Basal Cell Carcinoma

1
Basal Cell Carcinoma

• Presented by
• Bill V. Way, D.O.
• AOCD Board Certified Dermatologist
• Residency in US Army at Walter Reed
• Consultant for Charlton Methodist Hosp for past
  19 years

2
Epidemiology and Etiology

• Incidence US 500-1000 per 100,000
• gt400,000 new patients annually
• Age usually over age 40
• Sex Males gtFemales
• Race rare in brown and black skinned pt

3
Diagnosis

• High index of suspicion
• Onset
• Prior treatment

4
Types of BCC

• Supeficial BCC
• Nodular BCC
• Pigmented BCC
• Cystic BCC
• Sclerosing or Morpheaform BCC
• Recurrent BCC

5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
Biopsy

• Biopsy Shave, Punch,Excision
• Specimen to reliable dermatopathologist or
  pathologist

24
What to Biopsy

• Select a good representation of the lesion for
  biopsy
• If small lesion, biopsy the entire lesion
• Final treatment code is dependent on actual size
  of lesion at time of biopsy
• Get exact measurements of lesion, digital photo
  if possible

25
When should you do a biopsy?

• If you are unsure of diagnosis of lesion and have
  in the differential a skin cancer, basal cell
  carcinoma, squamous cell carcinoma or melanoma,
  then do a biopsy
• List your differential in the order which you
  think the lesion is. Learn from your errors.

26
Methods of Biopsy

• Shave Biopsy easiest and fastest
• Punch Biopsy depth of lesion
• Excisional Biopsy gt time, gt expense, complete
  removal of tumor
• Incisional Biopsy partial removal of tumor,
  gttime, gt expense

27
Shave Biopsy

• Xylocaine 2 with epi
• 1cc tuberculin syringe, 30g needle
• Non-sterile gloves
• 15 sterile blade Bard Parker
• Specimen bottle, labeled correctly
• Drysol solution
• Bacitracin Ointment, Bandaid

28
(No Transcript)
29
Punch Biopsy

• Xylocaine 2 with epi
• 1cc tuberculin syringe, 30g needle
• Sterile gloves
• Punch 2mm, 3mm, 4mm, 6mm
• Minor surgery tray, suture size for area
• Specimen bottle labeled correctly
• Bacitracin Ointment and bandaid

30
(No Transcript)
31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
Excision or Incisional Biopsy

• Xylocaine 2 with epi
• 3-5cc syringe, 30g needle, sterile gloves
• 15 or 11 sterile blade, surgery tray
• Suture for area, absorbable, non-absorbable
• Specimen bottle labeled correctly
• Bacitracin Ointment and sterile dressing

38
Treatment of BCC

• Electrodesiccation and curettage
• Excision
• Cryosurgery
• Mohs Surgery
• Radiation
• 5-Fluorouracil
• Aldara (Imiquimod)

39
Electrodesiccation Curettage

• Hyfrecator
• Curettes 2mm, 3mm, 4mm
• EDC times 3
• Expect scar formation
• 85-90 cure rate
• Check for Pacemaker, Defribralator

40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
Excision

• Adequate outline of tumor margin
• Adequate margins 3-5mm
• Surgery Tray, Hyfrecator
• Suture absorbable, non-absorbable
• Tag tip, specimen labeled correctly
• Pressure dressing, antibiotic ointment

46
Cryosurgery

• Used only for superficial and small nodular BCC
• Not indicated for deeper BCC
• High morbidity, very painful

47
Mohs Surgery

• Can be used on all BCC
• Difficult lesions sclerosing or recurrent,
  poorly defined borders, tumors of nose, eyelids
• Recurrent lesions
• Lesions over 25mm dia
• 98 cure rate
• Expensive, gt time
• Few Mohs Surgeons, Dermatologist

48
(No Transcript)
49
(No Transcript)
50
(No Transcript)
51
(No Transcript)
52
(No Transcript)
53
(No Transcript)
54
(No Transcript)
55
(No Transcript)
56
(No Transcript)
57
Radiation therapy

• For elderly pt who can not tolerate surgery
• Useful for eyelids and lips
• Requires several outpt visits
• If used in young pt can lead to development of
  SCC or recurrent BCC later in life at same site

58
5-Fluorouracil

• Should not be used today
• Can destroy surface without affecting deeper bcc
  cells

59
Prevention

• Frequent skin examination q 3 months
• Yearly by PCP or Dermatologist
• Sunscreens SPF 15 or higher
• Protective clothing, hats, sunglasses
• Team approach Patient, Family, Doctor

60
Remember

• Look at all the patients skin, especially the
  sun exposed skin.
• Biopsy ?? Lesions
• Treat if trained and comfortable
• Otherwise refer to a more qualified physician
  Dermatologist, Mohs Surgeon, Plastic Surgeon
• Follow patients frequently

61
Thank you

• We look forward to future lectures and having you
  each do rotations in dermatology if possible.