Difference between revisions of "Basal cell carcinoma"

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Basal cell carcinoma (view source)

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#redirect [[Dermatologic_neoplasms#Basal_cell_carcinoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Basal_cell_carcinoma_-_2_-_intermed_mag.jpg
| Width      =
| Caption    = Basal cell carcinoma. [[H&E stain]].
| Micro      = basaloid cells with moderate blue/grey cytoplasm, nests with peripheral palisading of cells, artefactual clefting, myxoid stroma
| Subtypes  =
| LMDDx      =
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      =
| Assdx      =
| Syndromes  = [[Bazex syndrome]], [[nevoid basal cell carcinoma syndrome]], [[seroderma pigmentosum]]
| Signs      =
| Symptoms  =
| Prevalence = very common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good
| Other      =
| ClinDDx    =
}}
 
'''Basal cell carcinoma''', abbreviated ''BCC'', is an extremely common form of skin cancer.
 
==General==
*Very common.
*Sun exposed skin.
*Hair bearing area; tumour derived from hair follicle - a more appropriate name might be ''trichoblastic carcinoma''.<ref name=Ref_Derm389>{{Ref Derm|389}}</ref>
*Very rarely metastasizes:
**Dermatopathologists might see a couple in their career.
**There are only ~ 300 literature reports of metastatic BCC.<ref name=pmid16208438>{{Cite journal  | last1 = Ting | first1 = PT. | last2 = Kasper | first2 = R. | last3 = Arlette | first3 = JP. | title = Metastatic basal cell carcinoma: report of two cases and literature review. | journal = J Cutan Med Surg | volume = 9 | issue = 1 | pages = 10-5 | month = Jan | year = 2005 | doi = 10.1007/s10227-005-0027-1 | PMID = 16208438 }}</ref>
 
===Clinical===
*Telangiectasias.
*Raised pearly nodule.
 
===As part of a syndrome===
*[[Nevoid basal cell carcinoma syndrome]] (NBCCS), AKA ''Gorlin syndrome''.
*[[Bazex syndrome]] (X-linked).<ref>URL: [http://emedicine.medscape.com/article/1101146-diagnosis http://emedicine.medscape.com/article/1101146-diagnosis]. Accessed on: 6 May 2010.</ref>
*[[Xeroderma pigmentosum]].
 
==Microscopic==
Features:<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref><ref name=Ref_Derm390>{{Ref Derm|390}}</ref>
#Basaloid cells - similar in appearance to basal cells:
#*Moderate blue/grey cytoplasm.
#*Dark ovoid/ellipsoid nucleus with uniform chromatin.
#Palisading of cells at the edge of the cell nests.
#Artefactual separation of cells (forming the nests) from the underlying stroma - '''key feature'''.
#Surrounded by blue [[myxoid stroma|(myxoid) stroma]] - '''key feature'''.
 
May be present:<ref name=Ref_Derm390>{{Ref Derm|390}}</ref>
*[[Dystrophic calcification]] - possibly more aggressive behaviour.<ref name=pmid20489568>{{Cite journal  | last1 = Slodkowska | first1 = EA. | last2 = Cribier | first2 = B. | last3 = Peltre | first3 = B. | last4 = Jones | first4 = DM. | last5 = Carlson | first5 = JA. | title = Calcifications associated with basal cell carcinoma: prevalence, characteristics, and correlations. | journal = Am J Dermatopathol | volume = 32 | issue = 6 | pages = 557-64 | month = Aug | year = 2010 | doi = 10.1097/DAD.0b013e3181ca65e2 | PMID = 20489568 }}</ref>
*[[Amyloid]].
*Inflammation.
 
Notes:
*Palisading = the long axes of the cells are alined and the axes are perpendicular to the interface between the (basaloid cell) nests and stroma.
*Key elements in a list: Artefactual clefting (of nests), Basaloid cells, Peripheral palisading, Myxoid stroma.
**Memory device ''PAM'': palisading, artefactual clefts, myxoid stroma.
 
DDx:
*[[Trichoepithelioma]] - no artefactual cleft.<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>
*[[Adenoid cystic carcinoma]] - no myxoid stroma, no peripheral palisading.
*[[Eccrine poroma]] - on palms & soles, BCC rarely found there.<ref>{{Ref DCHH|284}}</ref>
*Reticulated [[seborrheic keratosis]] - for BCC, fibroepitheliomatous pattern.
*[[Basaloid squamous cell carcinoma]] - [[AKA]] squamous cell carcinoma, basaloid variant.
*[[Basosquamous carcinoma]] - squamous cell carcinoma with basal cell carcinoma (a collision tumour).
*[[Solar elastosis]] with ectatic [[blood vessel]]s.
 
===Images===
<gallery>
Image:Basal_cell_carcinoma_-_2_-_intermed_mag.jpg | BCC - intermed. mag. (WC/Nephron)
Image:Basal_cell_carcinoma_-_high_mag.jpg | BCC - high mag. (WC/Nephron)
Image:Basal_cell_carcinoma_pathology.jpg | BCC - poor quality. (WC)
Image:Basal_cell_carcinoma_fibroepitheliomatous_pattern_-_very_low_mag.jpg | Fibroepithelioma of Pinkus. (WC/Nephron)
Image:SkinTumors-P6040209.JPG | Fibroepithelioma of Pinkus. (WC)
</gallery>
www:
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/basal_cell_carcinoma_high_power.jpg BCC (ucsf.edu)].<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html]. Accessed on: 4 September 2011.</ref>
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=1&sort=0&s=20080802171910891 BCC with fibroepitheliomatous pattern / fibroepithelioma of Pinkus (surgicalpathologyatlas.com)].
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=930934558 BCC with fibroepitheliomatous pattern (dermatlas.med.jhmi.edu)].
 
===Basal cell carcinoma subtypes/unique features===
*Many patterns exist.
*Recurrence higher in morpheaform (sclerosing), infiltrative, micronodular, and superficial patterns.<ref>Basal cell carcinoma. eMedicine. ''Prognosis'' section. URL: [http://emedicine.medscape.com/article/276624-overview http://emedicine.medscape.com/article/276624-overview]. Accessed on: 17 September 2011.</ref>
*DG says the prognosis is similar for all BCC subtypes, except for ''sclerosing'' pattern and ''infiltrative'' pattern.<ref>Ghazarian, Danny; 14 September 2011.</ref>
 
The subtypes:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref>
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! Pattern
! Key histologic feature
! Other histologic features
! Other
|-
| Superficial pattern
| connected to epidermis
|
|
|-
| Nodular pattern
| nodules
| partial detachment from epidermis
| subgroup ''micronodular'' = nests equal size ~ 0.2 mm dia., >=25% of lesion
|-
| Morpheaform (sclerosing) pattern
| stroma sclerosis
|
| often seen with ''infiltrative pattern'', DDx: desmoplastic trichoepithelioma<ref name=pmid22366669>{{Cite journal  | last1 = Kirzhner | first1 = M. | last2 = Jakobiec | first2 = FA. | last3 = Borodic | first3 = G. | title = Desmoplastic trichoepithelioma: report of a unique periocular case. | journal = Ophthal Plast Reconstr Surg | volume = 28 | issue = 5 | pages = e121-3 | month =  | year =  | doi = 10.1097/IOP.0b013e318245535a | PMID = 22366669 }}
</ref>
|-
| Infiltrative pattern
| small irregular cell aggregates
|
| often also sclerosing or morpheaform
|-
| Fibroepitheliomatous pattern
| cords and columns of basaloid cells
| fibrous stroma
| name of pattern comes from ''fibroepithelioma of Pinkus''; DDx: reticulated [[seborrheic keratosis]]
|-
| Infundibulocystic pattern
| small keratocysts (keratin cysts)
| usu. small, often in cords
| usu. indolent
|-
| Adenoidal pattern
| cribriform / pseudoglandular arch.
| myxoid stroma, peripheral palisading
| DDx: [[adenoid cystic carcinoma]]
|-
|}
 
Unique features/differentiation:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref>
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! Differentiation / unique cell
! Key histologic feature
! Other histologic features
! Other
|-
| Pigmented cells
| '''any pattern''' can have pigmentation
| pigment may be in malignant cell
| DDx: collision lesion with [[melanocytic lesion]]
|-
| Squamous differentiation (metatypical BCC)
| pink cytoplasm, keratinization
|
| assoc. with ulceration/tumour recurrence
|-
| Eccrine differentiation
| focal duct formation
|
| very rare, DDx: BCC engulfing sweat ducts
|-
| Clear cells (Clear cell BCC)
| clear cytoplasm
|
| due to glycogen
|}
 
==IHC==
*CK5/6 +ve.
**Useful to assess [[margins]]... if very close.
*CD10 +ve.
*Actin +ve.
 
Squamous cell carcinoma versus basal cell carcinoma:
*BerEP4 +ve.
**SCC usually negative.<ref name=pmid19187107>{{Cite journal  | last1 = Yu | first1 = L. | last2 = Galan | first2 = A. | last3 = McNiff | first3 = JM. | title = Caveats in BerEP4 staining to differentiate basal and squamous cell carcinoma. | journal = J Cutan Pathol | volume = 36 | issue = 10 | pages = 1074-176 | month = Oct | year = 2009 | doi = 10.1111/j.1600-0560.2008.01223.x | PMID = 19187107 }}</ref>
*EMA -ve.
**SCC usually positive.<ref name=pmid10971697>{{Cite journal  | last1 = Beer | first1 = TW. | last2 = Shepherd | first2 = P. | last3 = Theaker | first3 = JM. | title = Ber EP4 and epithelial membrane antigen aid distinction of basal cell, squamous cell and basosquamous carcinomas of the skin. | journal = Histopathology | volume = 37 | issue = 3 | pages = 218-23 | month = Sep | year = 2000 | doi =  | PMID = 10971697 }}</ref>
*SMA +ve.<ref>URL: [http://www.ihcworld.com/_newsletter/2004/2004-12_basal_cell_vs_squamous_v1.pdf http://www.ihcworld.com/_newsletter/2004/2004-12_basal_cell_vs_squamous_v1.pdf]. Accessed on: 19 December 2012.</ref>
**SCC usually negative.
 
==Sign-out==
<pre>
SKIN LESION, SHAVE BIOPSY WITH ELECTRODESICCATION AND CURETTAGE (EDC):
- BASAL CELL CARCINOMA, MARGIN STATUS ASSESSED CLINICALLY DURING EDC.
- EXTENSIVE SOLAR ELASTOSIS.
</pre>
 
<pre>
SKIN LESION, RIGHT EAR, EXCISION:
- BASAL CELL CARCINOMA.
- MARGINS NEGATIVE FOR BASAL CELL CARCINOMA.
- EXTENSIVE SOLAR ELASTOSIS.
</pre>
 
<pre>
SKIN LESION, RIGHT TEMPLE, RE-EXCISION:
- BASAL CELL CARCINOMA, NODULAR, MARGINS NEGATIVE.
- DERMAL SCAR.
- EXTENSIVE SOLAR ELASTOSIS.
</pre>
 
===Micro===
The sections show hair-bearing skin with nests of basaloid cells in the dermis.  The basaloid nests have peripheral palisading of the nuclei, have numerous mitoses, and are surrounded by a myxoid stroma.  The nests are well demarcated from the stroma and show focal clefting from the stroma. The margins are negative for basal cell carcinoma.
 
==See also==
*[[Dermatopathology]].
*[[Dermatologic neoplasms]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
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