Disclaimer
This guideline for the management of basal cell carcinoma (BCC) is based on that prepared by the British Association of Dermatologists and has been prepared by the BCC subcommittee of the Guidelines Committee of the European Dermatology Forum. It represents an evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guideline, and a brief overview of epidemiological aspects and clinical management of patients with BCC.
Many different and well-accepted treatments are used in the management of BCC. This guideline aims to aid selection of the most appropriate treatment for individual patients.
Definition
BCC is a slowly growing, locally invasive malignant epidermal skin tumour, which exhibits a differentiation potential comparable to at the embryonic hair bud. BCC tends to infiltrate tissues in a three-dimensional contiguous fashion through the irregular growth of subclinical finger-like outgrowths. Metastases are extremely rare, and the morbidity associated with BCC is related to local tissue invasion and destruction; growth pattern largely correlates with the aggressiveness of the tumour. 3,4,5 The tumour is mainly located on the head and neck and mainly affects Caucasians. The multipotent differentiation potentential is reflected by a larger diversity in clinical appearance and morphology, i.e. nodular, cystic, ulcerated, superficial, morphoeic (sclerosing), keratotic and pigmented variants. Histological subtypes can also serve a prognostic factor
Incidence/prevalence
BCC is the most common cancer in the U.S.A., Australia and Europe; its incidence (new cases/100.000 inhabitants/year) increases worldwide with the following numbers being reported: 1998: 128/105 male/female/ 100.000 in South Wales, Great Britain; 2058/1195 male/female/100.000 in Northern Australia. 6-8 The most significant aetiological factor is exposure to ultraviolet radiation. Sun exposure during childhood may be especially critical in the development of BCC in adult life. 9,10
Patients with BCC on head and neck show different phenotypes, including one with continuous development of BCC clusters on the trunk. Such patients are generally younger than patients with BCC on head and neck only. 11 Further risk factors are increasing age, male sex (18-40% more common in white men than women, skin type I and II) and chronic immunosuppression.. 12,6 Multiple BCCs may also arise in basal cell nevus (Gorlin's) syndrome. 13 Once a person has developed a BCC there is a significantly increased risk of developing subsequent BCCs at other sites. 14-15
There is evidence that epidemic of BCCs in Australia is beginning to abate, especially in younger people, possibly as a result of adequate photoprotection. 16
Diagnosis and Investigation
Ideally the treatment of BCC is based upon a clinical diagnosis. Where clinical doubt exists, or when patients are referred for specialized forms of treatment, histology is crucial. Information on the prognosis will be provided by histological subtype of the BCC. Clinically the extent of penetration of tumours is impossible to judge. Scanning techniques such as CT and MRI may be rarely needed
This guideline for the management of basal cell carcinoma (BCC) is based on that prepared by the British Association of Dermatologists and has been prepared by the BCC subcommittee of the Guidelines Committee of the European Dermatology Forum. It represents an evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guideline, and a brief overview of epidemiological aspects and clinical management of patients with BCC.
Many different and well-accepted treatments are used in the management of BCC. This guideline aims to aid selection of the most appropriate treatment for individual patients.
Definition
BCC is a slowly growing, locally invasive malignant epidermal skin tumour, which exhibits a differentiation potential comparable to at the embryonic hair bud. BCC tends to infiltrate tissues in a three-dimensional contiguous fashion through the irregular growth of subclinical finger-like outgrowths. Metastases are extremely rare, and the morbidity associated with BCC is related to local tissue invasion and destruction; growth pattern largely correlates with the aggressiveness of the tumour. 3,4,5 The tumour is mainly located on the head and neck and mainly affects Caucasians. The multipotent differentiation potentential is reflected by a larger diversity in clinical appearance and morphology, i.e. nodular, cystic, ulcerated, superficial, morphoeic (sclerosing), keratotic and pigmented variants. Histological subtypes can also serve a prognostic factor
Incidence/prevalence
BCC is the most common cancer in the U.S.A., Australia and Europe; its incidence (new cases/100.000 inhabitants/year) increases worldwide with the following numbers being reported: 1998: 128/105 male/female/ 100.000 in South Wales, Great Britain; 2058/1195 male/female/100.000 in Northern Australia. 6-8 The most significant aetiological factor is exposure to ultraviolet radiation. Sun exposure during childhood may be especially critical in the development of BCC in adult life. 9,10
Patients with BCC on head and neck show different phenotypes, including one with continuous development of BCC clusters on the trunk. Such patients are generally younger than patients with BCC on head and neck only. 11 Further risk factors are increasing age, male sex (18-40% more common in white men than women, skin type I and II) and chronic immunosuppression.. 12,6 Multiple BCCs may also arise in basal cell nevus (Gorlin's) syndrome. 13 Once a person has developed a BCC there is a significantly increased risk of developing subsequent BCCs at other sites. 14-15
There is evidence that epidemic of BCCs in Australia is beginning to abate, especially in younger people, possibly as a result of adequate photoprotection. 16
Diagnosis and Investigation
Ideally the treatment of BCC is based upon a clinical diagnosis. Where clinical doubt exists, or when patients are referred for specialized forms of treatment, histology is crucial. Information on the prognosis will be provided by histological subtype of the BCC. Clinically the extent of penetration of tumours is impossible to judge. Scanning techniques such as CT and MRI may be rarely needed
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