SCRUTINIZING THE NON-METASTASIZING BCC!

ameet77804 (46)in #health • 7 years ago (edited)

Hello dear Steemians.Hope you all are doing well!
Today we will be discussing on Basal cell carcinoma(BCC) and a case study on BCC, prepared by me during my ENT & HNS Posting.
Hope you will enjoy it.

Introduction

"Basal cell carcinoma" or rodent ulcer, the term is a misnomer, because it doesn't have all the properties of a typical Carcinoma.Unlike other Carcinomas, it rarely metastasizes but it is a locally invasive, slow growing malignant tumour of pleuripotent epithelial cells arising from basal epidermis and hair follicles, hence affecting the pilosebaceous skin.

Epidemiology

It is the most common malignant tumour in Humans and its incidence has increased greatly in the last few decades.It accounts for 32% of all cancers globally.It is the second most common tumour of skin after Melanoma.It is more commonly seen in the sun exposed areas of the body, but about 33% of the tumours are seen in non exposed parts.
It commonly occurs at 40-60 years of age with 90% of the lesion found on the face above a line from the lobe of the ear to the corner of mouth.UV-rays are the most common predisposing factor.Apart from it, BCC has some genetic influence too.It is said that between 30% and 75% of sporadic cases are associated with mutation of"patched hedgehog gene" present on chromosome 9q22.3.Person with light skin,red hair and freckles are more susceptible to BCC.Other predisposing factors are arsenical compounds, coal tar,aromatic hydrocarbons.

whites >> blacks
male>>females

image source

Pathogenesis

BCC doesn't have any apparent precursor lesion, but it can come in association with actinic keratosis, seborrheic keratosis,squamous cell carcinoma..The development of BCC is proportional to the initial dose of the carcinogen, but not duration of exposure.Over exposure to sun leads to formation of thymine dimer, a form of DNA damage and result in mutation.This over exposure to sun causes failure of the immune surveillance for the tumour cells resulting in hyperproliferative disorder.

Clinical features

Macroscopic appearance
BCC can be of Noduloulcerative(rodent ulcer),Superficial ,Morphoeic or Pigment types of which Noduloulcerative variant accounts for 90% of cases.
Microscopic appearance
26 different histological types have been described, but the characteristic finding is ovoid cells in nests with a single, outer 'palisading' layer.Since only the outer layer of cells are actively dividing, so incompletely excised lesions (if margins are not excised)are highly aggressive and can recur.

image source

Prognosis

There are 'high-risk and ' low-risk' BCCs.High risk BCCs are large(>2cm),located at specific sites (nose,ear,eye) with ill defined margins,large and deep rooted lesions and have poor prognosis.

Diagnosis

Diagnosis of BCC is based on:

skin biopsy(most common method is shave biopsy under local anesthesia)
characteristic appearance of ulcerated nodule with a pearly,beaded margin and telangiectasia.
slow growth
distinctive site of occurrence
BCC should be differentiated from Squamous cell carcinoma,Melanocytic naevus,Malignant melanoma.

Management

#Surgical & non surgical
Surgical approach

Standard surgical excision
Mohs surgery
Cryosurgery
Electrodessication and curettage
Non-surgical approach
Chemotherapy
Immunotherapy
Radiation

After knowing about BCC, you must be having a picture in your mind regarding the disease.Now let us see the real scenario that I encountered with a patient of BCC in our hospital.
She was 64 years old housewife who spent most of her time working in the fields under the scorching sun which as discussed above is one of the major risk factors.Apart from that,we could not find any other significant history.
It was initially five years back that she first noticed a small painless mass in the right side of her face near the nasolabial fold.Because it was painless,she didn't give much attention to it except for seeking advices from local practitioners.They just provided her with some common drugs which didn't seem to work and the mass grew in size and became painful.It was only after the mass became painful and large that she came to our center.

(We can see the mass in her face, a part of which was taken for further investigations.)

Here are the reports of lab investigations that she went through.

(The reports were equivocal and suspicion regarding some sorts of TB or other infections was aroused.So she was advised for CT-Scan and biopsy which gave the following results.)

(Confirmation of the diagnosis after histopathological examination)
After the confirmation of the diagnosis, she was advised for further evaluation and treatment in the Cancer center.

This was all about the BCC that i wanted to share.Hope it helped to add something to your pre-existing knowledge about BCC.Some things diagnosed in time can actually help lessen the future complications associated with it .So never ignore any sign that your body is trying to give you regarding your health.

Refrences :
1.https://www.bookdepository.com/Bailey-Loves-Short-Practice-Surgery-27th-Edition-Norman-Williams/9781498796507
2.https://www.elsevier.com/books/illustrated-synopsis-of-dermatology-and-sexually-transmitted-diseases/unknown/978-81-312-4231-5
3.https://en.wikipedia.org/wiki/Basal-cell_carcinoma
4.https://www.ncbi.nlm.nih.gov/pubmed/21603813
5.https://www.news-medical.net/health/Basal-Cell-Carcinoma-Prognosis.aspx
6.http://www.nobelmedicalcollege.com.np/

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