BASAL CELL CARCINOMA

(Basal Cell Epithelioma, BCC, Rodent Ulcer)

 It is the most common type of malignancy in
humans that develops frequently on the exposed
surfaces of the skin, the face and the scalp in the
middle aged and elderly persons.
The Basal Cell Carcinoma often develops an
ulcer that appears to have been bitten (gnawed) by a
rodent like a rat, thus the name RODENT ULCER.
 It is slow growing and rarely metastasizes,
however it can cause significant local destruction
and rarely disfigurement if treated inadequately.
This carcinoma does not arise from the oral
mucosa and thus is never seen in the oral cavity
unless it arrives there by the invasion and infiltration
by the skin surface.
BCC is believed to develop from the
pluripotential stem cells of the basal layer of
epidermis as well as follicular structures(hair follicle
stem cells).
Etiology
Ultraviolet Radiations are the most important and
common cause of BCC and Shorter wavelength UV
(290-320nm) being the major cause. A long latency
period is required for the clinical onset of the BCC.
X-ray exposure as well as Chemical like Arsenic
have also been associated with the basal cell
carcinoma development.
Syndromes like Xeroderma Pigmentosum and
Nevoid BCC syndrome are characterized by multiple
BCC occurring in early age.
Clinical Features
BCC occurs most frequently in persons in the 4th
decade of life.

The male to female ratio is 3:2 approximately.

It is rare in black skin individuals and frequent in

white skin individuals.

It is mostly seen in the middle third of the face.

Histological Features
Histopathological features vary somewhat with
subtypes, but most BCCs share some common
histological characteristics.
​The basal cells have large nuclei and relatively
little cytoplasm.
Nuclei are large but they may not appear
atypical.
Cleft formation, aka retraction artifact, commonly
occurs between BCC nests and stroma because of
shrinkage of mucin during tissue fixation and
staining. These are very helpful in histopathological
diagnosis.
The subtypes of BCC are as under:

Nodular Basal Cell Carcinoma

 It is the most common clinical subtype of the
BCC (almost half of all the BCCs).
It is characterized by the nodules of large
basophilic cells and stromal retraction(cleft
formation).
Basalioma cells have large,
hyperchromatic, oval nuclei with little cytoplasm.
Clinically, it appears as a small, slightly
elevated papule with a central depression which
ulcerates, heals over and then breaks down again.
Pigmented Basal Cell Carcinoma
 Similar to that of Nodular BCC but with the
addition of melanin.

The melanocytes are present between tumor

cells and contain numerous melanin granules in their
cytoplasm and dendrites.

Clinically, appears as a hyperpigmented

translucent papule which may be eroded.
Superficial Basal Cell Carcinoma
 Superficial BCC appears as a bud of basaloid
cells attached to the underlying surface of the
epidermis.

Nests of various sizes often are seen in the

upper dermis with palisading pattern.

Clinically, appears as scaly patches or papules

that are pink to red-brown in color often with central
clearing and a thread like border.
Morpheaform and Infiltrating BCC
 It is the more aggressive form of BCC that
exhibit patterns resulting in strands of cells rather
than round nests. These thin strands are embedded
in a dense fibrous stroma.

Peripheral palisading and retraction are less

pronounced in this type of BCC.

Clinically, presented as plaques or papules.

Ulceration, bleeding and crusting are uncommon.

Often mistaken for scar tissue.

Micronodular BCC
 It is same as nodular type with multiple
microscopic nodules smaller than 15µ.

Less prominent Retraction Artifact.

It is of aggressive variety.

Less prone to ulceration and have well defined

border.
Cystic BCC
 Presents cystic nodules that may mimic benign
cystic lesions.

Clinically, these are translucent and blue-grey in

color.
Treatment and Prognosis
Surgical Excision of tumor.

Each lesion treated separately.

Prognosis of basal cell lesions is good as it does

not tend to metastasize and responds well to
treatment.
CLINICAL PRESENTATION OF BCC
PIGMENTED BCC

NODULAR BCC
MORPHEAFORM &
INFILTRATING BCC

SUPERFICIAL BCC
MICRONODULAR BCC

CYSTIC BCC
 Source:
Shafers Textbook of Oral Pathology
Wikipedia
Atlas of Pathology www.pathologyatlas.com
WebMD www.webmd.com
Cambridge University Hospitals www.cuh.org.uk
www.cancer.org
Thank You

Presented by: Himayun Majeed Mir

BDS IIIrd Professional Year