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BASAL CELL CARCINOMA "RODENT ULCER"(Definition - Pathology - Clinical Picture - Treatment |
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Written by Administrator
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Thursday, 10 December 2009 20:46 |
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Definition: Locally malignant tumour arising from basal cell layer any stratified squamous epithelium..
Incidence:
-At any age but old people of both sexes are more affected.
-More common in people with fair, frecky skin.
Common sites:
-Usually in the face above a line extending from lobule of the ear to angle of the mouth (site of maximum expusure to sun "Solar dermatitis may be precancerous".
-Commonest at inner canthus and nasolabial fold.
-But may occur anywhere in skin e.g. mouth, pharynx esophagus & anal canal.
Pathology: Exposure to sun is predisposing factor solar dermatitis.
q Mic. masses of polyhedral cells surrounded by columnar cells arranged in palisade arrangement.
q Mac.
(I) Typical Cases Ulcer with:
-Rolled in edge why? growth in the basal layer.
- Beaded margin why? site with growth & site of fibrosis.
- Dry scab on the floor. If removed it reappear along the course of the disease. "Characteristic" .
(II) Other types:
Solid type: Slowly growing, raised above the surface & may fungate.
Cystic type: around the eye & nose
- Adenoid cystic basal cell carcinoma
- Usually wrongly diagnosed as seb. cyst.
Field - Fire type: Superficial flat lesion with active spreading edge surrounding scarred area.
Invasive type: small at the surface but it penetrates deeply infiltrating the bone.
Pigmented type: difficult to differentiate it from melanoma.
The turban tumour (cylindroma): extensive turban like swelling over the scalp.
Diagnosis:
Typical cases show rodent ulcer with rolled in edge and beaded margin with dry scab on the floor. It has mild indurated base but induration does not extend beyond the margin of the ulcer.
It is locally malignant i.e. may infiltrate surroundings fixation but give no lymphatic or blood spread.
If lymph nodes are enlarged it may be due to:
1- 2ry infection. 2-Basosquamous change.
Treatment:
[I] Surgical treatment:
1- Very small (no need for reconstruction).
2- > 2cm diameter (need > 2 plains of irradiation)
3- Infiltrating the bone (Malig. cells hidden in the bone trabeculae.)
4- Near the eye or nose. (Irradiation may destruct the cartilage or Injure the eye, recently sheilds can protect the eyes).
5- Recurrence after irradiation
-Excision of the ulcer with 1/2: 1cm safety margin or according to mapping of the tumour spread by frozen section biopsy (Mohs' micrographic surgery).
- Immediate plastic repair of the defect can be done.
[II] Radiotherapy: Infiltration by radium needle (7000 rad for one weak).
Indications: 1- Not very small & not more than 2cm.
2- Not infiltrating the bone.
[III] Cryotherapy: In small lesions but the scarring is less predectable than with other techniques.
[IV] Topical chemotherapy results in unacceptable cure rate.
[V] Curettage and electrodesiccation : It is acceptable for lesions less than 2cm in diameter. The disadvantage is the lack of a specimen for determining the adequacy of resection. SOURCE: Prof. AYMAN SALEM'S BOOK
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Not to be reproduced without permission of Vascular Society of Egypt
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