basal cell carcinoma of the skin

Last edited 03/2021 and last reviewed 04/2021

This is a locally invasive carcinoma of the basal layer of the epidermis. It almost never metastasizes but it may kill by local invasion.

Basal cell carcinoma (BCC) is the most common skin cancer and the most common cancer found in white-skinned individuals (1,2)

• BCCs are slow-growing, locally invasive, malignant (but not life threatening), epidermal skin tumours
• people with BCC are at high risk of developing further BCCs and other ultraviolet radiation (UVR)- related skin cancers (2)
• main clinical subtypes are:
• nodular, superficial, ulcerated (rodent ulcer), morphoeic (sclerodermiform), fibroepithelial (fibroepithelioma of Pinkus) and advanced BCC (resulting from prolonged neglect) (3)
• histopathological patterns are also diverse and include:
• nodular, superficial, morphoeic, micronodular, infiltrative, pigmented and basosquamous or metatypical subtypes (4)

Clinicopathological features of the tumours can be used to differentiate them into high-risk and low-risk subtypes, which has implications on the management approach (4):

• High-risk BCCs include: morphoeic, infiltrative, micronodular histological subtypes; presence of perineural or perivascular invasion; size > 5
  cm; recurrent lesion; centrofacial location, including periocular and ears and host immunosuppression
• Low-risk BCCs include: superficial and nodular histological subtypes when they are located on a low-risk site (e.g. not centrofacial location)

Click here for images of nodular, superficial and morphoeic BCCs and further information

BCCs are usually slow-growing tumours that only very rarely metastasize (spread) to other distant parts of the body (0.0028% to 0.55% of advanced BCCs metastasize (5)

• BCC can cause extensive tissue destruction, particularly on the face
• neglected cases may even infiltrate bone and deeper structures, like the brain

Click here for an example image of this condition

Reference:

• Verkouteren JA et al. Epidemiology of basal cell carcinoma: scholarly review. British Journal of Dermatology 2017;177(2):359–72.
• Lomas A et al. A systematic review of worldwide incidence of nonmelanoma skin cancer. British Journal of Dermatology 2012;166(5):1069-80.
• Madan V, Lear JT. Basal cell carcinoma. In: Rook's Textbook of Dermatology, Ninth Edition. John Wiley & Sons, Ltd, 2016.
• Crowson AN. Basal cell carcinoma: biology, morphology and clinical implications. Modern Pathology 2006;19(S2):S127.
• Ting PT et al. Metastatic basal cell carcinoma: report of two cases and literature review. Journal of Cutaneous Medicine and Surgery 2005;9(1):10-5.