Difference between revisions of "Basal cell carcinoma"
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# | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Basal_cell_carcinoma_-_2_-_intermed_mag.jpg | |||
| Width = | |||
| Caption = Basal cell carcinoma. [[H&E stain]]. | |||
| Micro = basaloid cells with moderate blue/grey cytoplasm, nests with peripheral palisading of cells, artefactual clefting, myxoid stroma | |||
| Subtypes = | |||
| LMDDx = | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = | |||
| Assdx = | |||
| Syndromes = [[Bazex syndrome]], [[nevoid basal cell carcinoma syndrome]], [[seroderma pigmentosum]] | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = very common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = good | |||
| Other = | |||
| ClinDDx = | |||
}} | |||
'''Basal cell carcinoma''', abbreviated ''BCC'', is an extremely common form of skin cancer. | |||
==General== | |||
*Very common. | |||
*Sun exposed skin. | |||
*Hair bearing area; tumour derived from hair follicle - a more appropriate name might be ''trichoblastic carcinoma''.<ref name=Ref_Derm389>{{Ref Derm|389}}</ref> | |||
*Very rarely metastasizes: | |||
**Dermatopathologists might see a couple in their career. | |||
**There are only ~ 300 literature reports of metastatic BCC.<ref name=pmid16208438>{{Cite journal | last1 = Ting | first1 = PT. | last2 = Kasper | first2 = R. | last3 = Arlette | first3 = JP. | title = Metastatic basal cell carcinoma: report of two cases and literature review. | journal = J Cutan Med Surg | volume = 9 | issue = 1 | pages = 10-5 | month = Jan | year = 2005 | doi = 10.1007/s10227-005-0027-1 | PMID = 16208438 }}</ref> | |||
===Clinical=== | |||
*Telangiectasias. | |||
*Raised pearly nodule. | |||
===As part of a syndrome=== | |||
*[[Nevoid basal cell carcinoma syndrome]] (NBCCS), AKA ''Gorlin syndrome''. | |||
*[[Bazex syndrome]] (X-linked).<ref>URL: [http://emedicine.medscape.com/article/1101146-diagnosis http://emedicine.medscape.com/article/1101146-diagnosis]. Accessed on: 6 May 2010.</ref> | |||
*[[Xeroderma pigmentosum]]. | |||
==Microscopic== | |||
Features:<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref><ref name=Ref_Derm390>{{Ref Derm|390}}</ref> | |||
#Basaloid cells - similar in appearance to basal cells: | |||
#*Moderate blue/grey cytoplasm. | |||
#*Dark ovoid/ellipsoid nucleus with uniform chromatin. | |||
#Palisading of cells at the edge of the cell nests. | |||
#Artefactual separation of cells (forming the nests) from the underlying stroma - '''key feature'''. | |||
#Surrounded by blue [[myxoid stroma|(myxoid) stroma]] - '''key feature'''. | |||
May be present:<ref name=Ref_Derm390>{{Ref Derm|390}}</ref> | |||
*[[Dystrophic calcification]] - possibly more aggressive behaviour.<ref name=pmid20489568>{{Cite journal | last1 = Slodkowska | first1 = EA. | last2 = Cribier | first2 = B. | last3 = Peltre | first3 = B. | last4 = Jones | first4 = DM. | last5 = Carlson | first5 = JA. | title = Calcifications associated with basal cell carcinoma: prevalence, characteristics, and correlations. | journal = Am J Dermatopathol | volume = 32 | issue = 6 | pages = 557-64 | month = Aug | year = 2010 | doi = 10.1097/DAD.0b013e3181ca65e2 | PMID = 20489568 }}</ref> | |||
*[[Amyloid]]. | |||
*Inflammation. | |||
Notes: | |||
*Palisading = the long axes of the cells are alined and the axes are perpendicular to the interface between the (basaloid cell) nests and stroma. | |||
*Key elements in a list: Artefactual clefting (of nests), Basaloid cells, Peripheral palisading, Myxoid stroma. | |||
**Memory device ''PAM'': palisading, artefactual clefts, myxoid stroma. | |||
DDx: | |||
*[[Trichoepithelioma]] - no artefactual cleft.<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref> | |||
*[[Adenoid cystic carcinoma]] - no myxoid stroma, no peripheral palisading. | |||
*[[Eccrine poroma]] - on palms & soles, BCC rarely found there.<ref>{{Ref DCHH|284}}</ref> | |||
*Reticulated [[seborrheic keratosis]] - for BCC, fibroepitheliomatous pattern. | |||
*[[Basaloid squamous cell carcinoma]] - [[AKA]] squamous cell carcinoma, basaloid variant. | |||
*[[Basosquamous carcinoma]] - squamous cell carcinoma with basal cell carcinoma (a collision tumour). | |||
*[[Solar elastosis]] with ectatic [[blood vessel]]s. | |||
===Images=== | |||
<gallery> | |||
Image:Basal_cell_carcinoma_-_2_-_intermed_mag.jpg | BCC - intermed. mag. (WC/Nephron) | |||
Image:Basal_cell_carcinoma_-_high_mag.jpg | BCC - high mag. (WC/Nephron) | |||
Image:Basal_cell_carcinoma_pathology.jpg | BCC - poor quality. (WC) | |||
Image:Basal_cell_carcinoma_fibroepitheliomatous_pattern_-_very_low_mag.jpg | Fibroepithelioma of Pinkus. (WC/Nephron) | |||
Image:SkinTumors-P6040209.JPG | Fibroepithelioma of Pinkus. (WC) | |||
</gallery> | |||
www: | |||
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/basal_cell_carcinoma_high_power.jpg BCC (ucsf.edu)].<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html]. Accessed on: 4 September 2011.</ref> | |||
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=1&sort=0&s=20080802171910891 BCC with fibroepitheliomatous pattern / fibroepithelioma of Pinkus (surgicalpathologyatlas.com)]. | |||
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=930934558 BCC with fibroepitheliomatous pattern (dermatlas.med.jhmi.edu)]. | |||
===Basal cell carcinoma subtypes/unique features=== | |||
*Many patterns exist. | |||
*Recurrence higher in morpheaform (sclerosing), infiltrative, micronodular, and superficial patterns.<ref>Basal cell carcinoma. eMedicine. ''Prognosis'' section. URL: [http://emedicine.medscape.com/article/276624-overview http://emedicine.medscape.com/article/276624-overview]. Accessed on: 17 September 2011.</ref> | |||
*DG says the prognosis is similar for all BCC subtypes, except for ''sclerosing'' pattern and ''infiltrative'' pattern.<ref>Ghazarian, Danny; 14 September 2011.</ref> | |||
The subtypes:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref> | |||
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto" | |||
! Pattern | |||
! Key histologic feature | |||
! Other histologic features | |||
! Other | |||
|- | |||
| Superficial pattern | |||
| connected to epidermis | |||
| | |||
| | |||
|- | |||
| Nodular pattern | |||
| nodules | |||
| partial detachment from epidermis | |||
| subgroup ''micronodular'' = nests equal size ~ 0.2 mm dia., >=25% of lesion | |||
|- | |||
| Morpheaform (sclerosing) pattern | |||
| stroma sclerosis | |||
| | |||
| often seen with ''infiltrative pattern'', DDx: desmoplastic trichoepithelioma<ref name=pmid22366669>{{Cite journal | last1 = Kirzhner | first1 = M. | last2 = Jakobiec | first2 = FA. | last3 = Borodic | first3 = G. | title = Desmoplastic trichoepithelioma: report of a unique periocular case. | journal = Ophthal Plast Reconstr Surg | volume = 28 | issue = 5 | pages = e121-3 | month = | year = | doi = 10.1097/IOP.0b013e318245535a | PMID = 22366669 }} | |||
</ref> | |||
|- | |||
| Infiltrative pattern | |||
| small irregular cell aggregates | |||
| | |||
| often also sclerosing or morpheaform | |||
|- | |||
| Fibroepitheliomatous pattern | |||
| cords and columns of basaloid cells | |||
| fibrous stroma | |||
| name of pattern comes from ''fibroepithelioma of Pinkus''; DDx: reticulated [[seborrheic keratosis]] | |||
|- | |||
| Infundibulocystic pattern | |||
| small keratocysts (keratin cysts) | |||
| usu. small, often in cords | |||
| usu. indolent | |||
|- | |||
| Adenoidal pattern | |||
| cribriform / pseudoglandular arch. | |||
| myxoid stroma, peripheral palisading | |||
| DDx: [[adenoid cystic carcinoma]] | |||
|- | |||
|} | |||
Unique features/differentiation:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref> | |||
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto" | |||
! Differentiation / unique cell | |||
! Key histologic feature | |||
! Other histologic features | |||
! Other | |||
|- | |||
| Pigmented cells | |||
| '''any pattern''' can have pigmentation | |||
| pigment may be in malignant cell | |||
| DDx: collision lesion with [[melanocytic lesion]] | |||
|- | |||
| Squamous differentiation (metatypical BCC) | |||
| pink cytoplasm, keratinization | |||
| | |||
| assoc. with ulceration/tumour recurrence | |||
|- | |||
| Eccrine differentiation | |||
| focal duct formation | |||
| | |||
| very rare, DDx: BCC engulfing sweat ducts | |||
|- | |||
| Clear cells (Clear cell BCC) | |||
| clear cytoplasm | |||
| | |||
| due to glycogen | |||
|} | |||
==IHC== | |||
*CK5/6 +ve. | |||
**Useful to assess [[margins]]... if very close. | |||
*CD10 +ve. | |||
*Actin +ve. | |||
Squamous cell carcinoma versus basal cell carcinoma: | |||
*BerEP4 +ve. | |||
**SCC usually negative.<ref name=pmid19187107>{{Cite journal | last1 = Yu | first1 = L. | last2 = Galan | first2 = A. | last3 = McNiff | first3 = JM. | title = Caveats in BerEP4 staining to differentiate basal and squamous cell carcinoma. | journal = J Cutan Pathol | volume = 36 | issue = 10 | pages = 1074-176 | month = Oct | year = 2009 | doi = 10.1111/j.1600-0560.2008.01223.x | PMID = 19187107 }}</ref> | |||
*EMA -ve. | |||
**SCC usually positive.<ref name=pmid10971697>{{Cite journal | last1 = Beer | first1 = TW. | last2 = Shepherd | first2 = P. | last3 = Theaker | first3 = JM. | title = Ber EP4 and epithelial membrane antigen aid distinction of basal cell, squamous cell and basosquamous carcinomas of the skin. | journal = Histopathology | volume = 37 | issue = 3 | pages = 218-23 | month = Sep | year = 2000 | doi = | PMID = 10971697 }}</ref> | |||
*SMA +ve.<ref>URL: [http://www.ihcworld.com/_newsletter/2004/2004-12_basal_cell_vs_squamous_v1.pdf http://www.ihcworld.com/_newsletter/2004/2004-12_basal_cell_vs_squamous_v1.pdf]. Accessed on: 19 December 2012.</ref> | |||
**SCC usually negative. | |||
==Sign-out== | |||
<pre> | |||
SKIN LESION, SHAVE BIOPSY WITH ELECTRODESICCATION AND CURETTAGE (EDC): | |||
- BASAL CELL CARCINOMA, MARGIN STATUS ASSESSED CLINICALLY DURING EDC. | |||
- EXTENSIVE SOLAR ELASTOSIS. | |||
</pre> | |||
<pre> | |||
SKIN LESION, RIGHT EAR, EXCISION: | |||
- BASAL CELL CARCINOMA. | |||
- MARGINS NEGATIVE FOR BASAL CELL CARCINOMA. | |||
- EXTENSIVE SOLAR ELASTOSIS. | |||
</pre> | |||
<pre> | |||
SKIN LESION, RIGHT TEMPLE, RE-EXCISION: | |||
- BASAL CELL CARCINOMA, NODULAR, MARGINS NEGATIVE. | |||
- DERMAL SCAR. | |||
- EXTENSIVE SOLAR ELASTOSIS. | |||
</pre> | |||
===Micro=== | |||
The sections show hair-bearing skin with nests of basaloid cells in the dermis. The basaloid nests have peripheral palisading of the nuclei, have numerous mitoses, and are surrounded by a myxoid stroma. The nests are well demarcated from the stroma and show focal clefting from the stroma. The margins are negative for basal cell carcinoma. | |||
==See also== | |||
*[[Dermatopathology]]. | |||
*[[Dermatologic neoplasms]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] |
Revision as of 21:38, 1 July 2013
Basal cell carcinoma | |
---|---|
Diagnosis in short | |
![]() Basal cell carcinoma. H&E stain. | |
| |
LM | basaloid cells with moderate blue/grey cytoplasm, nests with peripheral palisading of cells, artefactual clefting, myxoid stroma |
Syndromes | Bazex syndrome, nevoid basal cell carcinoma syndrome, seroderma pigmentosum |
| |
Prevalence | very common |
Prognosis | good |
Basal cell carcinoma, abbreviated BCC, is an extremely common form of skin cancer.
General
- Very common.
- Sun exposed skin.
- Hair bearing area; tumour derived from hair follicle - a more appropriate name might be trichoblastic carcinoma.[1]
- Very rarely metastasizes:
- Dermatopathologists might see a couple in their career.
- There are only ~ 300 literature reports of metastatic BCC.[2]
Clinical
- Telangiectasias.
- Raised pearly nodule.
As part of a syndrome
- Nevoid basal cell carcinoma syndrome (NBCCS), AKA Gorlin syndrome.
- Bazex syndrome (X-linked).[3]
- Xeroderma pigmentosum.
Microscopic
- Basaloid cells - similar in appearance to basal cells:
- Moderate blue/grey cytoplasm.
- Dark ovoid/ellipsoid nucleus with uniform chromatin.
- Palisading of cells at the edge of the cell nests.
- Artefactual separation of cells (forming the nests) from the underlying stroma - key feature.
- Surrounded by blue (myxoid) stroma - key feature.
May be present:[5]
- Dystrophic calcification - possibly more aggressive behaviour.[6]
- Amyloid.
- Inflammation.
Notes:
- Palisading = the long axes of the cells are alined and the axes are perpendicular to the interface between the (basaloid cell) nests and stroma.
- Key elements in a list: Artefactual clefting (of nests), Basaloid cells, Peripheral palisading, Myxoid stroma.
- Memory device PAM: palisading, artefactual clefts, myxoid stroma.
DDx:
- Trichoepithelioma - no artefactual cleft.[4]
- Adenoid cystic carcinoma - no myxoid stroma, no peripheral palisading.
- Eccrine poroma - on palms & soles, BCC rarely found there.[7]
- Reticulated seborrheic keratosis - for BCC, fibroepitheliomatous pattern.
- Basaloid squamous cell carcinoma - AKA squamous cell carcinoma, basaloid variant.
- Basosquamous carcinoma - squamous cell carcinoma with basal cell carcinoma (a collision tumour).
- Solar elastosis with ectatic blood vessels.
Images
www:
- BCC (ucsf.edu).[8]
- BCC with fibroepitheliomatous pattern / fibroepithelioma of Pinkus (surgicalpathologyatlas.com).
- BCC with fibroepitheliomatous pattern (dermatlas.med.jhmi.edu).
Basal cell carcinoma subtypes/unique features
- Many patterns exist.
- Recurrence higher in morpheaform (sclerosing), infiltrative, micronodular, and superficial patterns.[9]
- DG says the prognosis is similar for all BCC subtypes, except for sclerosing pattern and infiltrative pattern.[10]
The subtypes:[11]
Pattern | Key histologic feature | Other histologic features | Other |
---|---|---|---|
Superficial pattern | connected to epidermis | ||
Nodular pattern | nodules | partial detachment from epidermis | subgroup micronodular = nests equal size ~ 0.2 mm dia., >=25% of lesion |
Morpheaform (sclerosing) pattern | stroma sclerosis | often seen with infiltrative pattern, DDx: desmoplastic trichoepithelioma[12] | |
Infiltrative pattern | small irregular cell aggregates | often also sclerosing or morpheaform | |
Fibroepitheliomatous pattern | cords and columns of basaloid cells | fibrous stroma | name of pattern comes from fibroepithelioma of Pinkus; DDx: reticulated seborrheic keratosis |
Infundibulocystic pattern | small keratocysts (keratin cysts) | usu. small, often in cords | usu. indolent |
Adenoidal pattern | cribriform / pseudoglandular arch. | myxoid stroma, peripheral palisading | DDx: adenoid cystic carcinoma |
Unique features/differentiation:[11]
Differentiation / unique cell | Key histologic feature | Other histologic features | Other |
---|---|---|---|
Pigmented cells | any pattern can have pigmentation | pigment may be in malignant cell | DDx: collision lesion with melanocytic lesion |
Squamous differentiation (metatypical BCC) | pink cytoplasm, keratinization | assoc. with ulceration/tumour recurrence | |
Eccrine differentiation | focal duct formation | very rare, DDx: BCC engulfing sweat ducts | |
Clear cells (Clear cell BCC) | clear cytoplasm | due to glycogen |
IHC
- CK5/6 +ve.
- Useful to assess margins... if very close.
- CD10 +ve.
- Actin +ve.
Squamous cell carcinoma versus basal cell carcinoma:
- BerEP4 +ve.
- SCC usually negative.[13]
- EMA -ve.
- SCC usually positive.[14]
- SMA +ve.[15]
- SCC usually negative.
Sign-out
SKIN LESION, SHAVE BIOPSY WITH ELECTRODESICCATION AND CURETTAGE (EDC): - BASAL CELL CARCINOMA, MARGIN STATUS ASSESSED CLINICALLY DURING EDC. - EXTENSIVE SOLAR ELASTOSIS.
SKIN LESION, RIGHT EAR, EXCISION: - BASAL CELL CARCINOMA. - MARGINS NEGATIVE FOR BASAL CELL CARCINOMA. - EXTENSIVE SOLAR ELASTOSIS.
SKIN LESION, RIGHT TEMPLE, RE-EXCISION: - BASAL CELL CARCINOMA, NODULAR, MARGINS NEGATIVE. - DERMAL SCAR. - EXTENSIVE SOLAR ELASTOSIS.
Micro
The sections show hair-bearing skin with nests of basaloid cells in the dermis. The basaloid nests have peripheral palisading of the nuclei, have numerous mitoses, and are surrounded by a myxoid stroma. The nests are well demarcated from the stroma and show focal clefting from the stroma. The margins are negative for basal cell carcinoma.
See also
References
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 389. ISBN 978-0443066542.
- ↑ Ting, PT.; Kasper, R.; Arlette, JP. (Jan 2005). "Metastatic basal cell carcinoma: report of two cases and literature review.". J Cutan Med Surg 9 (1): 10-5. doi:10.1007/s10227-005-0027-1. PMID 16208438.
- ↑ URL: http://emedicine.medscape.com/article/1101146-diagnosis. Accessed on: 6 May 2010.
- ↑ 4.0 4.1 Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1180-1. ISBN 978-1416031215.
- ↑ 5.0 5.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 390. ISBN 978-0443066542.
- ↑ Slodkowska, EA.; Cribier, B.; Peltre, B.; Jones, DM.; Carlson, JA. (Aug 2010). "Calcifications associated with basal cell carcinoma: prevalence, characteristics, and correlations.". Am J Dermatopathol 32 (6): 557-64. doi:10.1097/DAD.0b013e3181ca65e2. PMID 20489568.
- ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 284. ISBN 978-0470519035.
- ↑ URL: http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html. Accessed on: 4 September 2011.
- ↑ Basal cell carcinoma. eMedicine. Prognosis section. URL: http://emedicine.medscape.com/article/276624-overview. Accessed on: 17 September 2011.
- ↑ Ghazarian, Danny; 14 September 2011.
- ↑ 11.0 11.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 392-5. ISBN 978-0443066542.
- ↑ Kirzhner, M.; Jakobiec, FA.; Borodic, G.. "Desmoplastic trichoepithelioma: report of a unique periocular case.". Ophthal Plast Reconstr Surg 28 (5): e121-3. doi:10.1097/IOP.0b013e318245535a. PMID 22366669.
- ↑ Yu, L.; Galan, A.; McNiff, JM. (Oct 2009). "Caveats in BerEP4 staining to differentiate basal and squamous cell carcinoma.". J Cutan Pathol 36 (10): 1074-176. doi:10.1111/j.1600-0560.2008.01223.x. PMID 19187107.
- ↑ Beer, TW.; Shepherd, P.; Theaker, JM. (Sep 2000). "Ber EP4 and epithelial membrane antigen aid distinction of basal cell, squamous cell and basosquamous carcinomas of the skin.". Histopathology 37 (3): 218-23. PMID 10971697.
- ↑ URL: http://www.ihcworld.com/_newsletter/2004/2004-12_basal_cell_vs_squamous_v1.pdf. Accessed on: 19 December 2012.