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Body Part: Face

Leukemia Cutis

Leukemia Cutis

Definition: Leukemia cutis (LC) is a rare condition that refers to cutaneous infiltration of neoplastic leukocytes due to peripheral leukemia. 

Etiology: The etiology of any leukemia can be attributed to genetic and environmental risk factors that promote the expression of neoplastic cells. The proposed etiology of LC involved mechanisms of various chemokines and molecular expression on leukemic cells mediating their migration to the skin through skin0 selective homing processes. Environmental risk factors include benzene exposure, ionizing radiation, viral and alkylating agents. Aneuploidy of chromosome 8, translocation of chromosome 3 and (6;9) have been observed in patients with LC. It has been reported that all-trans retinoic acid to treat promyelocytic leukemia may increase the risk of cutaneous involvement.

Epidemiology: Exact data on the incidence and specific predilections of LC are unknown. It is believed that LC may affect approximately 3% of individuals with leukemia. However, individuals with adult T- cell leukemia/ lymphoma are more likely to develop LC. Up to 30% of children with congenital leukemia are more likely to develop LC. The subtypes of leukemia that commonly affect the skin are chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML). Cutaneous involvement and the development of chloromas are typically indicative of advanced illness.

Signs: LC clinical presentation varies, and may be localized or disseminated and occur alone or in combination on any skin site. LC lesions favor previous sites of injury. LC lesions often appear as firm papules, nodules and plaques that are firm or rubbery in consistency. They may range in color from skin- coloured to erythematous to violaceous. In rare cases yellow, blue and gray lesions may be observed. LC lesions may also present with erythroderma, annular erythema, purpura, petechiae, ulceration, gingivitis/ gingival hyperplasia (AML). in infants, LC is a cause of “blueberry muffin syndrome”

Symptoms: LC lesions are usually not purritic or tender.

Differentials:  Lymphoma and pseudolymphoma, metastatic solid tumors, pyoderma gangrenosum, urticaria, vasculitis

Diagnosis: LC[1]  must be diagnosed using a skin biopsy, which will reveal a diffuse infiltration of malignant leukocytes in the dermis of the skin. Further histochemistry may reveal the specific cell type involved.

Treatment: Care of LC is directed towards addressing the underlying leukemia. Treatment includes electron beam, therapy, localized radiation and phototherapy.

References:

1.     Parsi M, Go MS, Ahmed A. Leukemia Cutis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 17, 2023.

2.     Leukemia cutis | DermNet. dermnetnz.org. https://dermnetnz.org/topics/leukaemia-cutis

Lentigo Maligna

Lentigo Maligna

Definition: Lentigo maligna (LM), also known as Hutchinson melanotic freckle, is a slow-growing precursor of lentigo maligna melanoma (LMM). LM often occurs in sun-damaged skin of the head and neck region, usually in the elderly.

Etiology: LM occurs due to the proliferation of malignant melanocytes within the hair follicle and the basal layer of the epidermis. Solar damage to the skin results in the abnormal melanocytes proliferating unchecked. Major risk factors for LM include cumulative lifetime UVR exposure, x-ray radiation, estrogen/progesterone therapy, nonpermanent hair dyes and genetic conditions predisposing to sun sensitivity. UVR exposure causes oxidative damage which affects genes involved in KIT CCND1, MITF, NRAS, and p53 pathways.

Epidemiology:  LM is the precursor to the third most common subtype of melanoma (LMM), comprising up to 15% of all melanomas and up to 26% of melanomas on the head and neck. Women are often more affected by LM than men, with the ratio being 1.7: 1. LM occurs often in those with very fair skin (Fitzpatrick types 1,2), and is rare in brown or black skin (Fitzpatrick types 4,5,6). LM is more common in males, and the mean age of diagnosis is between 66- 72 years.

Signs: LM is slow-growing and may resemble a lentigo in its early stages. Over several years it may develop the following characteristics: smooth, flat surface, size >6 mm and irregular shape with variable pigmentation ranging from light brown, tan, dark brown, pink, red or white. 86% of LM lesions occur on the head and neck, with a predilection for the cheek. Extrafacial lesions may be seen on the extremities of women and the back in men.

Symptoms: LM lesions are usually asymptomatic. In 3-10% of cases, invasive melanoma may arise from LM in which symptoms include thickened portions of the lesion, increasing number of colours, ulceration, bleeding, itching or stinging.

Differentials: Solar lentigo, Melanocytic naevi, seborrheic keratosis, lichen planus-like keratosis, and pigmented actinic keratosis

Diagnosis: The clinical diagnosis of LM is by dermoscopy or confocal microscopy. If a lesion if suspicious of LM, an excisional biopsy is indicated for histopathological diagnosis.

Treatment: The treatment of choice is surgical excision. For poor surgical candidates, radiotherapy, or a topical imiquimod 5% cream may be indicated.

References:

  1. Oakley A. Lentigo maligna and lentigo maligna melanoma | DermNet NZ. dermnetnz.org. Published 2011. https://dermnetnz.org/topics/lentigo-maligna-and-lentigo-maligna-melanoma
  2. ‌Xiong M, Charifa A, Chen CSJ. Lentigo Maligna Melanoma. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 31, 2022.

Lentigines, Solar Lentigines

Lentigines, Solar Lentigines

Definition: Lentigines are clearly defined, pigmented, flat or slightly raised lesions. Lentigines do not fade in the winter months. Solar Lentigines (SL) are also known as “liver” or “wisdom- spots”, are harmless areas of hyperpigmentation on the skin due to ultraviolet (UV) radiation.

Etiology:  Lentigines can occur due to exposure to ionizing radiation. Familial syndromes associated with widespread lentigines originate from mutations in Ras-MAP kinase, mTOR signaling and PTEN pathways. SLs occur due to exposure to ultraviolet radiation, as seen in sun damage/ sunburn, indoor tanning and phototherapy. Exposure causes local proliferation of melanocytes and the accumulation of melanin within keratinocytes.

Epidemiology: Lentigines affect males and females equally, and may occur in all ages and races. Lentigines are common in individuals with fair- skin, and frequently arise in sun- exposed areas on individuals with darker skin. Lentigines are commonly seen in individuals over 40 years of age. 

Signs: There are many classifications of lentigines depending on their appearance on the body, causative factors and likelihood of progressing to other diseases or conditions. These include lentigo simplex, ink spot lentigo, and tanning bed lentigo. SLs are flat, well- circumcised round, oval or irregularly shaped patches. They may be skin coloured, tan, dark- brown or black depending on skin tone. Sls range from a few millimeters to several centimeters in diameter. SLs may be scaly.

Differentials: Actinic keratosis, Seboorhoeic keratosis, Melanoma, nMelasma

Diagnosis: Lentigines are diagnosed clinically by their appearance. Examination using dermatoscopy may be used to differentiate lentigines from melanoma. A diagnostic excisional skin biopsy may be performed for histological examination. Histopathology will show a thickened epidermis, increased melanocytes along the basal layer of the epidermis and increased melanin pigment within the keratinocytes.

Treatment: Most lentigines persist indefinitely. SPF 50+ broad-spectrum sunscreen or hydroquinone bleaching cream may be used to lighten the lesions. Bleaching agents, however, are not effective in SL. Individual lesions may be lightened using cryotherapy, intense pulsed light or pigment lasers. Preventative measures include minimizing sun exposure and using sunscreen early in life.

References:

Chan B. Solar lentigo | DermNet NZ. dermnetnz.org. Published 2014. https://dermnetnz.org/topics/solar-lentigo

Brown spots, lentigines and freckles. DermNet®. Published October 26, 2023. Accessed September 25, 2024. https://dermnetnz.org/topics/brown-spots-and-freckles#:~:text=Lentigines%20are%20common%20in%20people

Lentigo, lentigines | DermNet NZ. dermnetnz.org. https://dermnetnz.org/topics/lentigo

Impetigo

Impetigo

Definition: Impetigo is a common infection of the superficial layers of the epidermis that is very contagious and most often caused by gram-positive bacteria. This condition is characterized by pustules and honey-coloured crusted erosions. It can be classified into non-bullous and bullous impetigo. 

Etiology: Impetigo is caused by Staphylococcus aureus and less commonly, Streptococcus pyogenes. Nonbullous impetigo can be caused by either bacteria or a conjoint infection. Disruption in skin integrity allows for the invasion and colonization of bacteria on the surface. Bullous impetigo is caused by Staphylococcus aureus, which produces exfoliative toxins that target intracellular adhesion molecules of the epidermal granular layer. This results in the dissociation of epidermal cells, leading to blister formation.

Epidemiology: Impetigo accounts for approximately 10% of skin ailments in the pediatric population, most prevalent in children aged 2-5. The male-to-female ratio of incidence is approximately 1:1. Men are more commonly affected. Bullous impetigo is more common in children younger than two. Non-bullous impetigo caused by S. aureus accounts for approximately 80% of cases. Group A beta-hemolytic Strep (GABHS) accounts for 10% of cases. Methicillin-resistant S aureus (MRSA) has become more prevalent in hospitalized patients. 

Signs: Non-bullous impetigo can occur on the face, extremities or other body parts. It begins with a single erythematous macule that evolves into a pustule. This may be erythematous on lighter skin tones, and violaceous or brown on deeper skin tones. When this pustule or vesicle ruptures, it releases serous contents which dry to leave a typical honey-coloured crust.

Bullous impetigo is typically found on the face, trunk, extremities, buttocks and perianal regions. Autoinoculation may cause distal spread of lesions. Bullous impetigo appears as superficial small or large, thin-roofed bullae which spontaneously rupture to leave collarette.

Ecthyma is a deep ulcerated infection that can develop as a complication of bullous impetigo.

Symptoms: Individuals with non-bullous impetigo may experience some itching and regional lymphadenopathy. Individuals with bullous impetigo may experience systemic symptoms of fever, malaise and lymphadenopathy.

Differentials: scabies, atopic dermatitis, contact dermatitis, candidiasis, herpes simplex

Diagnosis: diagnosis of impetigo begins with a thorough history and physical examination. Bacterial cultures may be in the confirmation of diagnosis if MRSA is suspected or if there is an impetigo outbreak. Skin biopsy may be used in refractory cases. Human immunodeficiency virus testing should be considered when a previously healthy adult develops bullous impetigo.

Treatment: Specific measures in treating impetigo include topical or oral antibiotics, proper hand hygiene and avoiding close contact with confirmed cases.

References:

1.     Nardi NM, Schaefer TJ. Impetigo. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 31, 2023.

2.     Quirke K. Impetigo | DermNet NZ. dermnetnz.org. Published March 2022. https://dermnetnz.org/topics/impetigo

Impetigo

Impetigo

Definition: Impetigo is a common infection of the superficial layers of the epidermis that is very contagious and most often caused by gram-positive bacteria. This condition is characterized by pustules and honey-coloured crusted erosions. It can be classified into non-bullous and bullous impetigo. 

Etiology: Impetigo is caused by Staphylococcus aureus and less commonly, Streptococcus pyogenes. Nonbullous impetigo can be caused by either bacteria or a conjoint infection. Disruption in skin integrity allows for the invasion and colonization of bacteria on the surface. Bullous impetigo is caused by Staphylococcus aureus, which produces exfoliative toxins that target intracellular adhesion molecules of the epidermal granular layer. This results in the dissociation of epidermal cells, leading to blister formation.

Epidemiology: Impetigo accounts for approximately 10% of skin ailments in the pediatric population, most prevalent in children aged 2-5. The male-to-female ratio of incidence is approximately 1:1. Men are more commonly affected. Bullous impetigo is more common in children younger than two. Non-bullous impetigo caused by S. aureus accounts for approximately 80% of cases. Group A beta-hemolytic Strep (GABHS) accounts for 10% of cases. Methicillin-resistant S aureus (MRSA) has become more prevalent in hospitalized patients. 

Signs: Non-bullous impetigo can occur on the face, extremities or other body parts. It begins with a single erythematous macule that evolves into a pustule. This may be erythematous on lighter skin tones, and violaceous or brown on deeper skin tones. When this pustule or vesicle ruptures, it releases serous contents which dry to leave a typical honey-coloured crust.

Bullous impetigo is typically found on the face, trunk, extremities, buttocks and perianal regions. Autoinoculation may cause distal spread of lesions. Bullous impetigo appears as superficial small or large, thin-roofed bullae which spontaneously rupture to leave collarette.

Ecthyma is a deep ulcerated infection that can develop as a complication of bullous impetigo.

Symptoms: Individuals with non-bullous impetigo may experience some itching and regional lymphadenopathy. Individuals with bullous impetigo may experience systemic symptoms of fever, malaise and lymphadenopathy.

Differentials: scabies, atopic dermatitis, contact dermatitis, candidiasis, herpes simplex

Diagnosis: diagnosis of impetigo begins with a thorough history and physical examination. Bacterial cultures may be in the confirmation of diagnosis if MRSA is suspected or if there is an impetigo outbreak. Skin biopsy may be used in refractory cases. Human immunodeficiency virus testing should be considered when a previously healthy adult develops bullous impetigo.

Treatment: Specific measures in treating impetigo include topical or oral antibiotics, proper hand hygiene and avoiding close contact with confirmed cases.

References:

1.     Nardi NM, Schaefer TJ. Impetigo. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 31, 2023.

2.     Quirke K. Impetigo | DermNet NZ. dermnetnz.org. Published March 2022. https://dermnetnz.org/topics/impetigo

Basal Cell Carcinoma – Nodular

Nodular Basal Cell Carcinoma 

Definition: Nodular Basal Cell carcinoma is a subtype of BCC that is marked by raised, pearly flesh coloured nodules with melanogenesis typically localized to the face (2,3).

Etiology: Similar to other BCCs, Nodular BCC is caused primarily by exposure to ultraviolet light as well as genetic factors (3). In the skin of color, pigmented Nodular BCCs are more common (1).

Epidemiology: Nodular Basal Cell carcinoma is the most common subtype of BCC and has a high incidence in individuals with fair skin with a significant history of sun exposure (1). Approximately 60% to 80% of BCC are of the Nodular subtype (4).

Signs: Nodular BCC manifests as skin-coloured papules or nodules with pearly or translucent telangiectatic border (3,4). It may be described as having a rolled border in which the edges of the lesion are higher than the center (4). Large lesions may include ulceration (4).

Symptoms: Typically asymptomatic but with time the lesions may crust or bleed (2,3).

Differentials: Trichoblastoma and trichoepithelioma (1).

Diagnosis: Diagnosis is confirmed through a shave or punch biopsy but clinical exam and dermoscopy can supplement the assessment (2).

Treatment: Treatment is usually surgical involving either surgical excision or Mohs micrographic surgery (1,3). Non-surgical options include cryotherapy, topical therapies or radiation in some cases (1,3).

References: (AMA)

1.      1. McDaniel B. Basal cell carcinoma. StatPearls [Internet]. March 13, 2024. Accessed August 18, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482439/#:~:text=BCC%20typically%20presents%20as%20a,rolled%20or%20rodent%20ulcer%20appearance.

2.     Oakley A. Basal cell carcinoma: Symptoms, causes, and treatment – dermnet. DermNet®. July 3, 2024. Accessed August 18, 2024. https://dermnetnz.org/topics/basal-cell-carcinoma. 

3.     1. Robert S Bader M. Basal cell carcinoma. Practice Essentials, Background, Pathophysiology. April 3, 2024. Accessed August 18, 2024. https://emedicine.medscape.com/article/276624-overview?gad_source=1&gbraid=0AAAAADoSQiUCwFng3uMBdxWlXHVuNMVrw&gclid=Cj0KCQjwt4a2BhD6ARIsALgH7Dqhf-P79uzm848PdW5k8auVX_QjoRGo38V0m2dFrNN42l3MpFCbyS0aAm4_EALw_wcB&form=fpf#a2.

4.     Tanese K. Diagnosis and management of basal cell carcinoma. Current Treatment Options in Oncology. 2019;20(2). doi:10.1007/s11864-019-0610-0 

Basal Cell Carcinoma – Nodular

Nodular Basal Cell Carcinoma 

Definition: Nodular Basal Cell carcinoma is a subtype of BCC that is marked by raised, pearly flesh coloured nodules with melanogenesis typically localized to the face (2,3).

Etiology: Similar to other BCCs, Nodular BCC is caused primarily by exposure to ultraviolet light as well as genetic factors (3). In the skin of color, pigmented Nodular BCCs are more common (1).

Epidemiology: Nodular Basal Cell carcinoma is the most common subtype of BCC and has a high incidence in individuals with fair skin with a significant history of sun exposure (1). Approximately 60% to 80% of BCC are of the Nodular subtype (4).

Signs: Nodular BCC manifests as skin-coloured papules or nodules with pearly or translucent telangiectatic border (3,4). It may be described as having a rolled border in which the edges of the lesion are higher than the center (4). Large lesions may include ulceration (4).

Symptoms: Typically asymptomatic but with time the lesions may crust or bleed (2,3).

Differentials: Trichoblastoma and trichoepithelioma (1).

Diagnosis: Diagnosis is confirmed through a shave or punch biopsy but clinical exam and dermoscopy can supplement the assessment (2).

Treatment: Treatment is usually surgical involving either surgical excision or Mohs micrographic surgery (1,3). Non-surgical options include cryotherapy, topical therapies or radiation in some cases (1,3).

References: (AMA)

1.      1. McDaniel B. Basal cell carcinoma. StatPearls [Internet]. March 13, 2024. Accessed August 18, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482439/#:~:text=BCC%20typically%20presents%20as%20a,rolled%20or%20rodent%20ulcer%20appearance.

2.     Oakley A. Basal cell carcinoma: Symptoms, causes, and treatment – dermnet. DermNet®. July 3, 2024. Accessed August 18, 2024. https://dermnetnz.org/topics/basal-cell-carcinoma. 

3.     1. Robert S Bader M. Basal cell carcinoma. Practice Essentials, Background, Pathophysiology. April 3, 2024. Accessed August 18, 2024. https://emedicine.medscape.com/article/276624-overview?gad_source=1&gbraid=0AAAAADoSQiUCwFng3uMBdxWlXHVuNMVrw&gclid=Cj0KCQjwt4a2BhD6ARIsALgH7Dqhf-P79uzm848PdW5k8auVX_QjoRGo38V0m2dFrNN42l3MpFCbyS0aAm4_EALw_wcB&form=fpf#a2.

4.     Tanese K. Diagnosis and management of basal cell carcinoma. Current Treatment Options in Oncology. 2019;20(2). doi:10.1007/s11864-019-0610-0 

Basal Cell Carcinoma

Basal Cell Carcinoma (BCC)

Definition: BCC is a slow-growing nonmelanocytic skin cancer arising from basal cells in the epidermis that rarely metastasizes but can invade locally and be destructive (1,4,5).

Etiology:  Ultraviolet exposure is a major risk factor and explains why BCC typically grows on sun-exposed areas of the skin (1). Other factors that influence the development of BCC include fairer skin colour, light-coloured eyes, Northern European ancestry, red hair and a history of sunburns (5). Pathobiologicallt, most BCCs are caused by activation of the Hedgehog signaling system, which is also a target for therapeutic intervention (5).

Epidemiology: The incidence of BCC varies depending on geographic location and race (5). Australia is reported to have one of the highest incidences of 1000/100,000 (5). BCC is one of the most common skin cancers in fair-skinned individuals and is increasing in incidence globally (1). It is usually seen after the age of 50 with an incidence ratio of 2:1 in females and males respectively (1).

Signs: BCC manifests as a translucent or pearly nodule accompanied by telangiectasia on sun-exposed regions such as the neck, ears, and face (2).

Symptoms: Typically asymptomatic but with time may crust, bleed or develop ulcers (2,3).

Differentials: Squamous cell carcinoma, adnexal tumors, seborrheic keratosis(1).

Diagnosis: Diagnosis requires a biopsy and is recommended before undergoing surgery or systemic treatment (1). Diagnosis also involves historical examination and direct inspection of the lesion (5). 

Treatment: The standard treatment for BCC is typically surgery (surgical excision, Mohs micrographic surgery and curettage and electrodesiccation) but non-surgical treatments options are also available including: freezing or light therapy, topical medications and radiation treatments (1).

References: (AMA)

1.      Basset-Seguin N, Herms F. Update in the management of basal cell carcinoma. Acta Dermato Venereologica. 2020;100(11). doi:10.2340/00015555-3495 

2.     1. McDaniel B. Basal cell carcinoma. StatPearls [Internet]. March 13, 2024. Accessed August 18, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482439/#:~:text=BCC%20typically%20presents%20as%20a,rolled%20or%20rodent%20ulcer%20appearance.

3.     Oakley A. Basal cell carcinoma: Symptoms, causes, and treatment – dermnet. DermNet®. July 3, 2024. Accessed August 18, 2024. https://dermnetnz.org/topics/basal-cell-carcinoma. 

4.     Robert S Bader M. Basal cell carcinoma. Practice Essentials, Background, Pathophysiology. April 3, 2024. Accessed August 18, 2024. https://emedicine.medscape.com/article/276624-overview?gad_source=1&gbraid=0AAAAADoSQiUCwFng3uMBdxWlXHVuNMVrw&gclid=Cj0KCQjwt4a2BhD6ARIsALgH7Dqhf-P79uzm848PdW5k8auVX_QjoRGo38V0m2dFrNN42l3MpFCbyS0aAm4_EALw_wcB&form=fpf#a2.

5.     Tanese K. Diagnosis and management of basal cell carcinoma. Current Treatment Options in Oncology. 2019;20(2). doi:10.1007/s11864-019-0610-0 

Basal Cell Carcinoma

Basal Cell Carcinoma (BCC)

Definition: BCC is a slow-growing nonmelanocytic skin cancer arising from basal cells in the epidermis that rarely metastasizes but can invade locally and be destructive (1,4,5).

Etiology:  Ultraviolet exposure is a major risk factor and explains why BCC typically grows on sun-exposed areas of the skin (1). Other factors that influence the development of BCC include fairer skin colour, light-coloured eyes, Northern European ancestry, red hair and a history of sunburns (5). Pathobiologicallt, most BCCs are caused by activation of the Hedgehog signaling system, which is also a target for therapeutic intervention (5).

Epidemiology: The incidence of BCC varies depending on geographic location and race (5). Australia is reported to have one of the highest incidences of 1000/100,000 (5). BCC is one of the most common skin cancers in fair-skinned individuals and is increasing in incidence globally (1). It is usually seen after the age of 50 with an incidence ratio of 2:1 in females and males respectively (1).

Signs: BCC manifests as a translucent or pearly nodule accompanied by telangiectasia on sun-exposed regions such as the neck, ears, and face (2).

Symptoms: Typically asymptomatic but with time may crust, bleed or develop ulcers (2,3).

Differentials: Squamous cell carcinoma, adnexal tumors, seborrheic keratosis(1).

Diagnosis: Diagnosis requires a biopsy and is recommended before undergoing surgery or systemic treatment (1). Diagnosis also involves historical examination and direct inspection of the lesion (5). 

Treatment: The standard treatment for BCC is typically surgery (surgical excision, Mohs micrographic surgery and curettage and electrodesiccation) but non-surgical treatments options are also available including: freezing or light therapy, topical medications and radiation treatments (1).

References: (AMA)

1.      Basset-Seguin N, Herms F. Update in the management of basal cell carcinoma. Acta Dermato Venereologica. 2020;100(11). doi:10.2340/00015555-3495 

2.     1. McDaniel B. Basal cell carcinoma. StatPearls [Internet]. March 13, 2024. Accessed August 18, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482439/#:~:text=BCC%20typically%20presents%20as%20a,rolled%20or%20rodent%20ulcer%20appearance.

3.     Oakley A. Basal cell carcinoma: Symptoms, causes, and treatment – dermnet. DermNet®. July 3, 2024. Accessed August 18, 2024. https://dermnetnz.org/topics/basal-cell-carcinoma. 

4.     Robert S Bader M. Basal cell carcinoma. Practice Essentials, Background, Pathophysiology. April 3, 2024. Accessed August 18, 2024. https://emedicine.medscape.com/article/276624-overview?gad_source=1&gbraid=0AAAAADoSQiUCwFng3uMBdxWlXHVuNMVrw&gclid=Cj0KCQjwt4a2BhD6ARIsALgH7Dqhf-P79uzm848PdW5k8auVX_QjoRGo38V0m2dFrNN42l3MpFCbyS0aAm4_EALw_wcB&form=fpf#a2.

5.     Tanese K. Diagnosis and management of basal cell carcinoma. Current Treatment Options in Oncology. 2019;20(2). doi:10.1007/s11864-019-0610-0 

Basal Cell Carcinoma

Basal Cell Carcinoma (BCC)

Definition: BCC is a slow-growing nonmelanocytic skin cancer arising from basal cells in the epidermis that rarely metastasizes but can invade locally and be destructive (1,4,5).

Etiology:  Ultraviolet exposure is a major risk factor and explains why BCC typically grows on sun-exposed areas of the skin (1). Other factors that influence the development of BCC include fairer skin colour, light-coloured eyes, Northern European ancestry, red hair and a history of sunburns (5). Pathobiologicallt, most BCCs are caused by activation of the Hedgehog signaling system, which is also a target for therapeutic intervention (5).

Epidemiology: The incidence of BCC varies depending on geographic location and race (5). Australia is reported to have one of the highest incidences of 1000/100,000 (5). BCC is one of the most common skin cancers in fair-skinned individuals and is increasing in incidence globally (1). It is usually seen after the age of 50 with an incidence ratio of 2:1 in females and males respectively (1).

Signs: BCC manifests as a translucent or pearly nodule accompanied by telangiectasia on sun-exposed regions such as the neck, ears, and face (2).

Symptoms: Typically asymptomatic but with time may crust, bleed or develop ulcers (2,3).

Differentials: Squamous cell carcinoma, adnexal tumors, seborrheic keratosis(1).

Diagnosis: Diagnosis requires a biopsy and is recommended before undergoing surgery or systemic treatment (1). Diagnosis also involves historical examination and direct inspection of the lesion (5). 

Treatment: The standard treatment for BCC is typically surgery (surgical excision, Mohs micrographic surgery and curettage and electrodesiccation) but non-surgical treatments options are also available including: freezing or light therapy, topical medications and radiation treatments (1).

References: (AMA)

1.      Basset-Seguin N, Herms F. Update in the management of basal cell carcinoma. Acta Dermato Venereologica. 2020;100(11). doi:10.2340/00015555-3495 

2.     1. McDaniel B. Basal cell carcinoma. StatPearls [Internet]. March 13, 2024. Accessed August 18, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482439/#:~:text=BCC%20typically%20presents%20as%20a,rolled%20or%20rodent%20ulcer%20appearance.

3.     Oakley A. Basal cell carcinoma: Symptoms, causes, and treatment – dermnet. DermNet®. July 3, 2024. Accessed August 18, 2024. https://dermnetnz.org/topics/basal-cell-carcinoma. 

4.     Robert S Bader M. Basal cell carcinoma. Practice Essentials, Background, Pathophysiology. April 3, 2024. Accessed August 18, 2024. https://emedicine.medscape.com/article/276624-overview?gad_source=1&gbraid=0AAAAADoSQiUCwFng3uMBdxWlXHVuNMVrw&gclid=Cj0KCQjwt4a2BhD6ARIsALgH7Dqhf-P79uzm848PdW5k8auVX_QjoRGo38V0m2dFrNN42l3MpFCbyS0aAm4_EALw_wcB&form=fpf#a2.

5.     Tanese K. Diagnosis and management of basal cell carcinoma. Current Treatment Options in Oncology. 2019;20(2). doi:10.1007/s11864-019-0610-0