Basal cell carcinoma natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
Basal cell carcinoma is slow-growing and locally invasive. Common complications of BCC include reoccurrence and development of other types of skin cancer.
Natural History
- Patients with basal cell carcinoma are often asymptomatic.
- Basal cell carcinoma is slow-growing and locally invasive.
- 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
Complications of basal cell carcinoma are the following:
- Reoccurrence
- Development of other types of skin cancer
- Metastasis
- Ovarian calcification or fibroma[1]
- Medulloblastoma[1]
- Cardiac fibroma[1]
- Cleft palate[1]
- Ophthalmic abnormalities such as squint or cataract[1]
Prognosis
Although basal cell carcinoma rarely metastasizes, it grows locally with invasion and destruction of local tissues, without stopping. The cancer can impinge on vital structures and result in loss of extension or loss of function or rarely death. The vast majority of cases can be successfully treated before serious complications occur. The recurrence rate for the above treatment options ranges from 50% to 1% or less.
In choosing the therapy, one must weigh the benefit gained from the morbidity of the procedure. As most basal cell carcinomas are slow growing, and not deadly; the health and age of the patient must be considered. Although difficult to discuss, radiation therapy, topical chemotherapy, or no treatment at all should be considered in ill or frail individuals in difficult to excise tumor of no immediate harm to the individual. While methods with the highest cure rate should be considered for young and healthy individuals with long life expectancy.