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Basal cell carcinoma

Basal cell carcinoma (BCC) is the most common skin tumor in Central Europe.1,2 It probably arises from stem cells in the area of the hair follicles and interfollicular epidermis. It occurs in most cases on the head and neck, but also on the trunk and extremities. BCC grows locally infiltrating and destructive, but metastasizes only very rarely.1,3 Different histological subtypes are distinguished, which play an essential role in assessing the aggressiveness of the tumour.1
The clinical appearance of basal cell carcinoma is highly variable. Frequently occurring features are1:

  • yellowish-reddish nodules, often with a pearl-like border
  • erythematous macules or plaques
  • atrophic alterations

It can also manifest as open sores that tend to bleed.

Epidemiology and risk factors

There have been hurdles in the past regarding registry data collection that prevented proper epidemiological observation of skin cancer in the UK. Only recently improvements have enabled more accurate analysis. This indicated that the absolute first BCC per person per annum (PPPA) count increased over a 3-year period from 145,817 in 2013. to 166,448 in 20152 Moreover, incidence increases with age and BCC is more common in men, with a male: female ratio of 1.2:1.1,2 Whereas the ears and scalp are usually affected in men, the lower limb is preferentially affected in women. However, the face is the most common site for BCCs in both sexes.2

Further risk factors for the development of BCC include1:

  • UV radiation
  • Fitzpatrick skin type I and II
  • genetic predisposition (e.g. Gorlin-Goltz syndrome)
  • long-term immunosuppression

Diagnosis

A medical examination of the patient is appropriate for a tentative clinical diagnosis of basal cell carcinoma. Dermoscopy may be performed to confirm this.1 Histological examination should be performed to confirm the diagnosis of BCC depending on the size of the tumor and therapeutic approach.1

When basal cell carcinoma is diagnosed, a full-body skin examination should be performed or at least recommended, since the presence of BCC increases the risk of other skin tumors, especially on sun-exposed areas of the head (incl. face), lower limps and also on the trunk.1,2

Therapy

Surgical excision is the recommended first-line therapy for BCC. Depending on the risk of recurrence, the tumor is excised either with systematic incision margin control or with a tumor-adapted safety margin. However, if there are concerns about excision due to tumor characteristics, frequency of occurrence, a patients’ medical condition, or cosmetic considerations, for example, other treatment options are available, such as1:
•    cryosurgery
•    immunological therapy
•    localised chemotherapy
•    radiotherapy
•    photodynamic therapy (PDT)
•    topical therapy


In the context of PDT, suitable superficial and nodular BCCs are treated with red light.4 For this purpose, two sessions should be performed at an interval of approximately one week. A follow-up examination is carried out 3 months after the treatment. Treated lesions that have not been cleared completely should be treated again.4

References

  1. Nasr et al. Br J Dermatol 2021;185:899–920.
  2. Venables ZC et al. Br J Dermatol 2019;181:474–482.
  3. Peterson SC et al. Cell Stem Cell 2015;16:400–412.
  4. Morton CA et al. 2019 J Eur Acad Dermatol Venereol 2019;33:2225–2238.

UKBF-2022-006i-V01, Date of preparation: June 2022