Browse Tag: basal cell cancer

Histopathologic examination of basal cell epitheliomas

Histopathologic examination of basal cell epitheliomas reveals collections of cells with dark-staining nuclei and scant cytoplasm. The periphery of the cell masses shows cells in a palisade arrangement resembling the basal layer of the epidermis. Treatment of basal cell epitheliomas consists of complete surgical excision, destruction by curettage and electrodesiccation, or radiation therapy. Cryosurgery has been employed for selected lesions, especially superficial basal cell carcinomas. A margin of seemingly normal tissue should be removed around the tumor to prevent recurrence arising from invasion by strands of tumor cells. The clean margins must be monitored by histopathologic examination.

Recurrent basal cell carcinomas are usually difficult to cure, but Mohs’ microscopic controlled surgery, when it is performed by a specially trained physician, is effective in eradicating the entire tumor. Routine in vivo chemosurgical fixation of the tumor with zinc
chloride paste is no longer required. In the current procedure, fresh tissue is removed after local anesthesia, and frozen sections are examined microscopically. This more efficient method spares a larger amount of normal skin and reduces the discomfort associated with chemical fixation. The tumor is removed layer by layer, and all margins are carefully examined until a tumor-free plane is achieved.

Indications for microscopic controlled excision of skin cancer include recurrent basal cell epitheliomas and squamous cell carcinomas; tumors with indistinct margins, such as sclerosing basal cell epitheliomas; and lesions in such areas as the inner and outer canthus of the eye and the tip of the nose, where maximal preservation of normal skin is desirable. For certain complicated or advanced tumors, the fixed-tissue approach is considered more reliable than the fresh-tissue technique.

Basal Cell Carcinoma

Basal cell carcinomas are among the most common cutaneous malignant tumors. Two thirds of basal cell carcinomas are associated with actinic damage; however, one third occur in areas not exposed to the sun. These lesions, although histologically malignant, only rarely metastasize. However, if neglected, they are destructive and can cause disability or death by invading adjacent soft tissue, cartilage, or bone.

A basal cell carcinoma usually presents as a dome-shaped, white to pink papule or nodule with a raised pearly border and prominent superficial vessels. There may be scaling, crusting, or ulceration. Various other clinical types of basal cell carcinoma have also been observed. The cystic variety is translucent and contains gelatinous fluid. The sclerosing variety, appearing as a fibrotic, whitish, macular plaque with indistinct borders, may easily be overlooked. Superficial multicentric lesions may resemble asymptomatic eczematous plaques, although close inspection reveals a fine, raised pearly border. The pigmented variety may be confused clinically with a malignant melanoma. A rodent ulcer is usually a painless basal cell carcinoma that has progressively enlarged, producing tissue destruction with invasion and ulceration of underlying structures.

Multiple basal cell carcinomas, ranging in number from a few to hundreds, may occur in patients with the basal cell nevus syndrome, an autosomal dominant condition. The basal cell carcinomas begin to appear after puberty on the face, the trunk, and the extremities. Many are highly invasive and involve the embryonic cleft areas of the face, especially the regions around the eyes and the nose. Other associated features of the basal cell nevus syndrome include odontogenic jaw cysts, palmar and plantar pits, ectopic calcification (particularly of the falx cerebri), and ocular and skeletal abnormalities such as hypertelorism and shortening of the fourth and fifth metacarpals. This disease complex has also been termed Gorlin’s syndrome.