Superficial basal cell carcinoma
There are many subtypes of BCC, including nodular, superficial, infundibulocystic, fibroepithelial, morpheaform (sclerosing, desmoplastic), infiltrative, micronodular, and basosquamous. Superficial BCCs typically occur at a younger age than other types of BCC (with a median age of 57 years at diagnosis) and are most commonly found on the trunk and extremities. They account for up to 30% of all BCCs and are the second most common subtype. In Black and Hispanic patients, BCCs are more commonly of the nodular subtype and are more often pigmented. Superficial BCCs typically grow horizontally but can become invasive. This horizontal spread is often not detected clinically, and superficial BCCs have a higher recurrence rate with surgical treatment.
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 (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
403914000 – Superficial basal cell carcinoma
Differential Diagnosis & Pitfalls
- Actinic keratosis
- Squamous cell carcinoma in situ (Bowen disease)
- Lichen planus-like keratosis
- Extramammary Paget disease
- Atypical fibroxanthoma
- Adenoid cystic carcinoma (see adenoid cystic carcinoma of ear)
- Merkel cell carcinoma
- Eccrine carcinoma
- Microcystic adnexal carcinoma
- Basosquamous carcinoma