Infiltrating Basal Cell Carcinoma.ppt

Infiltrating Basal Cell Carcinoma Laura S. Gilmore, MD Department of Ophthalmology October 8, 2004 Discussant: Kenn Freedman, MD Case Presentation CC: growth on right side of nose HPI: 81 yo HF who first noted growth on right side of nose “last December”, progressively growing. PMH: arthritis SH: ? ppd smoker X 25 years ROS: denies F/C, significant weight loss FH: non-contributory Physical Exam General: AAO, VSS and good VA: 20/80 OD, 20/50 OS Pupils: 3mm OU, no APD External: extensive ulcerative lesion from bridge of nose to RLL and R cheek, with almost complete destruction of RLL and nearly complete ptosis of RUL IOP, CVF, DFE normal OS, unobtainable OD Differential Diagnosis Malignant melanoma Squamous cell carcinoma Basal cell carcinoma, infiltrative Infectious Basics of BCC Background Most common cutaneous malignancy (~80-90%) Typically slow-growing, rarely metastasizes Sun-exposed skin, mostly face and scalp, esp nose, cheek, and periorbital regions (~80%) Frequency 900,000 Dx in US/year estimated lifetime risk of 33-39% for men and 23-28% for women Sex Men 2X over women Basics of BCC Mortality/Morbidity 0.1% metastasize Very low mortality Significant morbidity with direct invasion of adjacent tissues, especially when on face or near an eye Age Likelihood increases with age Rare in 40 yo Race Most often in light-skinned, rare in dark-skinned races Variants of Basal Cell Carcinoma Superficial Nodular Micronodular Infiltrating (5%) Sclerosing/ morpheaform (5%) Metatypical Infundibulocystic Nodulocystic Adenoid Clear cell Follicular Sebaceous Perineurally invasive Perineural Invasion May be seen in 3% of pts with infiltrating and morpheaform types Most often infiltrating type, which has highest rate of local recurrence Requires CT scan for full work-up Causes? inherently aggressive behavior vs inadequate early management? Treatment Options Electrodessication and curettage Curettage alone Surgical excision Mohs micrographically controlled surgery Cryosurger