Basal cell carcinoma natural history: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Basal cell carcinoma}} | {{Basal cell carcinoma}} | ||
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D. | {{CMG}} {{AE}}{{M.N}} Saarah T. Alkhairy, M.D. | ||
==Overview== | ==Overview== | ||
It is a slow-growing [[Local|locally]] [[invasive]] [[lesion]] with an unlikely risk of [[metastasis]]. Most [[patients]] are often [[asymptomatic]]. The major [[complication]] is its recurrence and involvement of surrounding structures. With appropriate treatment, the [[prognosis]] is usually excellent. | |||
==Natural History== | ==Natural History== | ||
*Patients with basal cell carcinoma are often asymptomatic<ref name="pmid14525881">{{cite journal |vauthors=Wong CS, Strange RC, Lear JT |title=Basal cell carcinoma |journal=BMJ |volume=327 |issue=7418 |pages=794–8 |date=October 2003 |pmid=14525881 |pmc=214105 |doi=10.1136/bmj.327.7418.794 |url=}}</ref> | *[[Patients]] with basal cell carcinoma are often [[asymptomatic]]<ref name="pmid14525881">{{cite journal |vauthors=Wong CS, Strange RC, Lear JT |title=Basal cell carcinoma |journal=BMJ |volume=327 |issue=7418 |pages=794–8 |date=October 2003 |pmid=14525881 |pmc=214105 |doi=10.1136/bmj.327.7418.794 |url=}}</ref> | ||
*They often report a slowly enlarging lesion which does not heal and bleeds when traumatized | *They often report a slowly enlarging [[lesion]] which does not [[Healing|heal]] and [[Bleed|bleeds]] when [[Trauma|traumatized]] | ||
*It is locally invasive and destructive so the name '''rodent cancer''' | *It is [[Local|locally]] [[invasive]] and destructive so the name [[Rodent ulcer|'''rodent cancer''']] | ||
*The overall risk of [[metastases]] is estimated to be less than 0.1% | *The overall risk of [[metastases]] is estimated to be less than 0.1% | ||
*The risk of invasion and recurrence is based on size, duration, location and subtype (sclerodermiform/morpheaform and micronodular clinical variants have a higher risk) | *The risk of [[invasion]] and recurrence is based on size, duration, [[Location parameter|location]] and subtype (sclerodermiform/morpheaform and micronodular [[clinical]] variants have a higher risk) | ||
*Even without a recurrence, a personal history of basal cell carcinoma increases the risk of developing all types of skin cancers | *Even without a recurrence, a [[Personal, Social and Health Education|personal]] [[History and Physical examination|history]] of basal cell carcinoma increases the risk of [[Development|developing]] all types of [[skin cancers]] | ||
==Complications== | ==Complications== | ||
*The main complication of basal cell carcinoma is recurrence | *The main [[complication]] of basal cell carcinoma is recurrence.<ref name="WortsmanVergara2015">{{cite journal|last1=Wortsman|first1=X.|last2=Vergara|first2=P.|last3=Castro|first3=A.|last4=Saavedra|first4=D.|last5=Bobadilla|first5=F.|last6=Sazunic|first6=I.|last7=Zemelman|first7=V.|last8=Wortsman|first8=J.|title=Ultrasound as predictor of histologic subtypes linked to recurrence in basal cell carcinoma of the skin|journal=Journal of the European Academy of Dermatology and Venereology|volume=29|issue=4|year=2015|pages=702–707|issn=09269959|doi=10.1111/jdv.12660}}</ref><ref name="pmid22560426">{{cite journal |vauthors=Jebodhsingh KN, Calafati J, Farrokhyar F, Harvey JT |title=Recurrence rates of basal cell carcinoma of the periocular skin: what to do with patients who have positive margins after resection |journal=Can. J. Ophthalmol. |volume=47 |issue=2 |pages=181–4 |date=April 2012 |pmid=22560426 |doi=10.1016/j.jcjo.2012.01.024 |url=}}</ref> | ||
*The following are the factors associated with increased risk of basal cell carcinoma recurrence: | *The following are the factors associated with increased risk of basal cell carcinoma recurrence: | ||
**[[Location parameter|Location]] and size | |||
**Location and size | ***>/= 6 mm in [[diameter]] in high-risk areas (eg, central [[face]], [[nose]], [[lips]], [[eyelids]], [[eyebrows]], periorbital [[skin]], [[chin]], [[mandible]], [[ears]], preauricular and postauricular areas, [[temples]], [[hands]], [[feet]]) | ||
***10 mm in [[diameter]] in other areas of the [[head]] and [[neck]] | |||
**>/= 6 mm in diameter in high-risk areas (eg, central face, nose, lips, eyelids, eyebrows, periorbital skin, chin, mandible, ears, preauricular and postauricular areas, temples, hands, feet) | ***20 mm in [[diameter]] in all other areas (excluding [[hands]] and [[feet]]) | ||
**Aggressive [[Pathological|pathologic]] variants | |||
**10 mm in diameter in other areas of the head and neck | ***Morpheaform, sclerosing, or mixed infiltrative | ||
***Micronodular | |||
**20 mm in diameter in all other areas (excluding hands and feet) | ***Basosquamous | ||
**[[Lesions]] in sites of prior [[radiation therapy]] (RT) | |||
**Aggressive pathologic | **[[Lesions]] with poorly defined borders | ||
**[[Lesions]] in [[immunocompromised]] [[patients]] | |||
**Morpheaform, sclerosing, or mixed infiltrative | **Perineural [[invasion]] | ||
**Micronodular | |||
**Basosquamous | |||
**Lesions in sites of prior radiation therapy (RT) | |||
**Lesions with poorly defined borders | |||
**Lesions in immunocompromised patients | |||
**Perineural invasion | |||
==Prognosis== | ==Prognosis== | ||
*Prognosis of basal cell carcinoma is usually excellent<ref name="Czarnecki1998">{{cite journal|last1=Czarnecki|first1=D.|title=The prognosis of patients with basal and squamous cell carcinoma of the skin|journal=International Journal of Dermatology|volume=37|issue=9|year=1998|pages=656–658|issn=00119059|doi=10.1046/j.1365-4362.1998.00559.x}}</ref><ref name="pmid26449265">{{cite journal |vauthors=Correia de Sá TR, Silva R, Lopes JM |title=Basal cell carcinoma of the skin (part 2): diagnosis, prognosis and management |journal=Future Oncol |volume=11 |issue=22 |pages=3023–38 |date=November 2015 |pmid=26449265 |doi=10.2217/fon.15.245 |url=}}</ref> | *[[Prognosis]] of basal cell carcinoma is usually excellent.<ref name="Czarnecki1998">{{cite journal|last1=Czarnecki|first1=D.|title=The prognosis of patients with basal and squamous cell carcinoma of the skin|journal=International Journal of Dermatology|volume=37|issue=9|year=1998|pages=656–658|issn=00119059|doi=10.1046/j.1365-4362.1998.00559.x}}</ref><ref name="pmid26449265">{{cite journal |vauthors=Correia de Sá TR, Silva R, Lopes JM |title=Basal cell carcinoma of the skin (part 2): diagnosis, prognosis and management |journal=Future Oncol |volume=11 |issue=22 |pages=3023–38 |date=November 2015 |pmid=26449265 |doi=10.2217/fon.15.245 |url=}}</ref> | ||
*These lesions are typically slow growing, and metastatic disease is a very rare event. | *These [[lesions]] are typically slow growing, and [[metastatic]] [[disease]] is a very [[rare]] event. | ||
* | *Basal cell carcinoma will cause considerable [[disfigurement]] by [[Local|locally]] destroying [[skin]], [[cartilage]], and even [[bone]]. | ||
*Recurrence is a issue with basal cell carcinoma. | *Recurrence is a issue with basal cell carcinoma. | ||
*Approximately 50% of recurrences are apparent within the first two years. | *Approximately 50% of recurrences are apparent within the first two years. | ||
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Latest revision as of 14:36, 11 March 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2] Saarah T. Alkhairy, M.D.
Overview
It is a slow-growing locally invasive lesion with an unlikely risk of metastasis. Most patients are often asymptomatic. The major complication is its recurrence and involvement of surrounding structures. With appropriate treatment, the prognosis is usually excellent.
Natural History
- Patients with basal cell carcinoma are often asymptomatic[1]
- They often report a slowly enlarging lesion which does not heal and bleeds when traumatized
- It is locally invasive and destructive so the name rodent cancer
- The overall risk of metastases is estimated to be less than 0.1%
- The risk of invasion and recurrence is based on size, duration, location and subtype (sclerodermiform/morpheaform and micronodular clinical variants have a higher risk)
- Even without a recurrence, a personal history of basal cell carcinoma increases the risk of developing all types of skin cancers
Complications
- The main complication of basal cell carcinoma is recurrence.[2][3]
- The following are the factors associated with increased risk of basal cell carcinoma recurrence:
- Location and size
- >/= 6 mm in diameter in high-risk areas (eg, central face, nose, lips, eyelids, eyebrows, periorbital skin, chin, mandible, ears, preauricular and postauricular areas, temples, hands, feet)
- 10 mm in diameter in other areas of the head and neck
- 20 mm in diameter in all other areas (excluding hands and feet)
- Aggressive pathologic variants
- Morpheaform, sclerosing, or mixed infiltrative
- Micronodular
- Basosquamous
- Lesions in sites of prior radiation therapy (RT)
- Lesions with poorly defined borders
- Lesions in immunocompromised patients
- Perineural invasion
- Location and size
Prognosis
- Prognosis of basal cell carcinoma is usually excellent.[4][5]
- These lesions are typically slow growing, and metastatic disease is a very rare event.
- Basal cell carcinoma will cause considerable disfigurement by locally destroying skin, cartilage, and even bone.
- Recurrence is a issue with basal cell carcinoma.
- Approximately 50% of recurrences are apparent within the first two years.
References
- ↑ Wong CS, Strange RC, Lear JT (October 2003). "Basal cell carcinoma". BMJ. 327 (7418): 794–8. doi:10.1136/bmj.327.7418.794. PMC 214105. PMID 14525881.
- ↑ Wortsman, X.; Vergara, P.; Castro, A.; Saavedra, D.; Bobadilla, F.; Sazunic, I.; Zemelman, V.; Wortsman, J. (2015). "Ultrasound as predictor of histologic subtypes linked to recurrence in basal cell carcinoma of the skin". Journal of the European Academy of Dermatology and Venereology. 29 (4): 702–707. doi:10.1111/jdv.12660. ISSN 0926-9959.
- ↑ Jebodhsingh KN, Calafati J, Farrokhyar F, Harvey JT (April 2012). "Recurrence rates of basal cell carcinoma of the periocular skin: what to do with patients who have positive margins after resection". Can. J. Ophthalmol. 47 (2): 181–4. doi:10.1016/j.jcjo.2012.01.024. PMID 22560426.
- ↑ Czarnecki, D. (1998). "The prognosis of patients with basal and squamous cell carcinoma of the skin". International Journal of Dermatology. 37 (9): 656–658. doi:10.1046/j.1365-4362.1998.00559.x. ISSN 0011-9059.
- ↑ Correia de Sá TR, Silva R, Lopes JM (November 2015). "Basal cell carcinoma of the skin (part 2): diagnosis, prognosis and management". Future Oncol. 11 (22): 3023–38. doi:10.2217/fon.15.245. PMID 26449265.