Pigmented basal cell carcinoma
Alerts and Notices
Synopsis
The greatest 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 closely associated with the development of BCCs than cumulative ultraviolet exposure.
There are many subtypes of BCC, including nodular, superficial, infundibulocystic, fibroepithelial, morpheaform (sclerosing, desmoplastic), infiltrative, micronodular, and basosquamous. Accumulation of melanin and melanophages in the BCC tumor nodules gives rise to clinically pigmented BCCs. Pigmented BCCs account for approximately 6%-7% of nodular, superficial, and micronodular subtypes. They can occur in any location but are most commonly found on the head and neck. They comprise more than 50% of all BCCs in individuals with intermediate and darker skin colors. Pigmented BCCs are observed twice as frequently in Hispanic patients as compared to White patients.
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 do occur. The metastasis rate is approximately 1 in 35 000. Metastasis is rare and typically occurs through perineural spread, lymph node metastasis, and then lung / bone metastasis.
Codes
ICD10CM:C44.91 – Basal cell carcinoma of skin, unspecified
SNOMEDCT:
403909004 – Pigmented basal cell carcinoma
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Melanocytic nevus including dysplastic nevus
- Seborrheic keratosis – often has textural changes not typical of pigmented BCCs
- Pigmented actinic keratosis – often has textural changes not typical of pigmented BCCs
- Melanoma including lentigo maligna
- Blue nevus
- Deep penetrating nevus
- Atypical fibroxanthoma
- Vascular proliferations – eg, hemangioma, angiokeratoma, or lobular capillary hemangioma (pyogenic granuloma)
- Basosquamous carcinoma
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:08/11/2021
Last Updated:01/29/2023
Last Updated:01/29/2023
Patient Information for Pigmented basal cell carcinoma
Overview
Basal cell carcinoma (BCC) is the most common type of skin cancer. Pigmented BCC is the most common type among people of African, Hispanic, and Asian descent who are in their 50s. It can occur on any body location, but is often found on the head and neck.Pigmented BCC can appear as a brown, blue, or black bump or spot with an irregular border and possible color variations (including clear). It may also contain varicose veins.
Who’s At Risk
You are more at risk for any type of BCC if you have:- A lighter skin type
- A history of sun exposure
- Advanced age
- Immunosuppression
- A personal history of skin cancer (other than melanoma)
Signs & Symptoms
Pigmented BCC looks like a brown, blue, or black raised or flat spot with a jagged border and possible color variation. It is found on sun-exposed areas. Sometimes, the BCC lesion may have spider veins, translucency, a rolled / rounded edge, or a depressed center.Self-Care Guidelines
To prevent skin cancer, avoid sun exposure in the middle of the day. The Centers for Disease Control and Prevention (CDC) recommends liberal use of sunscreen with SPF 15 or higher.Since BCC tends to recur, it is important to self-examine your skin for new spots or any changes to existing spots.
When to Seek Medical Care
Consult your doctor if you have:- A sore that won't heal
- A scar that enlarges, turns red, scaly, or crusted, or has spider veins
- A new raised spot within a scar
Treatments
A physician will examine your skin tissue to confirm the diagnosis.Treatment for any BCC widely varies based on the size and location of the lesion.
Your tumor will most likely be removed surgically. Sometimes, tumors can be removed using extremely cold liquid nitrogen.
More serious pigmented BCCs may require radiation to kill cancer cells that remain.
Small BCCs that are not widespread can sometimes be treated with a topical drug called imiquimod.
Pigmented basal cell carcinoma