Basal cell carcinoma (BCC) is the most common human malignancy. It arises from basal keratinocytes of the epidermis and hair follicles.
Key Features
- UV radiation is the primary carcinogen (cumulative exposure).
- Typically on sun‑exposed areas (face, neck, ears, scalp, shoulders).
- Rarely metastasizes (<0.1%) but locally destructive if neglected.
Clinical Subtypes
- Nodular: Pearly papule/nodule with telangiectasias, central ulceration (“rodent ulcer”).
- Superficial: Erythematous, scaly plaque (trunk/extremities); mimics eczema/psoriasis.
- Morpheaform (sclerosing): Waxy, scar‑like, ill‑defined borders; aggressive subclinical extension.
- Pigmented, cystic, fibroepithelioma of Pinkus – variants.
Diagnosis & Treatment
- Biopsy (shave/punch) confirms.
- Standard excision (4–5 mm margins) – most sites.
- Mohs micrographic surgery – high‑risk sites (face), recurrent, aggressive subtypes; tissue‑sparing, highest cure rate (99%).
- Alternatives: ED&C (low‑risk), radiation (non‑surgical candidates), topical (imiquimod, 5‑FU – superficial only), hedgehog inhibitors (vismodegib, sonidegib – advanced/metastatic).
Follow‑up
Lifetime skin exams (high risk of new BCCs). Sun protection essential.
