From the Guidelines
The patient with a nodular basal cell carcinoma on the right shoulder, which was completely excised with clear margins, has a favorable outcome and should follow up with a dermatologist to ensure complete healing and monitor for any recurrence or new lesions. The pathology report indicates that the entire lesion was removed during the biopsy procedure, which is a good prognostic sign. Basal cell carcinoma is the most common form of skin cancer, arising from the basal cells in the epidermis, and the nodular variant is characterized by rounded masses of tumor cells extending into the dermis 1.
According to the guidelines for the management of basal cell carcinoma, a treatment plan that considers recurrence rate, preservation of function, patient expectations, and potential adverse effects is recommended 1. For low-risk primary BCC, surgical excision with 4-mm clinical margins and histologic margin assessment is recommended, which is consistent with the patient's case. The guidelines also recommend Mohs micrographic surgery for high-risk BCC, but this is not applicable in this case since the margins are clear.
Some key points to consider in the management of basal cell carcinoma include:
- The risk of recurrence is highest in lesions where both lateral and deep margins were involved with BCC 1
- Incompletely excised lesions, especially those with aggressive histological subtypes, may require re-treatment with re-excision or Mohs micrographic surgery 1
- Regular skin examinations and sun protection measures are essential for preventing future skin cancers, as UV exposure is a major risk factor for basal cell carcinoma development 1
In terms of follow-up, the patient should be monitored for any signs of recurrence or new lesions, and regular skin examinations should be performed to ensure early detection and treatment of any new skin cancers. The patient should be advised to practice sun protection measures, such as using sunscreen and avoiding prolonged sun exposure, to reduce the risk of future skin cancers. Overall, the patient's prognosis is good, and with proper follow-up and sun protection measures, the risk of recurrence or new lesions can be minimized.
From the Research
Diagnosis and Treatment of Basal Cell Carcinoma
- Basal cell carcinoma (BCC) is the most common skin cancer, and its treatment depends on various factors, including tumor size, location, and patient condition 2, 3.
- The diagnosis of BCC is typically confirmed through skin biopsy, and the treatment options include surgical excision, Mohs micrographic surgery, cryosurgery, electrodesiccation and curettage, topical application of imiquimod or fluorouracil, photodynamic therapy, and radiation therapy 2, 3.
- For nodular basal cell carcinoma, topical imiquimod 5% cream has been shown to be an effective treatment option, with clinical and histological clearance rates of over 70% and a recurrence rate of 1.80% 4.
Clinical and Pathological Features of Basal Cell Carcinoma
- BCC can present in various clinical forms, including nodular, ulcerative, superficial, morpheiform, pigmented, and fibroepithelioma of Pinkus 5.
- The prognosis of BCC is influenced by clinical factors such as anatomic location, recurrence, and tumor size, as well as histopathological features like growth pattern, level of invasion, perineural and lymphovascular invasion, and involved surgical margins 5.
- Novel imaging tools, including optical coherence tomography, reflectance confocal microscopy, high-resolution ultrasonography, Raman spectroscopy, and terahertz pulse imaging, can improve diagnostic accuracy and provide tumor depth and lateral margins without invasive techniques 6.
Treatment Approaches for Basal Cell Carcinoma
- Surgical excision and Mohs micrographic surgery are the most commonly used treatments for BCC, due to their association with low recurrence rates and the ability to confirm residual tumor pathologically 2, 3.
- Hedgehog pathway inhibitors, such as Vismodegib, have been investigated as novel treatment approaches for BCC, aiming for complete resolution, minimal side-effects, and high patient satisfaction with optimal cosmetic results 6.
- The choice of treatment for BCC depends on various factors, including tumor subtype, patient condition, and treatment goals, and a comprehensive understanding of the clinical and histopathological aspects of BCC is essential for selecting the most appropriate treatment management 5, 6.