again these methods including either by surgical  removal or irradiation or currettage and cautery or cryosurgery or topical chemotherapy such as

Surgical removal or excision

Which means complete removal of the lesion with removal of healthy skin part about 1 cm as a safety margin then defect which left after removal it is either closed directly if the defect very small or closed by plastic closure by skin flapping or grafts

Most common indications for surgery are
very small ulcers are better to excised ,ulcers near the eye ulcer infiltrating to bone or cartilage   recurrent ulcers and cases resistant to irradiation

Irradiation therapy

Indicated in cases where surgery is difficult to done given on multiple session

Currettage and cautery

Which consists o scooping  out the basal cell carcinoma by using spoon like instrument called curette then cauterization using electric current is applied to control the bleeding and kills the remaining cancer cells better for small cancer such as in the trunk and extrimties

Cryosurgery

This done by special cryo device  to freezing the cancer cells and kill them by using liquid nitrogen

Topical chemotherapy

This is local treatment by using such as 5- fluorouracil is used in small and superficial lesions but recurrence rates are common

For sqaumous carcinoma or epitheluoma see here

For malignant melanoma see here
  
tags:basal,carcinoma,rodent,cell,ulcer,basosquousam,palisade

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