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SUMMARY
The epidemiology, risk factors, pathogenesis, clinical presentations, treatment options, and prognosis of basal cell carcinoma (BCC) will be reviewed here.
Particular focus will be given to the subtypes of BCC, detailing the clinical presentations, dermoscopy findings, and histologic features specific to each type.
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DON’T FORGET
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CLINICAL PEARLS
BCC is the most common type of skin cancer worldwide. The diagnosis of BCC is often made clinically and confirmed by histological evaluation.
Nodular BCC is the most common subtype of BCC, which presents as a pearly pink papule or plaque, sometimes with telangiectasia, usually on the face.
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PATIENT EDUCATION POINTS
Patients must avoid potential risk factors like sun exposure, tanning beds, ionizing radiation, and arsenic ingestion.
The regular use of sunscreen and sun-protecting clothing is recommended when outdoors.
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Basal cell carcinoma (BCC) is considered a nonmelanoma skin cancer (NMSC) and originates from the basal layer of the epidermis, as well as from its appendageal structures.
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BCC is the most common curable skin cancer, affecting men slightly more often than women.1 It can often be aggressive, invasive, and locally destructive, resulting in significant morbidity. Rates of BCC continue to rise, making it crucial for dermatologists to have a vast understanding of this form of NMSC, its variable clinical presentations, and the available options for prevention and treatment.
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Accurate estimates of the incidence and prevalence of BCC on the global level are challenging as there is no cancer registry collecting these data and countries are less inclined to gather information because of the high volume and low mortality of the tumor.2 Nonetheless, smaller-scale studies exist that reflect rising trends in BCC diagnosis and global variations in incidence. In Europe, it has been reported that rates of BCC have increased by 5% annually over the past decade.3 The rates are rising in Australia, where two-thirds of individuals will be diagnosed with BCC by 70 years of age.4 In Asia and South America, the incidence of BCC is lower than that of Australia but continues to rise. Global incidence is strongly related to the country’s distance from the equator combined with the phenotypic skin color of its population. For example, northern European countries, such as Finland, have an incidence one-fortieth that of Australia and one-fourth that of the Midwestern United States.5-7
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The American Cancer Society estimated 5.4 million cases of NMSC in 3.3 million individuals living in the United States in 2012, with the overwhelming majority of those cancers (80%) being BCC.8 Since this estimate, the rates of BCC have increased by roughly 2% each year.8 For example, in the Medicare fee-for-service population, the number of skin cancer procedures increased by 13% ...