Basal Cell Carcinoma (BCC) is the most common type of skin cancer, arising from the basal layer of the epidermis. It is a slow-growing, locally invasive malignancy that rarely metastasizes but can cause significant local tissue destruction if untreated.
Incidence
- Most common skin cancer worldwide (80% of all skin cancers).
- Higher risk in fair-skinned individuals and those with chronic sun
exposure.
- More frequent in older adults, males, and people living in sunny
climates.
Definition
Basal Cell Carcinoma (BCC) is a slow-growing,
locally invasive, malignant tumor of the basal keratinocytes of the
epidermis, often caused by chronic sun exposure.
Etiology
(Causes & Risk Factors)
1. Primary
Cause
- Chronic exposure to ultraviolet (UV) radiation
(sunlight, tanning beds).
2. Risk Factors
(Mnemonic: SUN DAMAGE)
- S – Sun exposure (chronic, intense exposure).
- U – UV radiation (from sunlight, tanning beds).
- N – Nevus sebaceous (congenital skin lesion predisposing to BCC).
- D – DNA repair defects (Xeroderma pigmentosum).
- A – Age > 50 years.
- M – Male gender (higher incidence than females).
- A – Arsenic exposure (industrial pollution, contaminated water).
- G – Genetic mutations (PTCH1 gene mutations in Gorlin syndrome).
- E – Ethnicity (fair-skinned individuals at higher risk).
Pathogenesis of
Basal Cell Carcinoma (Mnemonic: "MUTATE")
- M – Mutation in the PTCH1 gene (Hedgehog pathway mutation).
- U – Uncontrolled proliferation of basal keratinocytes.
- T – Tumor formation with pearly, nodular growth.
- A – Angiogenesis (new blood vessel formation supports tumor growth).
- T – Tissue invasion (deep penetration into the skin, but rare
metastasis).
- E – Epidermal damage and ulceration in advanced cases.
Clinical
Features (Mnemonic: "PEARLY")
Common
Presentation of BCC
- P – Pearly, translucent nodule (most common type).
- E – Erythematous (reddish) patch with telangiectasia (small
visible blood vessels).
- A – Asymptomatic or mild itching.
- R – Rolled borders with central ulceration (rodent ulcer).
- L – Local invasion, but no metastasis.
- Y – Yellowish, waxy plaque in some cases.
Types of Basal
Cell Carcinoma
- Nodular BCC (Most Common, 60%)
- Pearly, dome-shaped nodule with visible blood
vessels (telangiectasia).
- May ulcerate (rodent ulcer).
- Common on sun-exposed areas (face, nose,
forehead).
- Superficial BCC (30%)
- Red, scaly patches with slightly raised borders.
- Common on trunk and extremities.
- Often confused with eczema or psoriasis.
- Morpheaform (Sclerosing) BCC (5-10%)
- Flat, firm, scar-like lesion with ill-defined
borders.
- Highly invasive and difficult to treat.
- Pigmented BCC
- Darkly pigmented lesion resembling melanoma.
- Common in darker-skinned individuals.
- Basosquamous Carcinoma (Aggressive Variant)
- Combination of BCC and Squamous Cell Carcinoma
(SCC).
- More aggressive than pure BCC.
Complications
- Local invasion of deep tissues (muscles, cartilage, bone).
- Rodent ulcer formation (chronic ulcer with destruction of
surrounding skin).
- Recurrence after incomplete excision.
- Rare metastasis (< 0.1%).
Laboratory
Investigations
- Dermoscopy – To examine lesion
patterns (pearly appearance, telangiectasia).
- Skin Biopsy (Gold Standard) – Confirms basaloid cell
proliferation with palisading nuclei.
- Histopathology – Helps differentiate BCC
from melanoma or SCC.
- CT Scan/MRI – For deep or recurrent BCC
involving bones/cartilage.
Management of
Basal Cell Carcinoma
General
Measures (Mnemonic: "SUN BLOCK")
- S – Sunscreen (SPF 30+, broad-spectrum).
- U – UV protection (avoid direct sun exposure, wear protective
clothing).
- N – No tanning beds (increase BCC risk).
- B – Biopsy for any suspicious lesion.
- L – Laser therapy or cryotherapy for superficial lesions.
- O – Observation for small, non-aggressive lesions.
- C – Complete excision (Mohs surgery for best outcomes).
- K – Keep follow-up for recurrence prevention.
Allopathic
Treatment (Mnemonic: "CUT IT OUT")
- C – Cryotherapy (liquid nitrogen freezing for small lesions).
- U – Ultraviolet protection (prevent recurrence).
- T – Topical creams (Imiquimod, 5-Fluorouracil for superficial BCC).
- I – Incision (Mohs micrographic surgery for facial BCC).
- T – Targeted therapy (Vismodegib for advanced/metastatic cases).
- O – Observation for slow-growing lesions.
- U – Ulcerated tumors require aggressive management.
- T – Total excision (Surgical removal is curative in most cases).
Surgical
Treatment
- Excisional Surgery – First-line treatment (5mm
margin clearance).
- Mohs Micrographic Surgery – Gold standard for facial
and high-risk BCC.
- Curettage & Electrodesiccation – Used
for small, low-risk tumors.
- Radiation Therapy – For elderly or inoperable
cases.
Homeopathic
Treatment
- Thuja Occidentalis
- Warty, cauliflower-like growths on skin.
- Oily skin with tendency for abnormal tissue
growth.
- Useful for skin cancers with slow growth.
- Better in dry weather, worse in damp conditions.
- Good for early-stage BCC.
- Arsenicum Album
- Ulcerated, burning skin lesions with intense
pain.
- Skin appears dry, scaly, and sensitive.
- Restlessness, anxiety, and exhaustion present.
- Worse at night, better with warmth.
- Used in aggressive BCC with ulceration.
- Hydrastis Canadensis
- Indurated, hard skin growths.
- Yellowish discharge from ulcers.
- Weak immunity with slow-healing wounds.
- Good for chronic skin conditions.
- Used in BCC of mucocutaneous areas.
- Calcarea Fluorica
- Hard, stony tumors on skin.
- Prevents recurrence after surgical removal.
- Slow-growing BCC with deep tissue involvement.
- Used for fibrous, thickened skin conditions.
- Carcinosin
- History of multiple skin cancers in family.
- Weak immunity with recurrent skin tumors.
- Good for prevention of further malignancy.
- Worse from suppression of skin eruptions.
Mnemonic for
Homeopathic Treatment (T-A-H-C-C)
- T – Thuja (Warty growths).
- A – Arsenicum Album (Burning ulceration).
- H – Hydrastis (Hard skin tumors).
- C – Calcarea Fluorica (Deep-seated growths).
- C – Carcinosin (Cancer diathesis).
