Pathological Variants and Diagnosis of Basal Cell Carcinoma
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Abstract
Basal cell carcinoma (BCC) is the most common form of nonmelanoma skin cancer occurring in the skin. It is a locally destructive tumour with varied clinical and histological appearances. It is the most common cancer in white-skinned individuals with increasing incidence rates worldwide. BCC arises from the inter-follicular or follicular epithelium. It is the most common malignant tumour type in humans and is a local aggressive course. It has low disease associated death rate and metastases to lung and bone exceptionally rare. When multiple, associated with a number of genetic conditions, including basal cell nevus (Gorlin), Bazex-Dupré-Christol, Rombo syndromes and xeroderma pigmentosum. Patients with BCC place a large burden on healthcare systems, because of the high incidence and the increased risk of synchronous and metachronous BCCs and other ultraviolet radiation (UVR) related skin cancers (i.e. field cancerization). As a result, the disability-adjusted life years and healthcare costs have risen significantly in recent decades. The key feature of basal cell carcinoma at low power magnification is of a basaloid epithelial tumour arising from the epidermis. The basaloid epithelium typically forms a palisade with a cleft forming from the adjacent tumour stroma. Centrally the nuclei become crowded with scattered mitotic figures and necrotic bodies evident. A useful distinguishing feature from other basaloid cutaneous tumors is the presence of a mucinous stroma. Some tumors may also show foci of regression, seen as areas of eosinophilic stroma with lack of basaloid nests.
