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
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Figure 4 BCC can also occur behind the skin of the ear
April 2017 | etCETera 13