BASAL CELL CARCINOMA

Sinonim:
Basal cell epithelioma
Basalioma
Rodent ulcer (Jacobi
ulcer)

Basal cell carcinoma:

Malignant tumor of the skin
Believed to arise from the external
root sheat of Hair follicle or basal
cells of the epidermis
Most common malignancy in human
Typically occurs in chronic sun
exposure area

 Rarely metastasizes.
The incidence of metastatic 0,0028%
- 0.1%.
The most common sites of
metastasis are the lymph nodes,
lungs, and bones.
Typically, enlarge slowly tendency

History:
Complain of Patients slowly
enlarging lesion, does not heal &
bleeds when traumatized.
Hystory of chronic sun exposure:
- Recreational sun exposure (eg,
sunbathing, outdoor sports)
- Occupational sun exposure (eg,
farming, construction)

 Occasionally have a history of

exposure to ionizing radiation. or
a history of arsenic intake
Long term drug induced immune
supression risk
Develop within Associated with
xeroderma pigmentosum,
albinism, basal cell nevus syndrom

Clinical presentation
Nodular BCC
Its the most common type
usually a round, pearly, flesh
colored papule,telangiectases.
As it enlarges frequently
ulcerates centrally ( Rodent ulcer ),
leaving a raised,
pearly border with telangiectases,.

Ulkus rodent; destruksi lokal

luas pada lesi

 Most tumors are observed on the

face, although the trunk and
extremities also are affected.
Deferensial diagnosis :
-Dermal nevus
-Amelanotic melanoma
-Tricoepithelioma
-Fibrous Papul
-Sebaseus hiperplasia

Cystic BCC:
- An uncommon variant of
nodular BCC,
- It often is indistinguishable from
nodular BCC clinically,
- Polypoid appearance.

Difrensial diagnosis:
Nevus intradermal; konsistensi lebih
lunak, dan ukuran lebih stabil,
Hiperperplasia sebaseus : berwarna
kekuningan, dan disertai umbilikasi
sentral.
Hydrocystoma : kista pada kelenjar ekrin
atau apokrin

Pigmented BCC
Uncommon variant of nodular
BCC
Appears brown-black in some or
all areas,
it often difficult to differentiate from
melanoma, seboroik keratosis,
nevi.
Areas often do not retain much
pigment, and pearly, raised borders

Morpheaform (sclerosing) BCC

Morpheaform BCCuncommon variant
Tumor cells induce fibroblast proliferation
& collagen deposition (sclerosis)
clinically resembling a scar, scleroderma
. Appears as a white or yellow, waxy,
sclerotic plaque, rarely ulcerates.

Karsinoma sel basal

morfeaform; lesi menyerupai
skar

 Tumor infiltrates in thin strands

between collagen fibers treatment
is difficult & the clinical margins are
difficult to distinguish.
Mohs micrographic surgery is the
treatment of choice for this type

Superficial BCC

Appears as an erythematous,
well circumscribed patch or
plaque, often with a whitish scale.

The tumor appears multicentric.

Difrensial diagnosis:
- Dermatitis nummular
- psoriasis
- bowen disease
- keratosis seboroik
- nevi
- Actinic keratosis

Karsinoma sel basal superfisial

pada punggung ; plak batas
tegas, mirip psoriasis

Prognosis and staging

Incidence metastases: 1:1000
Staging use UICC classification,
Clinically useless because:
T- too rough & N and M
dont exist

The following information to

ensure quality of therapy:
Tumor size(horizontal diameter)
Localisation
Vertical tumor diameter
Therapeutical safety margin
Margin of surgical resection
microscopically in health tissue

Therapy
The recommended treatment
(standard procedure) surgical
with histological confirmation.
Newer, nonsurgical therapeutic
future possibilities, consider
current medical modalities to be
experimental cure rates <<
surgical modalities.

SURGICAL CARE

Surgical Care:
The goal of therapy removal of
the tumor with the best possible
cosmetic result.
Surgical modalities most used,
most effective, and most studied
treatments.
Selection of the modality depends:
tumor is primary or recurrent,
location, size, and type.

Micrographically controlle
surgery
recommended in all size of
tumor,recurring tumor
Procedure:
1. Border marker of the tumor
2. Local anesthetic .

3. Excision of the tumor (2-4 mm

safety margin) with topographical
marking
4. Complete histilogical examination
of the whole outside surface.
5. If necessary, reexcision until
outside is tumor free

Advantages:
highest cure rate of any treatment
modality (99% for primary BCC, 9095% for recurrent BCC
and is the treatment of choice for
morpheaform BCC and recurrent
BCC.

Disadvantages:
Micrographic surgery is time
consuming,
Patients might require additional
anesthesia before each stage.

Terapi alternatif
Bedah konvensional
Elektrodesikasi + kuretase
Crysurgery
Radioterapi
5-fluorourasil
interferon alfa-2b

Follow-up
Follow-up is necessary.
Possibility of new tumors
appearing (30 % of the cases)

Education & exact instruction for

self examination greatest
importance
A yearly clinical followup
examination at least 3 year

Prevention:
Avoid possible potentiating
factors (eg, sun exposure,
ionizing radiation, arsenic
ingestion).

Special Concerns:
Tumor locations for high risk of
recurrence, the nose or T-zone of
the face have a higher incidence
of recurrence.
Morpheaform (or sclerotic) type of
BCC has a high risk of recurrence.

KARSINOMA SEL
SKUAMOSA

 Merupakan proliferasi maligna

sel keratinosit epidermis
Etiologi: Sinar Surya, termal,
sikatriks, radiasi kronik, virus,
imunosupressant, tar, ulkus
kronik.

Manifestasi klinis
Karsinoma sel skuamosa In situ
Mengenai full thickness intraepidermal
Dapat timbul pada lesi kulit: keratosis
termal, keratosis radiasi kronik,
sikatriks, keratosis solar, keratosis
arsenik, kornu kutaneus

Dapat menetap dalam waktu lama

didalam epidermis dan tanpa
diprediksi melewati membrana
basalis meluas ke dermis

Karsinoma sel skuamosa Invasif

invasif awal : nodul warna seperti
warna kulit atau eritem ringan, batas
tidak jelas, permukaan biasanya halus
tetapi sering menjadi verukous atau
papillomatous
Dapat timbul sebagai patch eritem
disertai skuama persisten menyerupai
dermatitis atau dermatofitosis

 Pertumbuhan tumor elevasi &

diameter
Invasi progresif ke jaringan
dibawahnya memfiksir tumor
ke jaringan dibawahnya
Ulserasi
Mudah berdarah , krusta

Difrensial diagnosis
Verruka vulgaris
Giant seboroic keratosis
Giant keratoacanthoma
Deep mycosis
Granuloma pyogenic
Bowen disease

Diagnosis
Berdasarkan gambaran klinis dan
pemeriksaan histopatologi pada
lesi yang dicurigai

Terapi
Bedah eksisi mohs micrographic
surgery
Terapi radiasi
Photodynamic therapy
Immunoterapi
Kemoterapi

Pencegahan
Hindari paparan sinar surya
berlebihan
Pakai tabir surya khususnya pada
resiko tingggi: burn scar, discoid
lupus eritematosus, dan pada daerah
X-ray demage