Skip to main content
SpringerLink
Log in

Basal Cell Carcinoma

  • Chapter
  • First Online:
Evidence-Based Procedural Dermatology

  • 1506 Accesses

Abstract

Cutaneous basal cell carcinoma (BCC) is the most ubiquitous cancer affecting humans worldwide [1]. It is the most common cutaneous malignancy, accounting for approximately 60–75% of all skin cancers [2]. BCC is an indolent, locally invasive, malignant epithelial neoplasm arising from the basilar layer of the epidermis [3]. It slowly progresses, with projections of micro-tumor spreading in a three-dimensional manner throughout the papillary and reticular dermis [4], and rarely leads to metastasis. BCC is thought to be composed of aberrant follicular germinative cells, also known as trichoblasts, due to its morphological and immunohistochemical similarities to hair follicle structures [5].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. American Cancer Society. 2008 cancer facts and figures. http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf. Accessed 9 March 2009.

  2. Barksdale SK, O’Connor N, Barnhill R. Prognostic factors for cutaneous squamous cell and basal cell carcinoma. Determinants of risk of recurrence, metastasis, and development of subsequent skin cancers. Surg Oncol Clin N Am. 1997;6(3):625–38.

    PubMed  CAS  Google Scholar 

  3. Roewert-Huber J, Lange-Asschenfeldt B, Stockfleth E, Kerl H. Epidemiology and aetiology of basal cell carcinoma. Br J Dermatol. 2007;157 Suppl 2:47–51.

    Article  PubMed  CAS  Google Scholar 

  4. Braun RP, Klumb F, Girard C, Bandon D, Salomon D, Skaria A, et al. Three-dimensional reconstruction of basal cell carcinomas. Dermatol Surg. 2005;31(5):562–6.

    Article  PubMed  CAS  Google Scholar 

  5. Owens DM, Watt FM. Contribution of stem cells and differentiated cells to epidermal tumours. Nat Rev Cancer. 2003;3(6):444–51.

    Article  PubMed  CAS  Google Scholar 

  6. Diepgen TL, Mahler V. The epidemiology of skin cancer. Br J Dermatol. 2002;146 Suppl 61:1–6.

    Article  PubMed  Google Scholar 

  7. Basal Cell Carcinoma. http://www.skincancer.org/Basal-Cell-Carcinoma. Accessed 9 March 2009.

  8. Lear JT, Smith AG. Basal cell carcinoma. Postgrad Med J. 1997;73:538–42.

    Article  PubMed  CAS  Google Scholar 

  9. Staples MP, Elwood M, Burton RC, Williams JL, Marks R, Giles GG. Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Med J Aust. 2006;184(1):6–10.

    PubMed  Google Scholar 

  10. Richmond-Sinclair NM, Pandeya N, Ware RS, Neale RE, Williams GM, van der Pols JC, et al. Incidence of basal cell carcinoma multiplicity and detailed anatomic distribution: longitudinal study of an Australian population. J Invest Dermatol. 2009;129(2):323–8.

    Article  PubMed  CAS  Google Scholar 

  11. Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United States: incidence. J Am Acad Dermatol. 1994;30:774–8.

    Article  PubMed  CAS  Google Scholar 

  12. de Vries E, Louwman M, Bastiaens M, de Gruijl F, Coebergh JW. Rapid and continuous increases in incidence rates of basal cell carcinoma in the southeast Netherlands since 1973. J Invest Dermatol. 2004;123: 634–8.

    Article  PubMed  Google Scholar 

  13. Marcil I, Stern R. Risk of developing subsequent NMSC in patients with a history of NMSc: a critical review of the literature and metaanalysis. Arch Dermatol. 2000;136:1524–30.

    Article  PubMed  CAS  Google Scholar 

  14. Gallagher RP, Hill GB, Bajdik CD, Fincham S, Coldman AJ, McLean DI, et al. Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer. I. Basal cell carcinoma. Arch Dermatol. 1995;131(2):157–63.

    Article  PubMed  CAS  Google Scholar 

  15. Gallagher RP, Hill GB, Bajdik CD, et al. Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer. I. Basal cell carcinoma. Arch Dermatol. 1995;131:157–63.

    Article  PubMed  CAS  Google Scholar 

  16. Corona R, Dogliotti E, Eric M, et al. Risk factors for basal cell carcinoma in a Mediterranean population: role of recreational sun exposure early in life. Arch Dermatol. 2001;137:1162–8.

    PubMed  CAS  Google Scholar 

  17. Kricker A, Armstrong BK, English DR, Heenan PJ. Does intermittent sun exposure cause basal cell carcinoma? A case-control study in Western Australia. Int J Cancer. 1995;60:489–94.

    Article  PubMed  CAS  Google Scholar 

  18. Lear JT, Tan BB, Smith AG, et al. Risk factors for basal cell carcinoma in the UK: case-control study in 806 patients. J R Soc Med. 1997;90:371–4.

    PubMed  CAS  Google Scholar 

  19. Ron E. Cancer risks from medical radiation. Health Phys. 2003;85(1):47–59.

    Article  PubMed  CAS  Google Scholar 

  20. Yu HS, Liao WT, Chai CY. Arsenic carcinogenesis in the skin. J Biomed Sci. 2006;13(5):657–66.

    Article  PubMed  CAS  Google Scholar 

  21. Ho WL, Murphy GM. Update on the pathogenesis of post-transplant skin cancer in renal transplant recipients. Br J Dermatol. 2008;158(2):217–24.

    Article  PubMed  CAS  Google Scholar 

  22. Nijsten TE, Stern RS. The increased risk of skin cancer is persistent after discontinuation of psoralen+ ultraviolet A: a cohort study. J Invest Dermatol. 2003;121:252–8.

    Article  PubMed  CAS  Google Scholar 

  23. Sasson M, Mallory SB. Malignant primary skin tumors in children. Curr Opin Pediatr. 1996;8(4):372–7.

    Article  PubMed  CAS  Google Scholar 

  24. Hartevelt M, Bavinck J, Koote A, et al. Incidence of skin cancer after renal transplantation in the Netherlands. Transplantation. 1990;49:506–9.

    Article  PubMed  CAS  Google Scholar 

  25. Moloney F, Comber H, Conton P, Murphy G. The role of immunosuppression in the pathogenesis of basal cell carcinoma. Br J Dermatol. 2006;154:790–1.

    Article  PubMed  CAS  Google Scholar 

  26. Scrivener Y, Grosshans E, Cribier B. Variations of basal cell carcinomas according to gender, age, location and histopathological subtype. Br J Dermatol. 2002;147:41–7.

    Article  PubMed  CAS  Google Scholar 

  27. Sexton M, Jones DB, Maloney ME. Histologic pattern analysis of basal cell carcinoma: study of a series of 1039 consecutive neoplasms. J Am Acad Dermatol. 1990;23:1118–26.

    Article  PubMed  CAS  Google Scholar 

  28. Batra RS, Kelley LC. Predictors of extensive subclinical spread in nonmelanoma skin cancer treated with Mohs micrographic surgery. Arch Dermatol. 2002;138: 1043–51.

    Article  PubMed  Google Scholar 

  29. Saldanha G, Fletcher A, Slater DN. Basal cell carcinoma: a dermatopathological and molecular biological update. Br J Dermatol. 2003;148:195–202.

    Article  PubMed  CAS  Google Scholar 

  30. Hutchin M. Sustained Hedgehog signaling is required for basal cell carcinoma proliferation and survival: conditional skin tumorigenesis recapitulates the hair growth cycle. Genes Dev. 2005;19:214–23.

    Article  PubMed  CAS  Google Scholar 

  31. Gailani MR, Stahle-Backdahl M, Leffell DJ, et al. The role of the human homologue of Drosophila patched in sporadic basal cell carcinomas. Nat Genet. 1996;14: 78–81.

    Article  PubMed  CAS  Google Scholar 

  32. Xie J, Murone M, Luoh SM, et al. Activating smoothened mutations in sporadic basal-cell carcinoma. Nature. 1998;391:90–2.

    Article  PubMed  CAS  Google Scholar 

  33. Epstein E. Basal cell carcinoma: attack of the hedgehog. Nature. 2008;8:743–54.

    CAS  Google Scholar 

  34. Kim MY, Park HJ, Baek SC, Byun DG, Houh D. Mutations of the p53 and PTCH gene in basal cell ­carcinomas: UV mutation signature and strand bias. J Dermatol Sci. 2002;29:1–9.

    Article  PubMed  Google Scholar 

  35. Tilli CM, Van Steensel MA, Krekels GA, Neumann HA, Ramaekers FC. Molecular aetiology and pathogenesis of basal cell carcinoma. Br J Dermatol. 2005;152: 1108–24.

    Article  PubMed  CAS  Google Scholar 

  36. Ziegler A, Leffell DJ, Kunala S, et al. Mutation hotspots due to sunlight in the p53 gene of nonmelanoma skin cancers. Proc Natl Acad Sci USA. 1993;90:4216–20.

    Article  PubMed  CAS  Google Scholar 

  37. Rowe D. Comparison of treatment modalities for basal cell carcinoma. Clin Dermatol. 1995;13:617–20.

    Article  PubMed  CAS  Google Scholar 

  38. Walling HW, Fosko SW, Geraminejad PA, Whitaker DC, Arpey CJ. Aggressive basal cell carcinoma: presentation, pathogenesis, and management. Cancer Metastasis Rev. 2004;23:389–402.

    Article  PubMed  Google Scholar 

  39. Malone JP, Fedok FG, Belchis DA, Maloney ME. Basal cell carcinoma metastatic to the parotid: report of a new case and review of the literature. Ear Nose Throat J. 2000;79(7):511–5, 518–9.

    Google Scholar 

  40. Ting P, Kasper R, Arlette J. Metastatic basal cell carcinoma: report of two cases and literature review. J Cutan Med Surg. 2005;9:10–5.

    Article  PubMed  Google Scholar 

  41. Snow SN, Sahl W, Lo JS, Mohs FE, Warner T, Dekkinga JA, et al. Metastatic basal cell carcinoma. Report of five cases. Cancer. 1994;73(2):328–35.

    Article  PubMed  CAS  Google Scholar 

  42. Lo J, Snow S, Reizner G, et al. Metastatic basal cell carcinoma: report of twelve cases with a review of the literature. J Am Acad Dermatol. 1991;24:715–9.

    Article  PubMed  CAS  Google Scholar 

  43. Abide J, Nahai F, Bennett R. The meaning of surgical margins. Plast Reconstr Surg. 1984;73(3):492–7.

    Article  PubMed  CAS  Google Scholar 

  44. Neville J, Welch E, Leffell D. Management of NMSC in 2007. Nature. 2007;4(8):462–9.

    Google Scholar 

  45. Smeets N. Little evidence available on treatments for basal cell carcinoma. Cancer Treat Rev. 2005;31:143–6.

    Article  PubMed  Google Scholar 

  46. National Comprehensive Cancer Network Practice Guidelines in Oncology – Basal Cell Skin Cancer v.1.2009. http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf. Accessed 9 March 2009.

  47. Silverman M, Kopf A, Grin C, et al. Recurrence rates of treated basal cell carcinomas. Part 1: overview. J Dermatol Surg Oncol. 1991;17:713–8.

    PubMed  CAS  Google Scholar 

  48. Brodland D. Features associated with metastasis (basal cell carcinoma). In: Miller S, Maloney M, editors. Cutaneous oncology: pathophysiology, diagnosis, and management. Malden: Blackwell Science; 1998. p. 657–63.

    Google Scholar 

  49. Chapter 23: Carcinoma of the skin (excluding eyelid, vulva, and penis). In: Fleming ID, Cooper JS, Henson DE, et al., editors. American Joint Committee on Cancer Staging Manual. 5th ed. Philadelphia: Lippincott-Raven; 1997. p. 157–60.

    Google Scholar 

  50. Robinson JK. Follow-up and prevention (basal cell). In: Miller SJ, Maloney ME, editors. Cutaneous oncology pathophysiology, diagnosis, and management. Malden: Blackwell Science; 1998. p. 695–8.

    Google Scholar 

  51. Marghoob AA, Slade J, Salopek TG, Kopf AW, Bart RS, Rigel DS. Basal cell and squamous cell carcinomas are important risk factors for cutaneous malignant melanoma. Screening implications. Cancer. 1995;75(2 Suppl):707–14.

    Article  PubMed  CAS  Google Scholar 

  52. American Cancer Society. Detailed guide: skin cancer – basal and squamous cell. http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=51. Accessed 9 March 2009.

  53. National Cancer Institute: What you need to know about skin cancer. http://www.cancer.gov/pdf/WYNTK/WYNTK_skin.pdf. Accessed 10 March 2009.

  54. Smeets NW, Krekels GA, Ostertag JU, Essers BA, Dirksen CD, Nieman FH, et al. Surgical excision vs Mohs’ micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. Lancet. 2004;364(9447):1766–72.

    Article  PubMed  Google Scholar 

  55. Mosterd K, Krekels GA, Nieman FH, Ostertag JU, Essers BA, Dirksen CD, et al. Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncol. 2008;9(12):1149–56.

    Article  PubMed  Google Scholar 

  56. Avril MF, Auperin A, Margulis A, Gerbaulet A, Duvillard P, Benhamou E, et al. Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study. Br J Cancer. 1997;76(1):100–6.

    Article  PubMed  CAS  Google Scholar 

  57. Thissen MR, Nieman FH, Ideler AH, Berretty PJ, Neumann HA. Cosmetic results of cryosurgery versus surgical excision for primary uncomplicated basal cell carcinomas of the head and neck. Dermatol Surg. 2000;26(8):759–64.

    Article  PubMed  CAS  Google Scholar 

  58. Hall VL, Leppard BJ, McGill J, Kesseler ME, White JE, Goodwin P. Treatment of basal-cell carcinoma: comparison of radiotherapy and cryotherapy. Clin Radiol. 1986;37(1):33–4.

    Article  PubMed  CAS  Google Scholar 

  59. Rhodes LE, de Rie MA, Leifsdottir R, Yu RC, Bachmann I, Goulden V, et al. Five-year follow-up of a randomized, prospective trial of topical methyl aminolevulinate photodynamic therapy vs surgery for nodular basal cell carcinoma. Arch Dermatol. 2007; 143(9):1131–6.

    Article  PubMed  CAS  Google Scholar 

  60. Mosterd K, Thissen MR, Nelemans P, Kelleners-Smeets NW, Janssen RL, Broekhof KG, et al. Fractionated 5-aminolaevulinic acid-photodynamic therapy vs. surgical excision in the treatment of nodular basal cell carcinoma: results of a randomized controlled trial. Br J Dermatol. 2008;159(4):864–70.

    Article  PubMed  CAS  Google Scholar 

  61. Wang I, Bendsoe N, Klinteberg CA, Enejder AM, Andersson-Engels S, Svanberg S, et al. Photodynamic therapy vs. cryosurgery of basal cell carcinomas: results of a phase III clinical trial. Br J Dermatol. 2001;144(4):832–40.

    Article  PubMed  CAS  Google Scholar 

  62. Basset-Seguin N, Ibbotson SH, Emtestam L, Tarstedt M, Morton C, Maroti M, et al. Topical methyl aminolaevulinate photodynamic therapy versus cryotherapy for superficial basal cell carcinoma: a 5 year randomized trial. Eur J Dermatol. 2008;18(5):547–53.

    PubMed  CAS  Google Scholar 

  63. Soler AM, Angell-Petersen E, Warloe T, Tausjø J, Steen HB, Moan J, et al. Photodynamic therapy of superficial basal cell carcinoma with 5-aminolevulinic acid with dimethylsulfoxide and ethylendiaminetetraacetic acid: a comparison of two light sources. Photochem Photobiol. 2000;71(6):724–9.

    Article  PubMed  CAS  Google Scholar 

  64. Lui H, Hobbs L, Tope WD, Lee PK, Elmets C, Provost N, et al. Photodynamic therapy of multiple nonmelanoma skin cancers with verteporfin and red light-emitting diodes: two-year results evaluating tumor response and cosmetic outcomes. Arch Dermatol. 2004;140(1):26–32.

    Article  PubMed  CAS  Google Scholar 

  65. Beutner KR, Geisse JK, Helman D, Fox TL, Ginkel A, Owens ML. Therapeutic response of basal cell carcinoma to the immune response modifier imiquimod 5% cream. J Am Acad Dermatol. 1999;41(6): 1002–7.

    Article  PubMed  CAS  Google Scholar 

  66. Marks R, Gebauer K, Shumack S, Amies M, Bryden J, Fox TL, et al. Australasian Multicentre Trial Group. Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: results of a multicenter 6-week dose-response trial. J Am Acad Dermatol. 2001;44(5): 807–13.

    Article  PubMed  CAS  Google Scholar 

  67. Shumack S, Robinson J, Kossard S, Golitz L, Greenway H, Schroeter A, et al. Efficacy of topical 5% imiquimod cream for the treatment of nodular basal cell carcinoma: comparison of dosing regimens. Arch Dermatol. 2002;138(9):1165–71.

    Article  PubMed  CAS  Google Scholar 

  68. Sterry W, Ruzicka T, Herrera E, Takwale A, Bichel J, Andres K, et al. Imiquimod 5% cream for the treatment of superficial and nodular basal cell carcinoma: randomized studies comparing low-frequency dosing with and without occlusion. Br J Dermatol. 2002; 147(6):1227–36.

    Article  PubMed  CAS  Google Scholar 

  69. Geisse JK, Rich P, Pandya A, Gross K, Andres K, Ginkel A, et al. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: a double-blind, randomized, vehicle-controlled study. J Am Acad Dermatol. 2002;47(3):390–8.

    Article  PubMed  Google Scholar 

  70. Geisse J, Caro I, Lindholm J, Golitz L, Stampone P, Owens M. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from two phase III, randomized, vehicle-controlled studies. J Am Acad Dermatol. 2004;50(5):722–33.

    Article  PubMed  Google Scholar 

  71. Schulze HJ, Cribier B, Requena L, Reifenberger J, Ferrándiz C, Garcia Diez A, et al. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from a randomized vehicle-controlled phase III study in Europe. Br J Dermatol. 2005;152(5):939–47.

    Article  PubMed  CAS  Google Scholar 

  72. Eigentler TK, Kamin A, Weide BM, Breuninger H, Caroli UM, Möhrle M, et al. A phase III, randomized, open label study to evaluate the safety and efficacy of imiquimod 5% cream applied thrice weekly for 8 and 12 weeks in the treatment of low-risk nodular basal cell carcinoma. J Am Acad Dermatol. 2007;57(4):616–21.

    Article  PubMed  Google Scholar 

  73. Miller BH, Shavin JS, Cognetta A, Taylor RJ, Salasche S, Korey A, et al. Nonsurgical treatment of basal cell carcinomas with intralesional 5-fluorouracil/epinephrine injectable gel. J Am Acad Dermatol. 1997;36(1): 72–7.

    Article  PubMed  CAS  Google Scholar 

  74. Romagosa R, Saap L, Givens M, Salvarrey A, He JL, Hsia SL, et al. A pilot study to evaluate the treatment of basal cell carcinoma with 5-fluorouracil using phosphatidyl choline as a transepidermal carrier. Dermatol Surg. 2000;26(4):338–40.

    Article  PubMed  CAS  Google Scholar 

  75. Edwards L, Tucker SB, Perednia D, Smiles KA, Taylor EL, Tanner DJ, et al. The effect of an intralesional sustained-release formulation of interferon alfa-2b on basal cell carcinomas. Arch Dermatol. 1990;126(8):1029–32.

    Article  PubMed  CAS  Google Scholar 

  76. Cornell RC, Greenway HT, Tucker SB, Edwards L, Ashworth S, Vance JC, et al. Intralesional interferon therapy for basal cell carcinoma. J Am Acad Dermatol. 1990;23(4 Pt 1):694–700.

    Article  PubMed  CAS  Google Scholar 

  77. Punjabi S, Cook LJ, Kersey P, Marks R, Cerio R. Solasodine glycoalkaloids: a novel topical therapy for basal cell carcinoma. A double-blind, randomized, placebo-controlled, parallel group, multicenter study. Int J Dermatol. 2008;47(1):78–82.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Columbia University Medical Center/New York Presbyterian Hospital, Dermatologic Surgery Unit, 161 Fort Washington Avenue 12th Floor, New York, NY, 10032, USA

    Monica L. Halem, Désirée Ratner & Asha Patel

Authors
  1. Monica L. Halem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Désirée Ratner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Asha Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Monica L. Halem .

Editor information

Editors and Affiliations

  1. Aesthetic Surgery, Professor, Departments of Dermatology,, Chief, Section of Cutaneous and, Feinberg School of Med, Northwestern Univ, Chicago, 60611, Illinois, USA

    Murad Alam

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Halem, M.L., Ratner, D., Patel, A. (2012). Basal Cell Carcinoma. In: Alam, M. (eds) Evidence-Based Procedural Dermatology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-09424-3_2

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-09424-3_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-09423-6

  • Online ISBN: 978-0-387-09424-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation