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BasalCellCarcinomaWorkup:ApproachConsiderations,SkinBiopsy,Cytology

BasalCellCarcinomaWorkup
Author:RobertSBader,MDChiefEditor:WilliamDJames,MDmore...
Updated:Sep15,2015

ApproachConsiderations
Giventhatbasalcellcarcinomararelymetastasizes,laboratoryandimagingstudiesarenotcommonlyclinically
indicatedinpatientspresentingwithlocalizedlesions.Imagingstudiesmaybenecessarywheninvolvementof
deeperstructures,suchasbone,isclinicallysuspected.Insuchcases,CTscansorradiographycanbeused.

SkinBiopsy
Askinbiopsyisoftenrequiredtoconfirmthediagnosisanddeterminethehistologicsubtypeofbasalcellcarcinoma
(BCC).Mostoften,ashavebiopsyisallthatisrequired.Nevertheless,inthecaseofapigmentedlesionwhere
theremaybedifficultydistinguishingbetweenpigmentedBCCandmelanoma,anexcisionalorpunchbiopsymay
beindicatedthisistoensurethatthedepthofthelesioncanbedeterminedifitprovestobeamalignant
melanoma.
Inmostcases,asuperficialbiopsyspecimenthatcontainsdermisisallthatisrequiredtoconfirmthediagnosisof
BCC,althoughitispossibletomissthetumor.Forexample,anulceratedBCCmayreepithelializewithnormal
epidermiswhiletumorisstillpresentatadeeperlevel.PartoralloftheBCCmaybesampled,butavoidgoing
beyondtheclinicalmarginsifthebiopsyisonlyfordiagnosticpurposes.
Punchbiopsyisaneasymethodtoobtainathickspecimen,butisrarelyrequired.Themostsuspiciousareaofa
lesionmaybesampled,ormultiplebiopsysamplesmaybetakenifthetumorislargeorhasavariedappearancein
differentareas.Avoidpunchbiopsyifcurettageisplannedforfinaltreatment.
Occasionally,suspectedtumorsmayrequiremorethanasinglebiopsytomakethediagnosistherefore,withahigh
clinicalindexofsuspicion,asecondbiopsymaybeneededtoobtainapathologicaldiagnosisofBCC.

Cytology
ToaccuratelyanddefinitivelydiagnoseBCCoftheeyelid,histologicalconfirmationisrequiredandismost
commonlyobtainedthroughexcisional(shaveorpunch)biopsy,whichprovidesmoreinformationregardingthe
histologicalsubtypeofBCC.Cytologydoesprovidearapidalternativethatmayyieldandevenhelpconfirma
diagnosisduringtheinitialvisit,however.
Theaccuracyofthistechniquehasbeenreportedtobegood,butitssensitivityindiagnosingBCCoftheeyelidis
unknown.Itisnotconsideredtobesufficientlysensitiveinplanningsurgicalmanagement.
AstudybyBartonetalshowedthatforpatientswhounderwentcytologyfollowedbyexcisionalbiopsy,cytologyhad
asensitivityof92%indiagnosingBCCwithapredictiveaccuracyof75%. [57]Thesevalueswerecomparedtoa
secondgroupofpatientswhohadincisionalbiopsyandhistologicalexaminationfollowedbyexcisionwith
histologicalconfirmation.Thesecondgroupshowedasensitivityof100%indiagnosingBCCwithapredictive
accuracyof96%.

HistologicFindings
SeveralhistologictypesofBCCexist.Distinctionsareimportantbecauseclinicaldetectionoftumormarginsismore
difficultwithcertainhistologictypes. [58]Usually,BCCsarewelldifferentiatedandcellsappearhistologicallysimilar
tobasalcellsoftheepidermis.
TumorcellsofnodularBCC,sometimescalledbasaliomacells,typicallyhavelarge,hyperchromatic,ovalnucleiand
littlecytoplasm.Cellsappearuniform,andifpresent,mitoticfiguresareusuallyfew.Thenucleiresemblethatofthe
basalcellsoftheepidermis,althoughtheyhavealargernucleartocytoplasmicratioandlackintercellularbridges.A
mitoticfigureisveryrarelyobserved.Nodulartumoraggregatesmaybeofvaryingsizes,buttumorcellstendto
alignmoredenselyinapalisadepatternattheperipheryofthesenests(seetheimagebelow).

Nodularbasalcellcarcinoma.Nodularaggregatesofbasaliomacellsarepresentinthedermisandexhibitperipheralpalisadingand
retractionartifact.Melaninisalsopresentwithinthetumorandinthesurroundingstroma,asseeninpigmentedbasalcell
carcinoma.

Cleftformation,knownasretractionartifact,commonlyoccursbetweenBCCnestsandstromabecauseof
shrinkageofmucinduringtissuefixationandstaining.Somelobulesmayhaveareasofpseudoglandularchange,
andthisisthepredominantchangeinadenoidBCC.Inotherinstances,largetumorlobulesmaydegenerate
centrally,formingpseudocysticspacesfilledwithmucinousdebris.Thesechangesareseeninthenodulocystic
variantofBCC.

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Earlylesionsusuallyhavesomeconnectiontotheoverlyingepidermis,butsuchcontiguitymaybedifficultto
appreciateinmoreadvancedlesions.Increasedmucinisoftenpresentinthesurroundingdermalstroma.
AhistopathologicexaminationofparaffinembeddedsectionsofBCCusuallyrevealssolidcellularstrands,
collectionsofcellswithdarkstainingnucleiandscantcytoplasm.
Theperipheralcellmassisinapalisadearrangementthatresemblesthebasallayeroftheepidermis,sometimes
withpseudocysticaspects,andwithavariablenumberofmitoses.
Theconnectivetissuestromasurroundingthetumorislandsisarrangedinparallelbundlesandoftenshowsyoung
fibroblastsimmediatelyadjacenttothetumor.ThespecifichistologicpatternofeachtypeofBCCvariesintermsof
desmoplasticreactionofthemorpheaformtypeandinthestromalislandsseparatedbybasalcellsstrandsofthe
fibroepithelialtype.Artificialretractionofthestromafromthetumorislandsisfrequentlyobservedhistologically.
Additionally,thestromaisoftenmucinous.CellsfromrecurrentBCCoftenshowsquamousaspects.
Histologically,BCCisdividedinto2categories:undifferentiatedanddifferentiated.Whenthereislittleorno
differentiation,itisreferredtoassolidBCCandincludespigmentedBCC,superficialBCC,sclerosingBCC,and
infiltrativeBCC(ahistologicsubtype).
DifferentiatedBCCoftenhasslightdifferentiationtowardcutaneousappendages,includinghair(keratoticBCC),
sebaceousglands(BCCwithsebaceousdifferentiation),ortubularglands(adenoidBCC).Noduloulcerative(nodular)
BCCisusuallydifferentiated.Seetheimagesbelow.

Histologicpatternofawelldifferentiatedbasalcellcarcinoma(originalmagnificationX140).(ImagecourtesyofProfPantaleoBufo,
UniversityofFoggia,Italy)

Histologicpatternofawelldifferentiatedbasalcellcarcinoma(originalmagnificationX250).(ImagecourtesyofProfPantaleoBufo,
UniversityofFoggia,Italy)

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Histologicpatternofawelldifferentiatedbasalcellcarcinoma(originalmagnificationX250).(ImagecourtesyofProfPantaleoBufo,
UniversityofFoggia,Italy)

WhenthepresenceofadenseinflammatoryinfiltrateobscuresthehistologicmarginsofBCC,
immunohistochemicalstainsforcytokeratinscanhelptoidentifytumorcells.Thesestainscanbeusedwithfixedor
frozentissue.Suchstainingwithfrozentissuecantakeaslittleas19minutes,makingitpracticalforusewithMohs
micrographicsurgeryorwithstandardexcisionwithfrozensectionmargincontrol. [59]

Nodularbasalcellcarcinoma
Nodularornoduloulcerativebasalcellcarcinoma,themostcommontype,generallyconsistsoflarge,roundoroval
tumorislandswithinthedermis,oftenwithanepidermalattachment.Thesolid(nodular)typeaccountsfor
approximately70%ofallcases.Artificialretractionofthetumorislandsfromthesurroundingstromaiscommonly
seen.Ulcerationsmaybeseeninlargetumors.

Micronodularbasalcellcarcinoma
Anotheraggressivevariant,micronodularBCC,appearsassmall,nodularaggregatesofbasaloidcells.Seethe
imagebelow.

Micronodularbasalcellcarcinomaoftenhasanabsenceofretractionartifact.Thecharacteristichistologyissmallsizeand
uniformityofthetumornodules.(ImagecourtesyofShangIBrianJiang,MD)

RetractionartifacttendstobelesspronouncedthaninthenodularformofBCC,andsubclinicalinvolvementis
oftensignificant.Micronodularbasalcellcarcinomaissimilartothenoduloulcerativetype,althoughthetumor
islandsaresmall(often<15cellsindiameter).

Pigmentedbasalcellcarcinoma
Inpigmentedbasalcellcarcinoma(BCC),benignmelanocytesinandaroundthetumorproducelargeamountsof
melanin.Thesemelanocytescontainmanymelaningranulesintheircytoplasmanddendrites.SuperficialBCC(see
theimagebelow)appearsasbudsofbasaloidcellsattachedtotheundersurfaceoftheepidermis.Nestsofvarious
sizesareoftenseenintheupperdermis.Thetumorcellaggregatestypicallyshowperipheralpalisading.

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Histologyofsuperficialbasalcellcarcinoma.Nestsofbasaloidcellsareseenbuddingfromtheundersurfaceoftheepidermis.
(ImagecourtesyofMichaelLRamsey,MD)

Adenoidbasalcellcarcinoma
Theadenoidtypeconsistsofstrandsofbasaloidcellsinareticulatepattern,frequentlywithprominentstromal
mucin.Itmayoccurwiththesolidtype.

Morpheaform(sclerosing)basalcellcarcinoma
ThemoreaggressivemorpheaformBCCshavegrowthpatternsresultinginstrandsofcellsratherthanroundnests,
withinafibrousstroma.Theyconstituteapproximately5%ofBCCs.MorpheaformBCCarisesasthinstrandsof
tumorcells(oftenonly1cellinthickness)thatareembeddedinadensefibrousstroma.Themorpheaformbasal
cellcarcinomasexhibitislandsoftumorextendingintothetissueandmayexhibitperineuralinvasionin3%of
patients.Thisfindinghelpsclassifythese2histotypesasthemostaggressive,withthehighestratesofrecurrence
andpositivemarginsafterexcision.

Infiltrativebasalcellcarcinoma
ThistypeofBCCaccountsfor10%ofBCCs.Tumorcellshavegrowthpatternsresultinginstrandsofcells
infiltratingbetweencollagenbundlesratherthanroundnests.
ThestrandsofinfiltratingBCCtendtobesomewhatthickerthanthoseseeninmorpheaformBCC,andtheyhavea
spiky,irregularappearance(seetheimagebelow).

Infiltrativebasalcellcarcinoma.Tumorcellsarearrangedinnarrowstrands,andmucinrichstromaisoftenpresent.(Image
courtesyofShangIBrianJiang,MD)

InfiltratingBCCusuallydoesnotexhibitthescarlikestromaseeninmorpheaformBCC.Peripheralpalisadingand
retractionarelesspronouncedinmorpheaformandinfiltratingBCCthaninlessaggressiveformsofthetumor,and
subclinicalinvolvementisoftenextensive.

Cysticbasalcellcarcinoma
Cysticbasalcellcarcinomaconsistsoflarge,roundorovaltumorislandswithinthedermiswithmucinpresentinthe
centeroftheisland.Thisspaceiscausedbycentraltumorcelldegeneration.

Superficialbasalcellcarcinoma
The(multifocal)superficialtype(seetheimagebelow)ischaracterizedbynumeroussmallnestsoftumorcells
usuallyattachedtotheundersurfaceoftheepidermisbyabroadbase.Approximately1015%ofallBCCsareof
thistype.ThisisthemostcommonpatternseeninBCCsoftheshoulder.

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Histologyofsuperficialbasalcellcarcinoma.Nestsofbasaloidcellsareseenbuddingfromtheundersurfaceoftheepidermis.
(ImagecourtesyofMichaelLRamsey,MD)

Keratoticbasalcellcarcinoma
Thekeratotictyperesemblesthesolidtypeanditsnestsofbasaloidcellswithperipheralpalisading.Theisland
centersdisplaykeratinizationandsquamousdifferentiation.Seetheimagebelow.

Keratoticbasalcellcarcinoma.Raretypecharacterizedbykeratocysts.(ImagecourtesyofShangIBrianJiang,MD)

Infundibulocysticbasalcellcarcinoma
Theinfundibulocystictypeisrareandisusuallyfoundontheface.Itresemblesthekeratotictype.Nestsare
arrangedinananastomosingpatternandlackstroma.Manysmall,infundibularcystlikestructureswithkeratinous
materialarepresent.Melaninissometimespresent.

Metatypicalbasalcellcarcinoma
MetatypicalBCCisrare.Inthistype,nestsandstrandsofcellsmatureintolargerandpalercells,andperipheral
palisading,ifany,islessdevelopedthaninothertypes.Prominentstroma,prominentmitoticactivity,andmany
apoptoticcellsmaybepresent.ThisformmaybebestdiagnosedwhenoneevaluatesaBCCwithfeaturesbetween
thoseofanodularBCCandsquamouscellcarcinoma.Thesetumorsareoftenaggressive,withanincreased
tendencyforlymphaticandperineuralspread.

Basosquamouscarcinoma
Thebasosquamoustypeiscontroversial.Ithasbeendefinedasabasalcellcarcinoma(BCC)withdifferentiation
towardssquamouscellcarcinoma(SCC).Itismadeupofbasaloidcellsthatarealarger,paler,androunderthan
thoseofasolidBCC.Italsoconsistsofsquamoidcellsandintermediatecells.Someconsiderthediagnosisofthis
typemostappropriatewhenoneevaluatesatumorwithcontiguousareasofBCCandSCC.Thistypeisconsidered
tohavemetastaticpotentialandisconsideredanaggressiveskincancer(seetheimagebelow).

Basosquamousbasalcellcarcinoma.Fociofneoplasticcellswithsquamousdifferentiationarepresent.(ImagecourtesyofShangI
BrianJiang,MD)

FibroepitheliomaofPinkus
Thefibroepitheliomatypeconsistsofthin,anastomosingstrandsofbasaloidcellsinaprominentstroma.

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Accordingtosomestudies,thesocalledfibroepitheliomaofPinkus,consideredtobeapremalignantskincondition,
mustbeconsideredasafenestratedvariantofbasalcellcarcinoma. [60,61,62]

Ultrasonography
Theuseofultrasonographyiscontroversial.Highfrequency(20MHz)andultrahighfrequency(40100MHz)
ultrasoundsystemshavebeenusedtheiraccuracyindelineatingmalignantlesionsfrombenignlesionsremains
inadequate,however,withasuccessrateofapproximately20%.Furthermore,theclaimsofreliabletumorsizing
anddepthofinvasionarepromisingbutstillpassionatelydebated.

LaserDoppler
Asanadjuncttool,laserDopplermayassistophthalmologistsindistinguishingbetweenbenignandmalignant
adnexalskinlesionsandinestablishingthetumormargin.
Itisreportedthatcutaneousperfusiontotheeyelidsisstatisticallysignificantlyhigherthanotherregionsofthebody
(eg,forearm).Furthermore,themeanperfusioninpretarsalskinhasbeenshowntobe50%greaterthanthatin
preseptalskin.Inhistologicallydocumentedbasalcellcarcinomaoftheeyelid,cutaneousperfusionwassignificantly
greater. [63]

Staging
Basalcellcarcinomararelymetastasizesandisusuallynotstaged,unlessthecancerisverylargeandissuspected
ofspreadingtootherpartsofthebody.BCCstagingmaybesimilartothestagingofsquamouscellcarcinoma,
whichisaccordingtothefollowingscheme:
Stage0:Cancerinvolvesonlytheepidermisandhasnotspreadtothedermis
StageI:Cancerisnotlarge(ie,<2cm)andhasnotspreadtothelymphnodesorotherorgans
StageII:Cancerislarge(ie,>2cm)buthasnotspreadtolymphnodesorotherorgans
StageIII:Cancerhasspreadtotissuesbeneaththeskin(eg,muscle,bone,cartilage),and/ortoregional
lymphnodesbutnottootherorgans.
StageIV:Cancercanbeanysizeandhasspreadtootherorgans

Highrisktumors
HighriskBCCsincludethefollowing:
RecurrentorincompletelyexcisedBCC
PrimaryBCCwithclinicallyindistinctborders
Lesionsinhighrisk(theH,ormask)areas,mainlytheembryonicfusionplanes(eg,eyelids,nose,ear,
nasolabialfolds,upperlip,vermillionborder,columella,periorbitalregion,temples,preauricularand
postauricularareas,andscalp)
Lesionsthatdevelopincosmeticallyandfunctionallyimportantareas(eg,face,genitals,analandperianal
regions,handsandfeet,andthenailunitareas)
Tumorswithaggressiveclinicalbehavior(ie,growingrapidlyor>2cm)
Tumorswithaggressivehistologicsubtype,includingsclerosing(morpheaform),basosquamous(metatypical
orkeratinizing),perineural,periappendageal,orperivascularinvasion,infiltrating,adenoidal,ormulticentric
Tumorsthatdevelopinsiteswithpreviousradiationtherapy
Tumorsthatdevelopinimmunosuppressedpatients
Treatment&Management

ContributorInformationandDisclosures
Author
RobertSBader,MDDermatologist,SectionofDermatology,DepartmentofMedicine,BrowardHealthNorth
RobertSBader,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,Florida
MedicalAssociation,AmericanSocietyforDermatologicSurgery,AmericanSocietyforMOHSSurgery
Disclosure:Nothingtodisclose.
Coauthor(s)
AndrewScottKennedy,MDPhysicianinChief,RadiationOncology
AndrewScottKennedy,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AssociationforCancerResearch,AmericanSocietyforRadiationOncology,RadiologicalSocietyofNorth
America,AmericasHepatoPancreatoBiliaryAssociation,AmericanSocietyofClinicalOncology
Disclosure:Nothingtodisclose.
LuigiSantacroce,MDAssistantProfessor,MedicalSchool,StateUniversityatBari,Italy
Disclosure:Nothingtodisclose.
LauraDiomedeUniversityofBariSchoolofMedicine,Italy
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:ReceivedsalaryfromMedscapeforemployment.for:Medscape.
ChiefEditor
WilliamDJames,MDPaulRGrossProfessorofDermatology,ViceChairman,ResidencyProgramDirector,
DepartmentofDermatology,UniversityofPennsylvaniaSchoolofMedicine
WilliamDJames,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
SocietyforInvestigativeDermatology
Disclosure:Nothingtodisclose.
Acknowledgements

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SanjivSAgarwala,MDChiefofOncologyandHematology,StLuke'sCancerCenter,StLuke'sHospitaland
HealthNetworkProfessor,TempleUniversitySchoolofMedicine
SanjivSAgarwala,MDisamemberofthefollowingmedicalsocieties:AmericanAssociationforCancer
Research,AmericanSocietyforHeadandNeckSurgery,AmericanSocietyofClinicalOncology,Eastern
CooperativeOncologyGroup,andEuropeanSocietyforMedicalOncology
Disclosure:BMSHonorariaSpeakingandteachingNovartisConsultingfeeConsultingMerckConsultingfee
Consulting
MichaelGionoBarakatCaliforniaSurgicalInstitute
Disclosure:Nothingtodisclose.
DanielBerg,MD,FRCP(C)ProfessorofDermatology,DirectorofDermatologicSurgery,Universityof
WashingtonSchoolofMedicine
DanielBerg,MD,FRCP(C)isamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofDermatology,AmericanCollegeofMohsMicrographicSurgeryandCutaneousOncology,and
AmericanSocietyforDermatologicSurgery
Disclosure:GenentechHonorariaReviewpanelmembership
GregoryCaputy,MD,PhD,FICSChiefSurgeon,AestheticaPlasticandLaserSurgeryCenter,Inc
GregoryCaputy,MD,PhD,FICSisamemberofthefollowingmedicalsocieties:AmericanSocietyforLaser
MedicineandSurgery,InternationalCollegeofSurgeons,InternationalCollegeofSurgeonsUSSection,Pan
PacificSurgicalAssociation,andWoundHealingSociety
Disclosure:SyneronCorporationSalarySpeakingandteaching
EdwardFChan,MDClinicalAssistantProfessor,DepartmentofDermatology,UniversityofPennsylvania
SchoolofMedicine
EdwardFChan,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanSocietyofDermatopathology,andSocietyforInvestigativeDermatology
Disclosure:Nothingtodisclose.
RobertACopelandJr,MDChair,Professor,DepartmentofOphthalmology,HowardUniversityCollegeof
Medicine
RobertACopelandJr,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofOphthalmology
Disclosure:Nothingtodisclose.
MarkTDuffy,MD,PhDConsultingStaff,DivisionofOculoplastic,Orbitofacial,LacrimalandReconstructive
Surgery,GreenBayEyeClinic,BayCareClinicMedicalDirector,AdvancedCosmeticSolutions,ABayCare
Clinic
MarkTDuffy,MD,PhDisamemberofthefollowingmedicalsocieties:AmericanAcademyofOphthalmology,
AmericanMedicalAssociation,AmericanSocietyofOphthalmicPlasticandReconstructiveSurgery,SigmaXi,
andSocietyforNeuroscience
Disclosure:AllerganBotoxCosmeticHonorariaSpeakingandteaching
HonVuQDuong,MDClinicalInstructorofOphthalmologyandOphthalmicPathology,WestfieldNevadaEye
andEarSeniorLecturerofNeurosciences:AnatomyandPhysiology,NevadaStateCollege
HonVuQDuong,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofOphthalmology
Disclosure:Nothingtodisclose.
DirkMElston,MDDirector,AckermanAcademyofDermatopathology,NewYork
DirkMElston,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology
Disclosure:Nothingtodisclose.
JaimeRGarza,MD,DDS,FACSConsultingStaff,PrivatePractice
JaimeRGarza,MD,DDS,FACSisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofOtolaryngologyHeadandNeckSurgery,AmericanCollegeofSurgeons,AmericanSocietyfor
AestheticPlasticSurgery,AmericanSocietyofMaxillofacialSurgeons,TexasMedicalAssociation,andTexas
SocietyofPlasticSurgeons
Disclosure:AllerganNoneSpeakingandteachingLifeCellNoneConsultingGID,Inc.Grant/researchfunds
Other
ShahinJavaheri,MDChief,DepartmentofPlasticSurgery,MartinezVeteransAffairsOutpatientClinic
ConsultingStaff,AdvancedAestheticPlastic&ReconstructiveSurgery
ShahinJavaheri,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofOtolaryngologyHead
andNeckSurgeryandAmericanSocietyofPlasticSurgeons
Disclosure:Nothingtodisclose.
ShangIBrianJiang,MDAssociateClinicalProfessorofMedicineandDermatology,Director,Dermatologicand
MohsMicrographicSurgery,ProgramDirector,UCSDDermatologicandMohsSurgeryFellowship,Universityof
CaliforniaSchoolofMedicine,SanDiego
ShangIBrianJiang,MD,isamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanCollegeofMohsSurgery,AmericanSocietyforDermatologicSurgery,andAssociationofProfessors
ofDermatology
Disclosure:DUSACorporationGrant/researchfundsPIforIndustrySponsoredClincalTrial
KlausDieterLessnau,MD,FCCPClinicalAssociateProfessorofMedicine,NewYorkUniversitySchoolof
MedicineMedicalDirector,PulmonaryPhysiologyLaboratoryDirectorofResearchinPulmonaryMedicine,
DepartmentofMedicine,SectionofPulmonaryMedicine,LenoxHillHospital
KlausDieterLessnau,MD,FCCPisamemberofthefollowingmedicalsocieties:AmericanCollegeofChest

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Physicians,AmericanCollegeofPhysicians,AmericanMedicalAssociation,AmericanThoracicSociety,and
SocietyofCriticalCareMedicine
Disclosure:Nothingtodisclose.
ArlenDMeyers,MD,MBAProfessorofOtolaryngology,Dentistry,andEngineering,UniversityofColorado
SchoolofMedicine
ArlenDMeyers,MD,MBAisamemberofthefollowingmedicalsocieties:AmericanAcademyofFacialPlastic
andReconstructiveSurgery,AmericanAcademyofOtolaryngologyHeadandNeckSurgery,andAmericanHead
andNeckSociety
Disclosure:CovidienCorpConsultingfeeConsultingUSTobaccoCorporationUnrestrictedgiftUnknownAxis
ThreeCorporationOwnershipinterestConsultingOmniBiosciencesOwnershipinterestConsultingSentegra
OwnershipinterestBoardmembershipMedvoyOwnershipinterestManagementpositionCerescanImaging
ConsultingHeadwatersmbConsultingfeeConsultingVenturequestRoyaltyConsulting
MauriceYNahabedian,MD,FACSAssociateProfessor,DepartmentofPlasticSurgery,GeorgetownUniversity
Hospital
MauriceYNahabedian,MD,FACSisamemberofthefollowingmedicalsocieties:AmericanAssociationof
PlasticSurgeons,AmericanCollegeofSurgeons,AmericanSocietyforReconstructiveMicrosurgery,American
SocietyofPlasticSurgeons,JohnsHopkinsMedicalandSurgicalAssociation,andNortheasternSocietyof
PlasticSurgeons
Disclosure:LifecellcorpHonorariaSpeakingandteaching
SamiaNawaz,MBBS,MDAssociateProfessor,DepartmentofPathology,UniversityofColoradoHealth
ScienceCenter
SamiaNawaz,MBBS,MDisamemberofthefollowingmedicalsocieties:AmericanSocietyforClinical
Pathology,AmericanSocietyofCytopathology,andInternationalAcademyofPathology
Disclosure:Nothingtodisclose.
RonWPelton,MD,PhDPrivatePractice,ColoradoSprings,Colorado
RonWPelton,MD,PhDisamemberofthefollowingmedicalsocieties:AmericanAcademyofOphthalmology,
AmericanCollegeofSurgeons,AmericanSocietyofOphthalmicPlasticandReconstructiveSurgery,AO
Foundation,andColoradoMedicalSociety
Disclosure:Nothingtodisclose.
MichaelLRamsey,MDDirector,MohsSurgeryFellowship,CoDirector,ProceduralDermatologyFellowship,
DepartmentofDermatology,GeisingerMedicalCenter
MichaelLRamsey,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanCollegeofMohsMicrographicSurgeryandCutaneousOncology,andPennsylvaniaAcademyof
Dermatology
Disclosure:Nothingtodisclose.
RanaRofaghaSajjadian,MDClinicalInstructor,DepartmentofDermatology,UniversityofIrvine,California
DivisionofMohsSurgery,DepartmentofDermatology,SouthernCaliforniaPermanenteMedicalGroup
RanaRofaghaSajjadian,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Dermatology,AmericanSocietyforDermatologicSurgery,andAmericanSocietyforMOHSSurgery
Disclosure:Nothingtodisclose.
ThomasMRoy,MDChief,DivisionofPulmonaryDiseasesandCriticalCareMedicine,QuillenMountainHome
VeteransAffairsMedicalCenterProfessor,DepartmentofInternalMedicine,DivisionofPulmonaryMedicine,
FellowshipProgramDirector,EastTennesseeStateUniversity,JamesHQuillenCollegeofMedicine
ThomasMRoy,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofChestPhysicians,
AmericanCollegeofPhysicians,AmericanMedicalAssociation,AmericanThoracicSociety,SouthernMedical
Association,andWildernessMedicalSociety
Disclosure:Nothingtodisclose.
MSherifSaid,MD,PhDAssociateProfessorofPathology,DirectorofHeadandNeckPathology,Department
ofPathology,UniversityofColoradoSchoolofMedicine
MSherifSaid,MD,PhDisamemberofthefollowingmedicalsocieties:AmericanSocietyforClinicalPathology
andCollegeofAmericanPathologists
Disclosure:Nothingtodisclose.
AliSajjadian,MD,FACSPrivatePractice,NewportBeach,CaliforniaFormerAssistantProfessorofPlastic
Surgery,FormerDirectorofAestheticPlasticSurgerySatelliteCenters,UniversityofPittsburghMedicalCenter
AliSajjadian,MD,FACSisamemberofthefollowingmedicalsocieties:AmericanAcademyofFacialPlastic
andReconstructiveSurgery,AmericanAcademyofOtolaryngologyHeadandNeckSurgery,AmericanCollegeof
Surgeons,AmericanMedicalAssociation,AmericanSocietyofPlasticSurgeons,AmericanSocietyofPlastic
Surgeons,AmericanSocietyofPlasticSurgeons,CaliforniaMedicalAssociation,NortheasternSocietyofPlastic
Surgeons,andPennsylvaniaMedicalSociety
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NegarSajjadian,MDAssistantProfessorofPediatrics,TehranUniversityofMedicalSciences,ShariatiHospital
Disclosure:Nothingtodisclose.
WayneKarlStadelmann,MDStadelmannPlasticSurgery,PC
WayneKarlStadelmann,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
CollegeofSurgeons,AmericanSocietyofPlasticSurgeons,NewHampshireMedicalSociety,Northeastern
SocietyofPlasticSurgeons,andPhiBetaKappa
Disclosure:Nothingtodisclose.

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KatherineSzyfelbein,MDStaffPhysician,DepartmentofDermatology,BostonUniversity,BostonMedical
Center
Disclosure:Nothingtodisclose.
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:MedscapeSalaryEmployment
RStanTaylor,MDTheJBHowellProfessorinMelanomaEducationandDetection,Departmentsof
DermatologyandPlasticSurgery,Director,SkinSurgeryandOncologyClinic,UniversityofTexasSouthwestern
MedicalCenter
RStanTaylor,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanCollegeofMohsSurgery,AmericanDermatologicalAssociation,AmericanMedicalAssociation,
AmericanSocietyforDermatologicSurgery,ChristianMedical&DentalSociety,andSocietyforInvestigative
Dermatology
Disclosure:Nothingtodisclose.
Image1:KellyNelson(Photographer)Publicdomain,viaWikimediaCommons.

References
1. KumarN,SaxenaYK.Twocasesofrarepresentationofbasalcellandsquamouscellcarcinomaonthe
hand.IndianJDermatolVenereolLeprol.2002NovDec.68(6):34951.[Medline].
2. BarryJ,OonSF,WatsonR,BarnesL.Themanagementofbasalcellcarcinomas.IrMedJ.2006Jun.
99(6):17981.[Medline].
3. [Guideline]DandurandM,PetitT,MartelP,GuillotB.Managementofbasalcellcarcinomainadults
Clinicalpracticeguidelines.EurJDermatol.2006JulAug.16(4):394401.[Medline].
4. [Guideline]TrakatelliM,MortonC,NagoreE,UlrichC,DelMarmolV,PerisK,etal.Updateofthe
Europeanguidelinesforbasalcellcarcinomamanagement.EurJDermatol.2014MayJun.24(3):31229.
[Medline].
5. [Guideline]NationalComprehensiveCancerNetwork.NCCNClinicalPracticeGuidelinesinOncology:
BasalCellSkinCancer,Version1.2015.NCCN.Availableat
http://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf.Accessed:July29,2015.
6. MendenhallWM,AmdurRJ,HinermanRW,CognettaAB,MendenhallNP.Radiotherapyforcutaneous
squamousandbasalcellcarcinomasoftheheadandneck.Laryngoscope.2009Oct.119(10):19949.
[Medline].
7. ErbaP,FarhadiJ,WettsteinR,ArnoldA,HarrT,PiererG.Morphoeicbasalcellcarcinomaoftheface.
ScandJPlastReconstrSurgHandSurg.2007.41(4):1848.[Medline].
8. FresiniA,RossielloL,SeverinoBU,DelPreteM,SatrianoRA.Giantbasalcellcarcinoma.Skinmed.2007
JulAug.6(4):2045.[Medline].
9. ShindelAW,MannMW,LevRY,etal.Mohsmicrographicsurgeryforpenilecancer:managementand
longtermfollowup.JUrol.2007Nov.178(5):19805.[Medline].
10. MulvanyNJ,AllenDG.Differentiatedintraepithelialneoplasiaofthevulva.IntJGynecolPathol.2008Jan.
27(1):12535.[Medline].
11. CabreraHN,CudaG,LopezM,CostaJA.[Basalcellepitheliomaofthevulvainchronicendemicregional
arsenicpoisoning].MedCutanIberoLatAm.1984.12(2):815.[Medline].
12. NewmanJC,LeffellDJ.Correlationofembryonicfusionplaneswiththeanatomicaldistributionofbasalcell
carcinoma.DermatolSurg.2007Aug.33(8):95764discussion965.[Medline].
13. CabreraHN,GomezML.Skincancerinducedbyarsenicinthewater.JCutanMedSurg.2003MarApr.
7(2):10611.[Medline].
14. RomaoCorreaRF,MariaDA,SomaM,etal.Nucleolarorganizerregionstainingpatternsinparaffin
embeddedtissuecellsfromhumanskincancers.JCutanPathol.2005May.32(5):3238.[Medline].
15. OzyazganI,KontasO.Previousinjuriesorscarsasriskfactorsforthedevelopmentofbasalcell
carcinoma.ScandJPlastReconstrSurgHandSurg.2004.38(1):115.[Medline].
16. MohantyP,MohantyL,DeviBP.Multiplecutaneousmalignanciesinxerodermapigmentosum.IndianJ
DermatolVenereolLeprol.2001MarApr.67(2):967.[Medline].
17. KeyhaniK,AshenhurstM,OryschakA.Periocularbasalcellcarcinomaarisinginasiteofprevioustrauma.
CanJOphthalmol.2007Jun.42(3):4678.[Medline].
18. Aldaracream5%(imiquimod)[packageinsert].GracewayPharmaceuticals.2007.
19. GeisseJ,CaroI,LindholmJ,GolitzL,StamponeP,OwensM.Imiquimod5%creamforthetreatmentof
superficialbasalcellcarcinoma:resultsfromtwophaseIII,randomized,vehiclecontrolledstudies.JAm
AcadDermatol.2004May.50(5):72233.[Medline].
20. SapijaszkoMJ.Imiquimod5%cream(Aldara)inthetreatmentofbasalcellcarcinoma.SkinTherapyLett.
2005JulAug.10(6):25.[Medline].
21. MicaliM,NascaMR,MusumeciML.Treatmentofanextensivesuperficialbasalcellcarcinomaoftheface
withimiquimod5%cream.IntJTissueReact.2005.27(3):1114.[Medline].
22. BiluD,SauderDN.Imiquimod:modesofaction.BrJDermatol.2003Nov.149Suppl66:58.[Medline].
23. WuestM,DummerR,UrosevicM.InductionofthemembersofNotchpathwayinsuperficialbasalcell
carcinomastreatedwithimiquimod.ArchDermatolRes.2007Dec.299(10):4938.[Medline].
24. Efudex(fluorouracil)[packageinsert].ValeantPharmaceuticals.2005.
25. BaleAE,YuKP.Thehedgehogpathwayandbasalcellcarcinomas.HumMolGenet.2001Apr.10(7):757

http://emedicine.medscape.com/article/276624workup

9/12

1/6/2016

BasalCellCarcinomaWorkup:ApproachConsiderations,SkinBiopsy,Cytology

62.[Medline].
26. WickingC,McGlinnE.Theroleofhedgehogsignallingintumorigenesis.CancerLett.2001Nov8.
173(1):17.[Medline].
27. ZhangH,PingXL,LeePK,etal.RoleofPTCHandp53genesinearlyonsetbasalcellcarcinoma.AmJ
Pathol.2001Feb.158(2):3815.[Medline].[FullText].
28. NationalCenterforBiotechnicalInformation.TumorProteinp53TP53.Availableat
http://www.ncbi.nlm.nih.gov/omim/191170.Accessed:November7,2007.
29. YoungLC,ListgartenJ,TrotterMJ,AndrewSE,TronVA.EvidencethatdysregulatedDNAmismatch
repaircharacterizeshumannonmelanomaskincancer.BrJDermatol.2008Jan.158(1):5969.[Medline].
30. LimJL,SternRS.HighlevelsofultravioletBexposureincreasetheriskofnonmelanomaskincancerin
psoralenandultravioletAtreatedpatients.JInvestDermatol.2005Mar.124(3):50513.[Medline].
31. WallingHW,FoskoSW,GeraminejadPA,WhitakerDC,ArpeyCJ.Aggressivebasalcellcarcinoma:
presentation,pathogenesis,andmanagement.CancerMetastasisRev.2004AugDec.23(34):389402.
[Medline].
32. CentersforDiseaseControlandPrevention(CDC).SunburnprevalenceamongadultsUnitedStates,
1999,2003,and2004.MMWRMorbMortalWklyRep.2007Jun1.56(21):5248.[Medline].
33. WehnerMR,ShiveML,ChrenMM,HanJ,QureshiAA,LinosE.Indoortanningandnonmelanomaskin
cancer:systematicreviewandmetaanalysis.BMJ.2012Oct2.345:e5909.[Medline].[FullText].
34. FerrucciLM,CartmelB,MolinaroAM,LeffellDJ,BaleAE,MayneST.Indoortanningandriskofearly
onsetbasalcellcarcinoma.JAmAcadDermatol.2012Oct.67(4):55262.[Medline].[FullText].
35. CohenMMJr.Nevoidbasalcellcarcinomasyndrome:molecularbiologyandnewhypotheses.IntJOral
MaxillofacSurg.1999Jun.28(3):21623.[Medline].
36. KleinRD,DykasDJ,BaleAE.ClinicaltestingforthenevoidbasalcellcarcinomasyndromeinaDNA
diagnosticlaboratory.GenetMed.2005NovDec.7(9):6119.[Medline].
37. KaragasMR.Occurrenceofcutaneousbasalcellandsquamouscellmalignanciesamongthosewithaprior
historyofskincancer.TheSkinCancerPreventionStudyGroup.JInvestDermatol.1994Jun.102(6):10S
13S.[Medline].
38. MichaelssonG,OlssonE,WestermarkP.TheRombosyndrome:afamilialdisorderwithvermiculate
atrophoderma,milia,hypotrichosis,trichoepitheliomas,basalcellcarcinomasandperipheralvasodilation
withcyanosis.ActaDermVenereol.1981.61(6):497503.[Medline].
39. HealC,BuettnerP,BrowningS.Riskfactorsforwoundinfectionafterminorsurgeryingeneralpractice.
MedJAust.2006Sep4.185(5):2558.[Medline].
40. Whatarethekeystatisticsaboutbasalandsquamouscellskincancers?.AmericanCancerSociety.
Availableathttp://www.cancer.org/cancer/skincancerbasalandsquamouscell/detailedguide/skincancer
basalandsquamouscellkeystatistics.April30,2015Accessed:August31,2015.
41. MarksR,JolleyD,DorevitchAP,SelwoodTS.Theincidenceofnonmelanocyticskincancersinan
Australianpopulation:resultsofafiveyearprospectivestudy.MedJAust.1989May1.150(9):4758.
[Medline].
42. BrasseurR,LagesseCh.[Contributionofpsychometryofclinicalevaluationofthetherapeuticeffectof
"Solcoseryl"instatesofintellectualweaknessconnectedwithchroniccerebralcirculatoryinsufficiency
(author'stransl)].SchweizRundschMedPrax.1977Mar8.66(10):3127.[Medline].
43. CookBEJr,BartleyGB.Epidemiologiccharacteristicsandclinicalcourseofpatientswithmalignanteyelid
tumorsinanincidencecohortinOlmstedCounty,Minnesota.Ophthalmology.1999Apr.106(4):74650.
[Medline].
44. LeffellDJ,HeadingtonJT,WongDS,SwansonNA.Aggressivegrowthbasalcellcarcinomainyoung
adults.ArchDermatol.1991Nov.127(11):16637.[Medline].
45. PatelMS,ThigpenJT,VanceRB,ElkinsSL,GuoM.Basalcellcarcinomawithlungmetastasisdiagnosed
byfineneedleaspirationbiopsy.SouthMedJ.1999Mar.92(3):3214.[Medline].
46. AkinciM,AslanS,MarkocF,CetinB,CetinA.Metastaticbasalcellcarcinoma.ActaChirBelg.2008Mar
Apr.108(2):26972.[Medline].
47. McLooneNM,TollandJ,WalshM,etal.Followupofbasalcellcarcinomas:anauditofcurrentpractice.J
EurAcadDermatolVenereol.Jul2006.20(6):698701.
48. PiehS,KucharA,NovakP,KunstfeldR,NagelG,SteinkoglerFJ.Longtermresultsaftersurgicalbasal
cellcarcinomaexcisionintheeyelidregion.BrJOphthalmol.1999Jan.83(1):858.[Medline].[FullText].
49. MarcilI,SternRS.Riskofdevelopingasubsequentnonmelanomaskincancerinpatientswithahistoryof
nonmelanomaskincancer:acriticalreviewoftheliteratureandmetaanalysis.ArchDermatol.2000Dec.
136(12):152430.[Medline].
50. LeviF,RandimbisonL,MaspoliM,TeVC,LaVecchiaC.Highincidenceofsecondbasalcellskincancers.
IntJCancer.2006Sep15.119(6):15057.[Medline].
51. BruceAJ,BrodlandDG.Overviewofskincancerdetectionandpreventionfortheprimarycarephysician.
MayoClinProc.2000May.75(5):491500.[Medline].
52. BettiR,RadaelliG,MussinoF,MenniS,CrostiC.Anatomiclocationandhistopathologicsubtypeofbasal
cellcarcinomasinadultsyoungerthan40or90andolder:anydifference?.DermatolSurg.2009Feb.
35(2):2016.[Medline].
53. GriffinJR,CohenPR,TschenJA,etal.Basalcellcarcinomainchildhood:casereportandliterature
review.JAmAcadDermatol.2007Nov.57(5Suppl):S97102.[Medline].
54. GorlinRJ.Nevoidbasalcellcarcinoma(Gorlin)syndrome:unansweredissues.JLabClinMed.1999Dec.
134(6):5512.[Medline].
55. BernardiniFP.Managementofmalignantandbenigneyelidlesions.CurrOpinOphthalmol.2006Oct.
17(5):4804.[Medline].

http://emedicine.medscape.com/article/276624workup

10/12

1/6/2016

BasalCellCarcinomaWorkup:ApproachConsiderations,SkinBiopsy,Cytology

56. LyJQ.ScintigraphicfindingsinGorlin'ssyndrome.ClinNuclMed.2002Dec.27(12):9134.[Medline].
57. BartonK,CurlingOM,ParidaensAD,HungerfordJL.Theroleofcytologyinthediagnosisofperiocular
basalcellcarcinomas.OphthalPlastReconstrSurg.1996Sep.12(3):1904discussion195.[Medline].
58. OrengoIF,SalascheSJ,FewkesJ,KhanJ,ThornbyJ,RubinF.Correlationofhistologicsubtypesof
primarybasalcellcarcinomaandnumberofMohsstagesrequiredtoachieveatumorfreeplane.JAm
AcadDermatol.1997Sep.37(3Pt1):3957.[Medline].
59. CherpelisBS,TurnerL,LaddS,GlassLF,FenskeNA.Innovative19minuterapidcytokeratin
immunostainingofnonmelanomaskincancerinMohsmicrographicsurgery.DermatolSurg.2009Jul.
35(7):10506.[Medline].
60. AckermanAB,GottliebGJ.Fibroepithelialtumorofpinkusistrichoblastic(Basalcell)carcinoma.AmJ
Dermatopathol.2005Apr.27(2):1559.[Medline].
61. BowenAR,LeBoitPE.Fibroepitheliomaofpinkusisafenestratedtrichoblastoma.AmJDermatopathol.
2005Apr.27(2):14954.[Medline].
62. StraussRM,EdwardsS,StablesGI.PigmentedfibroepitheliomaofPinkus.BrJDermatol.2004Jun.
150(6):12089.[Medline].
63. MannorGE,WardellK,WolfleyDE,NilssonGE.LaserDopplerperfusionimagingofeyelidskin.Ophthal
PlastReconstrSurg.1996Sep.12(3):17885.[Medline].
64. BabilasP,LandthalerM,SzeimiesRM.Photodynamictherapyindermatology.EurJDermatol.2006Jul
Aug.16(4):3408.[Medline].
65. FoleyP.Clinicalefficacyofmethylaminolaevulinatephotodynamictherapyinbasalcellcarcinomaand
solarkeratosis.AustralasJDermatol.2005Feb.46Suppl3:S810discussionS235.[Medline].
66. ZimmermannA,WaltH,HallerU,BaasP,KleinSD.Effectsofchlorinmediatedphotodynamictherapy
combinedwithfluoropyrimidinesinvitroandinapatient.CancerChemotherPharmacol.2003Feb.
51(2):14754.[Medline].
67. LoveWE,BernhardJD,BordeauxJS.Topicalimiquimodorfluorouraciltherapyforbasalandsquamous
cellcarcinoma:asystematicreview.ArchDermatol.2009Dec.145(12):14318.[Medline].
68. BermanB.Scientificrationale:combiningimiquimodandsurgicaltreatmentsforbasalcellcarcinomas.J
DrugsDermatol.2008Jan.7(1Suppl1):s36.[Medline].
69. BrownellI.Nodularbasalcellcarcinoma:whenindoubt,cutitout.JDrugsDermatol.2007Dec.
6(12):12456.[Medline].
70. FarhiD,DupinN,PalangieA,CarlottiA,AvrilMF.Incompleteexcisionofbasalcellcarcinoma:rateand
associatedfactorsamong362consecutivecases.DermatolSurg.2007Oct.33(10):120714.[Medline].
71. [Guideline]AdHocTaskForce,ConnollySM,BakerDR,ColdironBM,FazioMJ,etal.
AAD/ACMS/ASDSA/ASMS2012appropriateusecriteriaforMohsmicrographicsurgery:areportofthe
AmericanAcademyofDermatology,AmericanCollegeofMohsSurgery,AmericanSocietyfor
DermatologicSurgeryAssociation,andtheAmericanSocietyforMohsSurgery.JAmAcadDermatol.
2012Oct.67(4):53150.[Medline].
72. MillerBH,ShavinJS,CognettaA,etal.Nonsurgicaltreatmentofbasalcellcarcinomaswithintralesional
5fluorouracil/epinephrineinjectablegel.JAmAcadDermatol.1997Jan.36(1):727.[Medline].
73. GreenwayHT,CornellRC,TannerDJ,PeetsE,BordinGM,NagiC.Treatmentofbasalcellcarcinoma
withintralesionalinterferon.JAmAcadDermatol.1986Sep.15(3):43743.[Medline].
74. GeisseJK,RichP,PandyaA,etal.Imiquimod5%creamforthetreatmentofsuperficialbasalcell
carcinoma:adoubleblind,randomized,vehiclecontrolledstudy.JAmAcadDermatol.2002Sep.
47(3):3908.[Medline].
75. GarciaMartinE,GilArribasLM,IdoipeM,etal.Comparisonofimiquimod5%creamversusradiotherapy
astreatmentforeyelidbasalcellcarcinoma.BrJOphthalmol.2011Oct.95(10):13936.[Medline].
76. EigentlerTK,KaminA,WeideBM,etal.AphaseIII,randomized,openlabelstudytoevaluatethesafety
andefficacyofimiquimod5%creamappliedthriceweeklyfor8and12weeksinthetreatmentoflowrisk
nodularbasalcellcarcinoma.JAmAcadDermatol.2007Oct.57(4):61621.[Medline].
77. StockflethE,UlrichC,HauschildA,LischnerS,MeyerT,ChristophersE.Successfultreatmentofbasal
cellcarcinomasinanevoidbasalcellcarcinomasyndromewithtopical5%imiquimod.EurJDermatol.
2002NovDec.12(6):56972.[Medline].
78. AritsAH,MosterdK,EssersBA,etal.Photodynamictherapyversustopicalimiquimodversustopical
fluorouracilfortreatmentofsuperficialbasalcellcarcinoma:asingleblind,noninferiority,randomised
controlledtrial.LancetOncol.2013Jun.14(7):64754.[Medline].
79. BianchiL,OrlandiA,CampioneE,AngeloniC,CostanzoA,SpagnoliLG,etal.Topicaltreatmentofbasal
cellcarcinomawithtazarotene:aclinicopathologicalstudyonalargeseriesofcases.BrJDermatol.2004
Jul.151(1):14856.[Medline].
80. LewisJE.Keloidalbasalcellcarcinoma.AmJDermatopathol.2007Oct.29(5):485.[Medline].
81. CognettaAB,HowardBM,HeatonHP,StoddardER,HongHG,GreenWH.Superficialxrayinthe
treatmentofbasalandsquamouscellcarcinomas:aviableoptioninselectpatients.JAmAcadDermatol.
2012Dec.67(6):123541.[Medline].
82. BraathenLR,SzeimiesRM,BassetSeguinN,etal.Guidelinesontheuseofphotodynamictherapyfor
nonmelanomaskincancer:aninternationalconsensus.InternationalSocietyforPhotodynamicTherapyin
Dermatology,2005.JAmAcadDermatol.2007Jan.56(1):12543.[Medline].
83. [Guideline]MortonCA,McKennaKE,RhodesLE.Guidelinesfortopicalphotodynamictherapy:update.Br
JDermatol.2008Dec.159(6):124566.[Medline].
84. CalzavaraPintonPG,SzeimiesRM,OrtelB,ZaneC.Photodynamictherapywithsystemicadministration
ofphotosensitizersindermatology.JPhotochemPhotobiolB.1996Nov.36(2):22531.[Medline].
85. PuccioniM,SantoroN,GiansantiF,etal.Photodynamictherapyusingmethylaminolevulinateacidin
eyelidbasalcellcarcinoma:a5yearfollowupstudy.OphthalPlastReconstrSurg.2009MarApr.

http://emedicine.medscape.com/article/276624workup

11/12

1/6/2016

BasalCellCarcinomaWorkup:ApproachConsiderations,SkinBiopsy,Cytology

25(2):1158.[Medline].
86. MosterdK,ThissenMR,NelemansP,etal.Fractionated5aminolaevulinicacidphotodynamictherapyvs.
surgicalexcisioninthetreatmentofnodularbasalcellcarcinoma:resultsofarandomizedcontrolledtrial.
BrJDermatol.2008Sep.159(4):86470.[Medline].
87. RhodesLE,deRieMA,LeifsdottirR,etal.Fiveyearfollowupofarandomized,prospectivetrialoftopical
methylaminolevulinatephotodynamictherapyvssurgeryfornodularbasalcellcarcinoma.ArchDermatol.
2007Sep.143(9):11316.[Medline].
88. ChristensenE,MorkC,SkogvollE.Highandsustainedefficacyaftertwosessionsoftopical5
aminolaevulinicacidphotodynamictherapyforbasalcellcarcinoma:aprospective,clinicalandhistological
10yearfollowupstudy.BrJDermatol.2012Jun.166(6):13428.[Medline].
89. KempfRA.Systemictherapyofskincarcinoma.CancerTreatRes.1995.78:13762.[Medline].
90. VonHoffDD,LoRussoPM,RudinCM,etal.Inhibitionofthehedgehogpathwayinadvancedbasalcell
carcinoma.NEnglJMed.2009Sep17.361(12):116472.[Medline].
91. Erevedge(vismodegib)PrescribingInformation.Availableat
http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/203388lbl.pdf.Accessed:August31,2015.
92. MigdenMR,GuminskiA,GutzmerR,DirixL,LewisKD,CombemaleP,etal.Treatmentwithtwodifferent
dosesofsonidegibinpatientswithlocallyadvancedormetastaticbasalcellcarcinoma(BOLT):a
multicentre,randomised,doubleblindphase2trial.LancetOncol.2015Jun.16(6):71628.[Medline].
93. DouglasD.Fluorouracilmayboostinvasiveskincancerriskinsome.Medscape[serialonline].Availableat
http://www.medscape.com/viewarticle/815053.2013Nov26Accessed:August31,2015.
94. NationalCenterforBiotechnicalInformation.BazexSyndromeBZX.OnlineMendelianInheritancein
Man.Availableathttp://www.ncbi.nlm.nih.gov/omim/301845\t_blank.Accessed:November7,2007.
95. XiongMY,KorgavkarK,DigiovannaJJ,WeinstockMA,VeteransAffairsTopicalTretinoin
ChemopreventionTrialGroup.Fluorouracilandotherpredictorsofmorpheaformbasalcellcarcinoma
amonghighriskpatients:theVeteransAffairsTopicalTretinoinChemopreventionTrial.JAMADermatol.
2014Mar.150(3):3324.[Medline].
MedscapeReference2011WebMD,LLC

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