BASAL CELL

CARSINOMA

Nadhilla Alkatiri 12 16 777 14

Dwi Yunisari Priyono 12 16 777 14 165
Supervisor : dr. Syahriani. M. Kes, Sp.KK
 Definition
- Basal cell carsinoma (BCC) is the most common cancer.
Although it rarely result in death or metastatic disease, BCC can
cause significant morbidity due to destructive local spread.
- BCC is the most common cancer in human. Cause by UV, PICH
gene mutation in most cases. Clinically differen types: nodular,
ulcerating, pigmented, sclerosing, and superficial.

1. G Alexander, MD Marzuka, E Samuel. Book. Basal Cell Carsinoma: Pathogenesis, Epidemiology, Clinical Features, Diagnosis, Histopathology,
and Management. Depatements of dermatology and internal medicine, Yale School of Medicine, New Haven, Connecticut. 2015.p.167-175
2. Wolf K, Johnson RA. Rosacea. Basal Cell Carsinoma. In: Wolff K, Johnson RA, editors. Fitzpatrick’s Color Atlas and Synopsis of Clinical
Dermatology. 6th ed. New York: McGraw-Hill Companies; 2009. p. 3, 9-13, 5, 50, 372, 9.
 Epidemiology
- Epidemiologi data indicate that the overall incidence is increasing
wordwide significantly by 3% - 10% per year.
- BCC is more common in elderly individuals but is becoming increasingly
frequent in people younger than 50 years of age.
- Tumor were more frequent in patients older than 60 years of age, and 57
% were in men. The highest percentage of lesion occurred on the nose
(20.9%), followed by other site on the face (17.7%). The vast majority if
BCC were located on the head and neck.

Carucci J, Leffel D, Pettersen J. Basal Cell Carsinoma. editors. Fitzpatrick’s Dermatology in

Genaral Medicine. 8th ed. New York : Mc. Graw Hill ; 2011.p. 1294-1303.
 Etiopathogenesis

The pathogenesis of BCC involves exposure to

UVL, particularly the ultraviolet B spectrum
(290–320 nm) that induces mutations in
tumor suppressor genes. UVB radiation
damages DNA and affects the immune system
resulting in a progressive genetic alterations
and neoplasms.

Carucci J, Leffel D, Pettersen J. Basal Cell Carsinoma. editors. Fitzpatrick’s Dermatology in

Genaral Medicine. 8th ed. New York : Mc. Graw Hill ; 2011.p. 1294-1303.
 Clinical Findings
Nodular Basal Cell Carcinoma
Papule or nodule, translucent or “pearly.” Skin-colored
or reddish, smooth surface with telangiectasia.Portions
of nodular BCC may have erosions or stipples of
melanin pigmentation
Ulcerating Basal Cell Carcinoma
Ulcer (often covered with a crust) with a rolled border
(rodent ulcer), which again is translucent, pearly, smooth
with telangiectasia.
Sclerosing Basal Cell Carcinoma
Appears as a small patch of morphea or a
superficial scar, often ill defined, skin-colored,
whitish but also with peppery pigmentation.
Superficial Basal Cell Carcinoma
Appear as thin plaques. Pink or red characteristic fine
thread like border and telangiectasia can be seen with
the aid of a hand lens.This can also give rise to nodular
and ulcerating BCC. BCC often bleeds with minimal
excoriation. Solar keratosis, in comparison, does not
bleed but is painful with excoriation.
Pigmented Basal Cell Carcinoma
May be brown to blue or black. Smooth, glistening
surface hard, firm may be indistinguishable from
superficial spreading or nodular melanoma but is
usually harder. Cystic lesions may occur: round, oval
shape, depressed center (“umbilicated”). Stippled
pigmentation can be seen in any of BCC types.
 Cystic Basal Cell Carcinoma
These dome shaped, blue – gray cystic nodules, are
clinically similar to eccrine and apocrine
hidrocystomas.

2. Wolf K, Johnson RA. Rosacea. Basal Cell Carsinoma. In: Wolff K, Johnson RA, editors. Fitzpatrick’s Color Atlas and Synopsis of Clinical
Dermatology. 6th ed. New York: McGraw-Hill Companies; 2009. p. 3, 9-13, 5, 50, 372, 9.
6. James W.D, Berger T, Dirk M.E’ Disease Of The Skin; Clinical Dermatology, Tenth Edition. hal 646-650.
 Diagnosis of BCC
Diagnosis of BCC is accomplished by accurate
interpretation of the skin biopsy results. The
preferred biopsy methods are shave biopsy,
which is often sufficient, and punch biopsy

Carucci J, Leffel D, Pettersen J. Basal Cell Carsinoma. editors. Fitzpatrick’s Dermatology in Genaral Medicine. 8th ed. New York
: Mc. Graw Hill ; 2011.p. 1294-1303.
 Histopathology
The malignant basal cells have large nuclei and
relatively little cytoplasm. Although the nuclei are large,
they may not appear atypical. Usually, mitotic figures
are absent. Frequently, slit-like retraction of stroma
from tumor islands is present, creating peritumoral
lacunae that are helpful in histopathologic diagnosis.

•Carucci J, Leffel D, Pettersen J. Basal Cell Carsinoma. editors. Fitzpatrick’s Dermatology in Genaral Medicine. 8th ed. New
York : Mc. Graw Hill ; 2011.p. 1294-1303.
 Differential Diagnosis Of BCC
Squamous Cell Carcinoma
Squamous cell carcinomas (SCCs) are malignant neoplasms
derived from suprabasal epidermal keratinocytes. A firm, flesh-
colored or erythematous, keratotic papule or plaque is most
common, but SCCs may also be pigmented. Other presentations
include as an ulcer, a smooth nodule , or a thick cutaneous horn.
SCC may also be verrucous or present as an abscess.

Carucci J, Leffel D, Pettersen J. Basal Cell Carsinoma.

editors. Fitzpatrick’s Dermatology in Genaral Medicine. 8th
ed. New York : Mc. Graw Hill ; 2011.p. 1294-1303.
 Nodular Melanoma
Nodular melanoma (NM) is the second most common
melanoma. It is more common for NM to begin de novo
than to arise in a preexisting nevus. NM typically
appears as a uniformly dark blue-black or bluish-red
raised lesion, but 5% are amelanotic. Early lesions often
lack asymmetry, have regular borders, and are a
uniform color

Bailey E.C, Sober A.J, Tsao H, Johnson T.M. Nodular

Melanoma. editors. Fitzpatrick’s Dermatology in
Genaral Medicine. 8th ed. New York : Mc. Graw Hill ;
2011.p. 1420-1423
 Bowen’s Disease (BD)
Bowen disease (BD) is SCC in situ, it affects both skin
and mucous membranes and has the potential to
progress to invasive SCC. BD typically presents as a
discrete, slowly enlarging, pink to erythematous thin
plaque with well-demarcated, irregular borders and
overlying scale or crust resembling a psoriatic plaque.

Duncan K.O, K John, Leffel D.J. Bowen’s Disease.

editors. Fitzpatrick’s Dermatology in Genaral Medicine.
8th ed. New York : Mc. Graw Hill ; 2011.p. 12731276
 Morphea
Morphea is a chronic autoimmune disease
characterized by sclerosis of the skin.
Erythematous patch or thin plaque, Central
sclerosis and violaceous, hyperpigmented
border, Atrophy dermal, subcutaneous, or
muscle

Daniels S.S, Jacobe H.T. Morphea. editors.

Fitzpatrick’s Dermatology in Genaral Medicine. 8th ed.
New York : Mc. Graw Hill ; 2011.p. 692-701
 Prognosis
With appropriate treatment, the prognosis for
most patients with BCC is excellent. Control
rates as high as 99% have been achieved by
MMS.
For the rare patient with metastatic disease,
prognosis is poor, with a mean survival of 8–10
months from the time of diagnosis.

•Carucci J, Leffel D, Pettersen J. Basal Cell Carsinoma. editors. Fitzpatrick’s Dermatology in Genaral Medicine. 8th ed. New York :
Mc. Graw Hill ; 2011.p. 1294-1303.
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