Basal cell carcinoma

Author: Jagadeesh D, MBBS

Basal cell carcinoma, also known as basal cell cancer, is the

most common malignant tumor of the skin, which is aggressive
locally but rarely metastasizes.
Basal cell carcinoma arises from the progenitors of sweat
glands, the folliculo-sebaceous-apocrine germ cell, also known as
Trichoblasts, present in the basal layer or stratum basale of skin.
While most of the Basal cell carcinoma are attributed to
excessive exposure to sunlight, which causes DNA strands to
break and thymidine dimers to accumulate, leading to mutation
which results in uncontrolled proliferation and the development of
tumor. Some Basal cell carcinomas are associated with an
inherited syndrome, one of them is the nevoid basal cell
carcinoma syndrome or Gorlin syndrome, which is an autosomal
dominant disease caused by a mutation in the PTCH 1 gene
located on the 9q22.3 chromosome, a tumor suppressor gene
leading to disinhibition of Hedgehog signaling pathway resulting in
an uncontrolled cell proliferation. The affected individual also
presents with pits in hands and foot, cysts in jaw, calcification of
falx cerebri and rib abnormalities. Another gene involved in Basal
cell carcinoma is the SMO gene, which also acts via Hedgehog
signaling pathway.
Risk factors for Basal cell carcinoma includes exposure to
UV light, having lighter skin, long term exposure to arsenic,
radiation therapy and conditions involving poor immune function,
such as xeroderma pigmentosum.
Lesions of the Basal cell carcinoma may be superficial, with
rolled out edges and telangiectasia, a dilated running blood vessel
in the lesion; or it may be nodular with waxy, pink, pearly nodules;
or a deep infiltrating one, with central crusting and ulceration. A
variant of Basal cell carcinoma, the Rodent ulcer, is a large
nodular skin lesion with a central necrosis usually on the face.
Diagnosis of Basal cell carcinoma is mainly clinical by
identifying the characteristic lesions. Wait!!! What if it’s a deep
infiltrating one? Then the definitive test would be a skin biopsy. In
which case, palisading nuclei surrounded by artifactual cleft or pit
confirms the diagnosis.

Treatment of Basal cell carcinoma mainly involves surgical

excision of the tumor. If the tumor size is large, then Mohs surgery
is done. Other treatment options include chemotherapy with
Imiquimod and 5- Fluorouracil, radiotherapy, laser therapy and
less used, application of cold.
Alright, as a quick recap, Basal cell carcinoma is a locally
aggressive tumor arising from trichoblasts in the basal layer of
skin, with lesions having a characteristic rolled out edges and
telangiectasia. Basal cell carcinoma is usually associated with
excessive exposure to sun and mutations that activate hedgehog
signaling pathway, and is mainly treated surgically.

References
1) First aid USMLE, 2018
2) Robbins and Cotran Pathologic basis of disease
3) https://en.wikipedia.org/wiki/Basal-cell_carcinoma
4) http://www.pathologyoutlines.com/topic/skintumornonmelanocyticbcc.html
5) Articles of my seniors