Diagnosis
The Importance of Early Diagnosis of Basal Cell Carcinoma
Presentation of Basal Cell Carcinoma
BCCs typically present as shiny, pink- or flesh-colored papules or nodules with surface telangiectasia. The tumor may enlarge and ulcerate, giving the borders a rolled or rodent ulcer appearance. The most common sites for nodular basal cells are the face, especially the nose, cheeks, forehead, nasolabial folds, and eyelids. Patients often give a history of crusting and recurrent bleeding, causing them to seek evaluation. Pigmented nodular BCCs are more common in dark-skinned individuals.
A skin biopsy is necessary for clinical confirmation of BCC. A shave, punch, or excisional biopsy are all options, taking care to include some portion of the dermis in the specimen to differentiate between superficial and other invasive histologic subtypes of BCC. It should be noted that punch and shave biopsy techniques are about 80% accurate in diagnosing the various subtypes of BCC.
Tumor Prognosis
- Good prognosis: primary superficial BCC, primary nodular BCC <1 cm in intermediate-risk location or <2 cm in low-risk location
- Intermediate prognosis: recurrent superficial BCC, nodular BCC <1cm in high-risk location or <2 cm in intermediate-risk location or >2 cm in low-risk location
- Poor prognosis: nodular BCC >1 cm in high-risk location (high risk of recurrence), morpheaform, infiltrative or histologically aggressive (very high risk of recurrence), recurrent tumor, except superficial BCC (very high risk of recurrence)
References
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