Nodular basal cell carcinoma - External and Internal Eye
Eyelid malignancies comprise 90% of all ophthalmic tumors. Eyelid BCC is the most common type and is particularly difficult to treat, given the complex anatomy and sensitive nature of the involved area. Most eyelid BCCs are of the nodular subtype and are located on the lower lid, which fits with their prevalence in hair-bearing skin of the periorbital region.
Risk factors for BCCs include: light skin phototype, sun exposure, radiation, advanced age, immunosuppression, and a personal history of non-melanoma skin cancer. Hereditary conditions associated with BCCs in general include albinism, xeroderma pigmentosum, nevoid basal cell carcinoma syndrome, Rasmussen syndrome, Rombo syndrome, Bazex-Dupré-Christol syndrome, and Darier disease.
The molecular pathogenesis of BCC formation is just beginning to be understood. The primary pathway that appears to be dysregulated is the sonic-hedgehog pathway that normally regulates early embryonic development. Mutations in this pathway, particularly inactivation of PTCH1 as seen in nevoid basal cell carcinoma syndrome or sporadic activating mutations in SMO, lead to BCC formation.
Patients should be followed regularly, as there is a significant chance of a second BCC.
C44.91 – Basal cell carcinoma of skin, unspecified
403911008 – Nodulo-ulcerative basal cell carcinoma
- Sebaceous hyperplasia can appear as yellow-white papules with a rolled edge.
- Seborrheic keratosis
- Bowen disease
- Apocrine hidrocystoma
- Eccrine hidrocystoma
- Molluscum contagiosum can appear similar as well.
- Amelanotic melanoma may be mistaken for a BCC.
- Melanocytic nevus
- Squamous cell carcinoma
- Merkel cell tumor