Etiology & Pathogenesis

The pathogenesis of BCC involves exposure to

UVL,particularly the ultraviolet B spectrum
(290–320 nm) that induces mutations in tumor
suppressor genes. UVB radiation damages DNA
and affects the immune system resulting in a
progressive genetic alterations and neoplasms.
Nodular Basal Cell Carcinoma
Papule or nodule, translucent or “pearly.” Skin-
colored or reddish, smooth surface with
telangiectasia.Portions of nodular BCC may have
erosions or stipples of melanin pigmentation
Ulcerating Basal Cell Carcinoma
Ulcer (often covered with a crust) with a rolled
border (rodent ulcer), which again is translucent,
pearly, smooth with telangiectasia.
Sclerosing Basal Cell Carcinoma
Appears as a small patch of morphea or a
superficial scar, often ill defined, skin-colored,
whitish but also with peppery pigmentation.
Superficial Basal Cell Carcinoma
Appear as thin plaques .Pink or red characteristic fine
thread like border and telangiectasia can be seen with
the aid of a hand lens.This can also give rise to nodular
and ulcerating BCC. BCC often bleeds with minimal
excoriation. Solar keratosis, in comparison, does not
bleed but is painful with excoriation.
Pigmented Basal Cell Carcinoma
May be brown to blue or black. Smooth, glistening
surface hard, firm may be indistinguishable from
superficial spreading or nodular melanoma but is
usually harder. Cystic lesions may occur: round, oval
shape, depressed center (“umbilicated”). Stippled
pigmentation can be seen in any of BCC types.
Cystic Basal Cell Carcinoma
These dome shaped, blue – gray cystic nodules,
are clinically similar to eccrine and apocrine
hidrocystomas.
Diagnosis of BCC
Diagnosis of BCC is accomplished by accurate
interpretation of the skin biopsy results. The
preferred biopsy methods are shave biopsy,
which is often sufficient, and punch biopsy
Histopathology
The malignant basal cells have large nuclei and
relatively little cytoplasm. Although the nuclei are large,
they may not appear atypical. Usually, mitotic figures
are absent. Frequently, slit-like retraction of stroma
from tumor islands is present, creating peritumoral
lacunae that are helpful in histopathologic diagnosis.
Differential Diagnosis Of BCC
Squamous Cell Carcinoma
Squamous cell carcinomas (SCCs) are malignant neoplasms
derived from suprabasal epidermal keratinocytes. A firm, flesh-
colored or erythematous, keratotic papule or plaque is most
common, but SCCs may also be pigmented. Other presentations
include as an ulcer, a smooth nodule , or a thick cutaneous horn.
SCC may also be verrucous or present as an abscess.
Nodular Melanoma
Nodular melanoma (NM) is the second most common
melanoma. It is more common for NM to begin de novo
than to arise in a preexisting nevus. NM typically
appears as a uniformly dark blue-black or bluish-red
raised lesion, but 5% are amelanotic. Early lesions often
lack asymmetry, have regular borders, and are a
uniform color
Bowen’s Disease (BD)
Bowen disease (BD) is SCC in situ, it affects both skin
and mucous membranes and has the potential to
progress to invasive SCC. BD typically presents as a
discrete, slowly enlarging, pink to erythematous thin
plaque with well-demarcated, irregular borders and
overlying scale or crust resembling a psoriatic plaque.
Morphea
Morphea is a chronic autoimmune disease
characterized by sclerosis of the skin.
Erythematous patch or thin plaque, Central
sclerosis and violaceous, hyperpigmented
border, Atrophy dermal, subcutaneous, or
muscle
Prognosis
With appropriate treatment, the prognosis for
most patients with BCC is excellent. Control
rates as high as 99% have been achieved by
MMS.
For the rare patient with metastatic disease,
prognosis is poor, with a mean survival of 8–10
months from the time of diagnosis.