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Basal cell carcinoma

Basal cell carcinoma (BCC) is the most common malignant or neoplastic skin tumour of the face, eyelids and peri-ocular area.

Basal cell carcinoma is also called a rodent ulcer, because of its tendency to slowly "eat" away at the normal tissue. The good thing about this type of skin cancer is that it is very slow growing are only rarely spreads elsewhere, so can be detected and treated early.

It arises in the epidermis layer of the skin.

BCC typically affects people of fair complexion who have had a lot of sun exposure or repeated episodes of sunburn at a younger age. BCCs occurs in the head and neck, particularly the face around the eyelids, the temporal region and forehead. The tendency to develop BCCs may be inherited in some individuals. Patients with Gorlin's syndrome are particularly prone to multiple basal cell carcinomas.

BCCs can vary in size from a few millimetres to several centimetres in diameter, growing slowly over months or years. Basal cell carcinomas are painless but may ulcerate and bleed as they get larger. The typical appearance of a basal cell carcinoma is usually nodular with pearly edges (lightly pigmented only), with no eyelashes or fine hairs growing within it, but with some telangiectatic vessels seen in it. As it gets larger it often develops a central ulcerated area. A small number of basal cell carcinomas have a different growth pattern, with indistinct edges, which are more difficult to diagnose and treat, and are called morphoeic basal cell carcinomas. Recurrent basal cell carcinoma can look and behave like a morphoeic BCC.

Oculoplastic / oculofacial plastic surgeons are trained to diagnose and treat skin cancer on the face, particularly on the forehead, eyelids, peri-ocular region, side of the nose, the cheeks and temporal areas. We work closely with our Dermatologic colleagues, who excise basal cell carcinomas with Mohs' micrographic surgery, after which we do the reconstructive oculofacial plastic surgery to restore a normal anatomy and function of the face and eyelids.

The principle of treatment is :

  1. establish diagnosis
  2. completely excise the tumour
  3. do a good functional repair maintaining normal appearance and function of the eyelids and facial tissues.

Mohs' micrographic surgery is a special frozen tissue histopathology technique to ensure that all of the tumour cells, both at the edges and in the base of the tumour have been removed, with minimal removal of normal tissue. Could put the picture of Mohs freezing glass slide here if it helps?

Although basal call carcinomas are malignant, they spread locally and so if they are completely removed surgically, the chance of recurrence is very low. They only rarely spread elsewhere, for instance, if morphoeic and diagnosed late, or are left to grow for two long.