Basal Cell Carcinoma( BCC)
Also known as rodent ulcer, BCC is the most common type of skin cancer. 1 85 % of BCCs occur on the face and they are often positioned on the eyelids or nose, most commonly near the medical canthus on the lower lid. 2 They can be easily mistaken for irritation caused by poorly-fitting spectacle pads.
BCCs arise from basal cells found in the deepest layer of the epidermis. They develop mostly in areas of skin exposed to the sun including parts of the face such as the nose, forehead and cheeks, back or lower legs. 3 The term‘ rodent ulcer’ refers to the destructive nature of BCCs which expand over time to involve ever-greater areas of surrounding skin.
BCCs mainly affect fair skinned adults, but other skin types are also at risk. It is most often diagnosed in people who are of middle or old age.
Those with the highest risk of developing a basal cell carcinoma are: 4
• People with pale skin who burn easily and rarely tan( generally with light coloured or red hair, although some may have dark hair but still have fair skin).
• Those who have had a lot of exposure to the sun, such as people with outdoor hobbies or outdoor workers, and people who have lived in sunny climates.
• People who have used sun beds or have regularly sunbathed.
• People who have previously had a basal cell carcinoma.
There are several different subtypes of BCC but the most common is the nodular type. BCCs almost never spread to another part of the body( metastasise) to form a secondary cancer but it is possible to have more than one BCC at the same time and having had one does increase the risk of further BCCs developing. 5
People often first become aware of them as a scab that bleeds and does not heal completely or a new lump on the skin. Superficial BCCs look like a scaly red flat mark on the skin. Others form a lump and have a pearl-like rim surrounding a central crater and there may be small red blood vessels( telangiectasia) present across the surface. If left untreated, BCCs spread across the skin surface. Unlike Squamous Cell Carcinoma( SCC) they don’ t penetrate into the deeper tissues. Most BCCs are painless, although sometimes they can be itchy or bleed if caught.
Management Patients with suspected BCC should be referred to their GP. The commonest treatment for BCC is surgery to remove the affected skin. The skin can usually be closed with a few stitches, but sometimes, especially on eyelids, a skin graft is needed. While, surgical excision is the preferred treatment, the choice of other treatments depends on the site and size of the BCC, the condition of the surrounding skin and number of BCCs to be treated( some people have multiple) as well as the general health of each person to be treated. Other types of treatment include cryotherapy( freezing with liquid nitrogen), curettage( scraping off after applying local anaesthetic), Chemotherapeutic creams( the two most commonly used are 5-fluorouracil and imiquimod), photodynamic therapy and radiotherapy.
Figure 1 A superficial rodent ulcer can look red and scaly with no ulcer
Figure 2 More than half of rodent ulcers are nodular exhibiting raised, rolled edges around a central ulcer that may scab or bleed
Figure 3 Nodular BCC can also take the form of a raised‘ lump’ varying in colour from pale pink to dark brown and often shows telangiectasia( blood vessels visible on the surface)
See more images of Basal Cell Carcinoma on CETpoints. com
Continued overleaf
Figure 4 BCC can also occur behind the skin of the ear
April 2017 | etCETera 13