Basal cell carcinoma: Difference between revisions

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Basal_cell_carcinoma_-_high_mag.jpg
| Image      = Basal_cell_carcinoma_-_high_mag.jpg  
| Width      =
| Width      =
| Caption    = Basal cell carcinoma. [[H&E stain]].
| Caption    = Basal cell carcinoma. [[H&E stain]].
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| LMDDx      = [[trichoepithelioma]], [[adenoid cystic carcinoma]], [[eccrine poroma]], reticulated [[seborrheic keratosis]] (for BCC, fibroepitheliomatous pattern), [[basaloid squamous cell carcinoma]], [[basosquamous carcinoma]]  
| LMDDx      = [[trichoepithelioma]], [[adenoid cystic carcinoma]], [[eccrine poroma]], reticulated [[seborrheic keratosis]] (for BCC, fibroepitheliomatous pattern), [[basaloid squamous cell carcinoma]], [[basosquamous carcinoma]]  
| Stains    =
| Stains    =
| IHC        =
| IHC        = Ber-EP4 +ve, EMA -ve
| EM        =
| EM        =
| Molecular  =
| Molecular  =
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**Dermatopathologists might see a couple in their career.
**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>  
**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>  
*Uncommon in patients less than 35 years old.<ref name=pmid1637690>{{Cite journal  | last1 = Cox | first1 = NH. | title = Basal cell carcinoma in young adults. | journal = Br J Dermatol | volume = 127 | issue = 1 | pages = 26-9 | month = Jul | year = 1992 | doi =  | PMID = 1637690 }}</ref>


===Clinical===
===Clinical===
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DDx:
DDx:
*Benign hair follicle - lacks necrosis, core has lower cellular density, surrounding sheath composed of loose connective tissue.
*[[Trichoepithelioma]] - no artefactual cleft,<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref> and typically no [[solar elastosis]].
*[[Trichoepithelioma]] - no artefactual cleft,<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref> and typically no [[solar elastosis]].
*[[Adenoid cystic carcinoma]] - no myxoid stroma, no peripheral palisading.
*[[Adenoid cystic carcinoma]] - no myxoid stroma, no peripheral palisading.
Line 80: Line 82:
*Reticulated [[seborrheic keratosis]] - for BCC, fibroepitheliomatous pattern.
*Reticulated [[seborrheic keratosis]] - for BCC, fibroepitheliomatous pattern.
*[[Basaloid squamous cell carcinoma]] - [[AKA]] squamous cell carcinoma, basaloid variant.
*[[Basaloid squamous cell carcinoma]] - [[AKA]] squamous cell carcinoma, basaloid variant.
*[[Basosquamous carcinoma]] - squamous cell carcinoma with basal cell carcinoma (a collision tumour).
*[[Basosquamous carcinoma]] - squamous cell carcinoma with basal cell carcinoma (a [[collision tumour]]).
*[[Solar elastosis]] with ectatic [[blood vessel]]s.  
*[[Solar elastosis]] with ectatic [[blood vessel]]s.  
*[[Microcystic adnexal carcinoma]] - for sclerosing basal cell carcinoma.


===Images===
===Images===
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Image:Basal_cell_carcinoma_fibroepitheliomatous_pattern_-_very_low_mag.jpg | Fibroepithelioma of Pinkus. (WC/Nephron)
Image:Basal_cell_carcinoma_fibroepitheliomatous_pattern_-_very_low_mag.jpg | Fibroepithelioma of Pinkus. (WC/Nephron)
Image:SkinTumors-P6040209.JPG | Fibroepithelioma of Pinkus. (WC)
Image:SkinTumors-P6040209.JPG | Fibroepithelioma of Pinkus. (WC)
Fiboepithelioma of Pinkus 10x 4.tif | Fiboepithelioma of Pinkus 10x 4.tif (MLA)
Fiboepithelioma of Pinkus 10x 3.tif | Fiboepithelioma of Pinkus 10x 3.tif (MLA)
Fiboepithelioma of Pinkus 10x 2.tif | Fiboepithelioma of Pinkus 10x 2.tif (MLA)
Fiboepithelioma of Pinkus 10x.tif | Fiboepithelioma of Pinkus 10x.tif (MLA)
Fibro of pinkus.tif | Fiboepithelioma of Pinkus 4x.tif (MLA)
</gallery>
</gallery>
[[File: 5 41110532329262 sl 1.png|Basal cell carcinoma with mucin production]]
[[File: 5 41110532329262 sl 2.png|Basal cell carcinoma with mucin production]]
[[File: 5 41110532329262 sl 3.png|Basal cell carcinoma with mucin production]]
Basal cell carcinoma with mucin production in the left nasal bridge of a 59 year old man, presenting as a presumptive lacrimal cyst. Because of the location, immunohistochemical stains were needed to exclude eccrine tumors and salivary gland type tumors. A. A spheroidal, well circumscribed mass shows intertwining nests (green arrow), isles with cribriforming (yellow arrows), and large acini (cyan arrows), with good circumscription. B. Round to ovoid nuclei show > 4:1 nuclear size variation in some adjacent pairs (black arrows) and occasional pyknotic nuclei (green arrows). Lumens show mucinous material with vacuoles (yellow arrows); the color argues against adenoid cystic carcinoma, but certainty in that respect could not be maintained without immunostains. Note lining up of nuclei suggestive of palisades (blue arrows). C. Nuclei are P63 positive, not shown are the negative stains for SOX10, CK7, and CD117.
www:
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://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://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)].
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=930934558 BCC with fibroepitheliomatous pattern (dermatlas.med.jhmi.edu)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157603/figure/Fig2/ BCC in vitiligo (nih.gov)].<ref name=pmid20623309>{{Cite journal  | last1 = Rustemeyer | first1 = J. | last2 = Günther | first2 = L. | last3 = Deichert | first3 = L. | title = A rare association: basal cell carcinoma in a vitiliginous macula. | journal = Oral Maxillofac Surg | volume = 15 | issue = 3 | pages = 175-7 | month = Sep | year = 2011 | doi = 10.1007/s10006-010-0240-y | PMID = 20623309 }}</ref>
*[https://dermpath.wordpress.com/category/malignant-cutaneous-neoplasms/basal-cell-carcinoma/ Clear cell BCC (dermpath.wordpress.com)].


===Basal cell carcinoma subtypes/unique features===
===Basal cell carcinoma subtypes/unique features===
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! Other histologic features
! Other histologic features
! Other
! Other
! Image
|-
|-
| Superficial pattern
| Superficial pattern
| connected to epidermis
| connected to epidermis
|  
|  
|
|
|
|-
|-
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| partial detachment from epidermis
| partial detachment from epidermis
| subgroup ''micronodular'' = nests equal size ~ 0.2 mm dia., >=25% of lesion
| subgroup ''micronodular'' = nests equal size ~ 0.2 mm dia., >=25% of lesion
|
|-
|-
| Morpheaform (sclerosing) pattern
| Morpheaform (sclerosing) pattern
Line 123: Line 145:
| 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 }}
| 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>
</ref>
|
|-
|-
| Infiltrative pattern
| Infiltrative pattern
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|  
|  
| often also sclerosing or morpheaform
| often also sclerosing or morpheaform
|
|-
|-
| Fibroepitheliomatous pattern
| Fibroepitheliomatous pattern
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| fibrous stroma
| fibrous stroma
| name of pattern comes from ''fibroepithelioma of Pinkus''; DDx: reticulated [[seborrheic keratosis]]
| name of pattern comes from ''fibroepithelioma of Pinkus''; DDx: reticulated [[seborrheic keratosis]]
|
|-
|-
| Infundibulocystic pattern
| Infundibulocystic pattern
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| usu. small, often in cords
| usu. small, often in cords
| usu. indolent
| usu. indolent
|
|-
|-
| Adenoidal pattern
| Adenoidal pattern
| cribriform / pseudoglandular arch.
| [[cribriform]] / pseudoglandular arch.
| myxoid stroma, peripheral palisading
| myxoid stroma, peripheral palisading
| DDx: [[adenoid cystic carcinoma]]
| DDx: [[adenoid cystic carcinoma]]
| [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667320/figure/F2/ Adenoidal BCC (nih.gov)]
|-
|-
|}
|}
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==IHC==
==IHC==
*CK5/6 +ve.
*[[Ber-EP4]] +ve -- typically weak and focal staining.
**[[Microcystic adnexal carcinoma]] negative.<ref name=pmid23398472 >{{Cite journal  | last1 = Sellheyer | first1 = K. | last2 = Nelson | first2 = P. | last3 = Kutzner | first3 = H. | last4 = Patel | first4 = RM. | title = The immunohistochemical differential diagnosis of microcystic adnexal carcinoma, desmoplastic trichoepithelioma and morpheaform basal cell carcinoma using BerEP4 and stem cell markers. | journal = J Cutan Pathol | volume = 40 | issue = 4 | pages = 363-70 | month = Apr | year = 2013 | doi = 10.1111/cup.12085 | PMID = 23398472 }}</ref>
*CK5/6 +ve (52 of 52<ref name=pmid18496426/>).
**Useful to assess [[margins]]... if very close.
**Useful to assess [[margins]]... if very close.
*CK7 +ve (30 +ve of 52 cases<ref name=pmid18496426>{{cite journal |authors=Alessi E, Venegoni L, Fanoni D, Berti E |title=Cytokeratin profile in basal cell carcinoma |journal=Am J Dermatopathol |volume=30 |issue=3 |pages=249–55 |date=June 2008 |pmid=18496426 |doi=10.1097/DAD.0b013e31816c828a |url=}}</ref>).
*CK19 -ve/+ve (14 +ve 52<ref name=pmid18496426/>).
*CD10 +ve.
*CD10 +ve.
*Actin +ve.
*Actin +ve.
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*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>
*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.
**SCC usually negative.
Other:
*p63 +ve.<ref name=pmid16630179>{{Cite journal  | last1 = Bircan | first1 = S. | last2 = Candir | first2 = O. | last3 = Kapucoglu | first3 = N. | last4 = Baspinar | first4 = S. | title = The expression of p63 in basal cell carcinomas and association with histological differentiation. | journal = J Cutan Pathol | volume = 33 | issue = 4 | pages = 293-8 | month = Apr | year = 2006 | doi = 10.1111/j.0303-6987.2006.00436.x | PMID = 16630179 }}</ref>


==Sign-out==
==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>
<pre>
SKIN LESION, RIGHT EAR, EXCISION:  
SKIN LESION, RIGHT EAR, EXCISION:  
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- DERMAL SCAR.
- DERMAL SCAR.
- EXTENSIVE SOLAR ELASTOSIS.
- EXTENSIVE SOLAR ELASTOSIS.
</pre>
===Electrodesiccation and curettage===
<pre>
Skin, Left Brow, Biopsy with Electrodesiccation and Curettage (EDC):
- BASAL CELL CARCINOMA, margin status assessed clinically during EDC.
</pre>
====Block letters====
<pre>
SKIN LESION, LEFT FOREARM, SHAVE BIOPSY WITH ELECTRODESICCATION AND CURETTAGE (EDC):
- BASAL CELL CARCINOMA, MARGIN STATUS ASSESSED CLINICALLY DURING EDC.
- EXTENSIVE SOLAR ELASTOSIS.
</pre>
<pre>
SKIN LESION, RIGHT UPPER BACK, SHAVE BIOPSY WITH ELECTRODESICCATION AND CURETTAGE (EDC):
- BASAL CELL CARCINOMA, MARGIN STATUS ASSESSED CLINICALLY DURING EDC.
- SOLAR ELASTOSIS.
COMMENT:
The tumour is clear of the edges of the tissue in the planes of section.
</pre>
===Close margin===
<pre>
SKIN LESION, SCALP, EXCISION:
- BASAL CELL CARCINOMA, NODULAR.
-- LATERAL MARGIN CLEARANCE LESS THAN 0.2 MILLIMETRES, SEE COMMENT.
-- DEEP MARGIN NEGATIVE FOR BASAL CELL CARCINOMA.
- SOLAR ELASTOSIS.
COMMENT:
The lesion is focally very close to the green inked margin in block A5
(3 o'clock to 6 o'clock margin).
The lateral margins elsewhere are 2-3 millimetres.
The deep margin is approximately 3 millimetres.
</pre>
===Positive lateral margin===
<pre>
SKIN LESION, LOWER MID BACK, EXCISION:
- BASAL CELL CARCINOMA, NODULAR, LATERAL MARGIN POSITIVE.
-- DEEP MARGIN NEGATIVE.
- SOLAR ELASTOSIS.
</pre>
===Infiltrative BCC===
<pre>
SKIN LESION, RIGHT EAR, SHAVE BIOPSY:
- INFILTRATIVE BASAL CELL CARCINOMA WITH FOCAL SCLEROSIS, DEEP AND LATERAL
  MARGINS POSITIVE.
- ACTINIC KERATOSIS.
- ULCERATION.
COMMENT:
The tumour stains as follows:
POSITIVE: CK34betaE12, Ber-EP4.
NEGATIVE: S-100, EMA.
</pre>
</pre>


===Micro===
===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.
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.
====Infiltrative BCC====
The sections show ulcerated skin. In the dermis, there are single atypical cells, small clusters of atypical cells and rows of atypical cells.  The atypical cells have moderate grey cytoplasm, irregular nucleoli, and pale nuclei. Mitotic activity is present. The stroma is partially sclerotic.
The epidermis (where present) has basal atypia and focal parakeratosis.
The atypical lesion is present at the deep and lateral margins.
====Small basal cell - curettage afterward====
The sections show hair-bearing skin with small groups of basaloid cells attached to the epidermis. The groups of basaloid cells have peripheral palisading of the nuclei and are surrounded by a myxoid stroma. The groups of basaloid cells are well demarcated from the stroma and show focal clefting from the stroma. The edge of the tissue focally has basal cell carcinoma, the deep aspect is clear.


==See also==
==See also==
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
==External links==
*[http://xoomer.virgilio.it/cylagu/pagina14eng.html Basal cell carcinoma (virgilio.it)].


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