Infiltrating Basal Cell Carcinoma

1
Infiltrating Basal Cell Carcinoma

• Maysoon ALGain
• Dermatology Demonstrator
• KAAU

2
Case Presentation

• CC growth on right side of nose
• HPI 81 yo HF who first noted growth on right
  side of nose last December, progressively
  growing.
• PMH arthritis
• SH ½ ppd smoker X 25 years
• ROS denies F/C, significant weight loss
• FH non-contributory

3
Physical Exam

• General AAO, VSS and good
• VA 20/80 OD, 20/50 OS
• Pupils 3mm OU, no APD
• External extensive ulcerative lesion from bridge
  of nose to RLL and R cheek, with almost complete
  destruction of RLL and nearly complete ptosis of
  RUL
• IOP, CVF, DFE normal OS, unobtainable OD

4
(No Transcript)
5
(No Transcript)
6
Differential Diagnosis

• Malignant melanoma
• Squamous cell carcinoma
• Basal cell carcinoma, infiltrative
• Infectious

7
Basics of BCC

• Background
• Most common cutaneous malignancy (80-90)
• Typically slow-growing, rarely metastasizes
• Sun-exposed skin, mostly face and scalp, esp
  nose, cheek, and periorbital regions (80)
• Frequency
• 900,000 Dx in US/year
• estimated lifetime risk of 33-39 for
• men and 23-28 for women
• Sex
• Men 2X over women

8
Basics of BCC

• Mortality/Morbidity
• lt0.1 metastasize
• Very low mortality
• Significant morbidity with direct invasion of
  adjacent tissues, especially when on face or near
  an eye
• Age
• Likelihood increases with age
• Rare in lt40 yo
• Race
• Most often in light-skinned, rare in dark-skinned
  races

9
Variants of Basal Cell Carcinoma

• Superficial
• Nodular
• Micronodular
• Infiltrating (5)
• Sclerosing/ morpheaform (5)
• Metatypical
• Infundibulocystic

• Nodulocystic
• Adenoid
• Clear cell
• Follicular
• Sebaceous
• Perineurally invasive

10
Perineural Invasion

• May be seen in 3 of pts with infiltrating and
  morpheaform types
• Most often infiltrating type, which has highest
  rate of local recurrence
• Requires CT scan for full work-up
• Causes? inherently aggressive behavior vs
  inadequate early management?

11
Treatment Options

• Electrodessication and curettage
• Curettage alone
• Surgical excision
• Mohs micrographically controlled surgery
• Cryosurgery
• Ionizing radiation
• Surgical excision plus radiation
• Exenteration

12
Factors Considered in Treatment Planning

• Pt preference to keep eye
• Pt age
• Surgical excision-considered definitive tx
• Careful frozen section controlled excision of
  periocular BCCs yields cure rates comparable to
  Mohs micrographic surgery at 5-year follow-up
• 5 year recurrence of 2.2 in one study
• Wong, et al. Management of Periocular Basal Cell
  Carcinoma with Modified En Face Frozen Section
  Controlled Excision. Ophthalmic and Plastic
  Reconstructive Surgery. 2002. Vol 18 (6)
  430-435.
• Therefore, avoiding exenteration was considered a
  good possibility

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
Conclusion

• Basal cell carcinomas are not always as innocent
  as we tend to believe
• In formulating treatment course
• Strong pt preference and
• other pt factors
• Current research