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Basal Cell Carcinoma ( BCC )

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Basal Cell Carcinoma ( BCC )

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Basal cell carcinoma ( BCC ) BCC is a slow growing , locally invasive malignant epidermal skin
 tumour predominantly affecting Caucasians

Most common cancer in Europe , Australia and US Incidence increasing worldwide & shows marked geographical variation
Accurate incidence figures difficult to obtain ( under-reported )
Reflects effects of UVB radiation and ethnicity ( on BCC pathogenesis ) Non-melanoma skin cancer NMSC
Together with cutaneous squamous cell carcinoma form the bulk of NMSCs Rarely metastisizes Uncommon in dark-skinned people and rare before age 20 Typically a neoplasm of the elderly

Risk factors

Genetic predisposition and exposure to UV radiation –> most significant aetiological factors

Tends to arise in sun exposed areas of the head and neck
Commonest peri-ocular malignancy Sun exposure in childhood may be important Positive family history Increasing age Male sex Fair skin types I and II Immunosuppression History of previous BCC Arsenic exposure Individual suffering from haematological diseases Hereditary conditions as 
○ nevoid basal cell nevus ( Gorlin-Goltz syndrome )
○ Bazex- Spiegler syndrome
○ abinism High dietary fat intake

Multifactorial DNA mutations in the patched ( PTCH ) tumour suppressor gene – part of hedgehog signaling pathway Complex interaction between duration and intensity of exposure to UV radiation and polymorphic genes

Slow growth 80 % occur in head and neck- rest in trunk and lower limbs Intermittent bleeding and scab formation Does not cause pain or itching Skin coloured , pink or pigmented , translucent or pearly – dilated vessels telengiectasis may be seen Size can vary from fe millimeters to several centimeters Classical- rodent ulcer – indurated edges and ulcerated centre

Differential diagnosis- Squamous cell carcinoma Malignant melanoma Melanocytic naevi Bowen’s disease Psoriasis Eczema Sebaceous hyperplasia Molluscum contagiosum Chalazion Keratoacanthoma Papilloma

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