Nodular basal cell carcinoma - External and Internal Eye
There are many subtypes of BCC, including nodular, superficial, infundibulocystic, fibroepithelial, morpheaform (sclerosing, desmoplastic), infiltrative, micronodular, and basosquamous. Nodular BCC is the most common subtype overall and accounts for half of all lesions. In Black and Hispanic patients, BCCs are more often pigmented.
Nodular BCC is typically seen on the face, most commonly on the cheeks, nose, melolabial fold, forehead, and eyelids.
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.
The most prevalent risk factor contributing to the development of BCCs is sun exposure, and people with light skin phototypes are at higher risk. Intermittent sun exposure is more associated with the development of BCCs than cumulative ultraviolet (UV) exposure.
Other risk factors for BCCs include environmental exposure (ie, ionizing radiation, indoor tanning, chemicals such as arsenic, psoralen plus UVA, and coal tar), phenotype (freckling, red hair, light skin that always burns and never tans), immunosuppression such as organ transplantation (which results in a 5-10 times higher risk of BCCs than the general population), and various genetic syndromes including xeroderma pigmentosum, oculocutaneous albinism, Muir-Torre syndrome, basal cell nevus syndrome (Gorlin syndrome), Rombo syndrome, and Bazex-Dupré-Christol syndrome. The gene most frequently altered in BCCs is the PTCH1 gene, followed by the TP53 gene.
Although BCCs are almost never fatal, local tissue destruction and disfiguration occur. The metastasis rate of BCCs is approximately 1 in 35 000. Metastasis is rare and typically occurs through perineural spread, lymph node metastasis, and then lung / bone metastasis.
C44.91 – Basal cell carcinoma of skin, unspecified
403911008 – Nodulo-ulcerative basal cell carcinoma
Differential Diagnosis & Pitfalls
- Lid notching
- Lid retraction
- Actinic keratosis
- Sebaceous hyperplasia
- Apocrine hidrocystoma
- Eccrine hidrocystoma
- Squamous cell carcinoma in situ (Bowen disease)
- Sebaceous carcinoma
- Molluscum contagiosum
- Merkel cell carcinoma
- Microcystic adnexal carcinoma
- Basosquamous carcinoma
Drug Reaction Data