Types of Basal Cell Carcinoma

TYPES OF BASAL CELL CARCINOMA

There are several distinct clinical types of BCC, and over 20 histological growth patterns of BCC.

Nodular BCC

The most common subtype of BCC, mostly found on the head, especially the cheeks, nasolabial folds, forehead, and eyelids.

  • Shiny or pearly nodule with a smooth surface
  • May have central depression or ulceration, so its edges appear rolled
  • Blood vessels cross its surface
  • Cystic variant is soft, with jelly-like contents

Superficial BCC

the second most common histological subtype, is frequently found on the trunk, arms and legs

  • Most common type in younger adults
  • Slightly scaly, irregular plaque
  • Thin, translucent rolled border

Basosquamous carcinoma

Mixed basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)

  • Infiltrative growth pattern
  • Potentially more aggressive than other forms of BCC

Morpheaform BCC

Most aggressive form of  (BCC)

  • Clinically mimics a scar
  • Usually found in mid-facial sites
  • Waxy, scar-like plaque with indistinct borders

Other histologic subtypes include:

Infiltrative, micronodular, and mixed, and are frequently found on the head and neck1

Advanced BCC 

Advanced BCC encompasses a heterogeneous assortment of cases, including metastatic BCC as well as locally advanced BCC (for which no formal definition exists but which generally includes large, deep, aggressive, or recurrent tumors).

  • Most BCCs can be effectively treated with standard surgical excision, Mohs micrographic surgery, curettage and electrodessication, radiotherapy, and/or superficial field therapies (including 5-fluorouracil, imiquimod, and photodynamic therapy); however, a minority of patients develop advanced BCC.

Locally advanced BCC In general, this classification often includes large, aggressive, or recurrent tumors or those with deeper penetration into the underlying skin and surrounding tissues.

  • LaBCC may be broadly categorized as cases for which (further) surgery is considered inappropriate (i.e., would be substantially disfiguring, may cause significant morbidity, loss of function), and radiation is considered inappropriate as a single modality or second-line treatment.

Metastatic BCC is defined as primary cutaneous basal cell carcinoma that has spread to local or distant lymph
nodes or to distant organs or tissues.

Risk for Recurrence and Metastasis

Recurrence of primary BCC lesions can also occur. The 3 year risk of BCC recurrence after having a single BCC is about 44%.

  • Despite the fact that recurrent lesions tend to be more aggressive, the prognosis for patients with recurrent BCC generally remains favorable. However, recurrent BCC is an indication for even more frequent monitoring and skin examinations.

Risk factors for BCC recurrence and the rare likelihood of metastasis include tumor location and size, tumor involvement of clinical borders, recurrent disease, immunosuppression, prior radiotherapy, perineural involvement, and micronodular, infiltrative, sclerosing, and morpheaform patterns on histology.

BCC Incidence Rates in Canada

BCC incidence in Canada: 50,000 – 60,000 per year. based on CADTH Jan 2014 Assessment

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Find Support 

Melanoma Network of Canada offers free support services for Basal Cell Carcinoma

Basal Cell Carcinoma (BCC)  Treatments

Treatment options for BCC patients.

BCC Patient Forum

A place to ask questions or provide insights and information on your own experience with other patients and caregivers.

Refrences

  1. What Are Basal and Squamous Cell Skin Cancers? https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/about/what-is-basal-and-squamous-cell.html;
  2.  NCCN, V1.2020; 5. Asgari, et al. JAMA Dermatol. 2015;151(9):976-981
  3. Sanofi Advnaced Basal Cell Carcinoma Burdon of Illness https://www.melanomanetwork.ca/wp-content/uploads/2021/03/Advanced-basal-cell-carcinoma-Burden-of-Illness.pptx
  4. IMAGES provided by DermNet NZ https://dermnetnz.org/
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