Basal cell carcinoma

Yulia Farida Yahya

Dept I Kesehatan kulit & kelamin
FK UNSRI-RSUP M Hoesin
Palembang
Basal cell carcinoma (BCC) malignan
neoplasma derived nonkeratinizing cell
originate in basal layer epidermis
Most common in human
Left untreated BCC continue invade
locally tissue damage that compromises
function & cosmetic
Metastatic extremely rare event
Introduction
Epidemiology
Estimate > 1 million new cases occur each
year in USA
In Indonesia unknown study in Palembang
The malignancy accounts approximately 75%
all non melanoma skin cancer (NMSC)
More common in elderly, men affected slightly
more often than women
Characteristically develops in sun-exposed
skin lighter individuals
Insiden KSB di Palembang
0,30%
0,11%
0,042%
Risk factor
ultraviolet light (UV) Exposure
Light hair & eye color
Inability to tan
BCC patients increased risk for melanoma
3X
No increased risk for other type of cancer
Etiopathogenesis
UV exposureparticularlyUVB spectrum
(290-320nm) mutation tumor supressor
genesp53, patches (PTCH)
Exposure inonizing radiation, alternation
immunity survaillance
Potential link UV & decreased immunity
induced BCC demonstrated express Fas
Ligand (CD95L)-bearing T cell undergoing
apoptosis
The role immun systemnot completely
understood
Inheriteddevelopment nevoid basal cell
carcinoma syndromeor basal cell nevus
syndrome (BCNS), bazex syndrome, Rombo
syndrome


Etiopathogenesis
Patiens with BCNSdeveloped hundred BCC may
exhibit a broad nasal root, boderline intelligence, jaw
cysts, palmar pits, multiple skletal abnormalities
BCNS occurs Mutations in tumor supressor gene
(PTCH)
Bazex syndrometransmitted in an X-linked
dominant fashion
Rombo syndrome--.transmitted in an autosoma
dominant
Etiopathogenesis
Clinical manifestation
Translucency, ulceration, telangiectasis, rolled
border
Characteristics vary for different clinical sub-
type
Nodular pigmented BCC
Superficial fibroepithelioma of
Morphea form Pinkus (FEP)
infiltrat
Clinical features
Nodular BCC Pigmented BCC
Clinical features


Nodular-Pigmented BCC
Nodular-ulcerative BCC
Clinical features
Rodent Ulcus with
central necrosis
Superficial BCC
Massive local tissue damage
from multiple recurrent BCC
Local invasion
The greatest danger BCC local
invasion
BCC is slow-growing tumor that
invades locally rather than
metastasizes
Perineural invasion
Perineural invasion
uncommon in BCC
In histologically BCC
agressive or recurrent
lesions
Metastasis BCC rarely
rayes varying 0,0028%-
0,55%, involvement lymph
nodes & lungs most
common Orbital invasion BCC which
requires extensive surgery
Histologic variant BCC
Nodular BCC
Micro Nodular BCC
Infiltrat BCC
Differential diagnosis
Management BCC
Guided by anatomic location & histologic
features
Approaches Mohs micrographic surgery
(MMS)
standart surgical excision flap/grafts excision
Destruction by various modalities diameter
lesion < 2 cm
Topical chemotherapy cream atau solusio 5-
fluouracil, Imiquimod (IMQ), Tazarotene

Destruction therapy
C & D (curretage & desiccation)
Cryosurgery
Photodynamic therapy (PDT)
Photosensitizing drug (aminolevulinic acid) by
visible light to produce activated oxygen species
(ROS) destroy cancer cell
Topicaly chemotherapy
5-Fluoro uracil cream
Imiquimod 5% cream
Radiotherapy

Treatment
Management BCC