Basal cell carcinoma: superficial

Patient Information Leaflet
Link: Basal cell carcinoma

https://www.pcds.org.uk/patient-info-leaflets/basal-cell-carcinoma

Superficial basal cell carcinoma (BCC) are the most common type of BCC in younger adults, and present most frequently on the trunk and shoulders as a slowly expanding pink-red patch. 

This chapter is set out as follows:

Distribution

• Frequently multiple
• Most often found on the trunk, shoulders, and shins

Morphology

• Expand slowly as a red / pink patch
• Develop a very fine raised 'whipcord' edge
• As they enlarge the surface becomes more fragile developing focal erosions and crust - a crust represents dried blood, plasma, or exudate that results from the erosion. Erosions / crust tend to have a different appearance to the white-yellow rough surface scale seen in actinic keratoses and Bowen's disease 

Dermoscopic features (hover over terminologies for description)

• Focal erosions
   
• Much of the pigment in superficial BCC is peripheral:
  • Irregular peripheral brown clods (sometimes referred to as leaf-like structures)  
  • Spoke-wheel like structures
  • Brown dots, sometimes a dot within a clod (referred to as concentric structures)
     
• Structureless white / red areas
   
• Shiny-white structures
   
• Vascular appearance - vessels are fine and sharply focused. They can be serpentine or short-fine branching vessels (narrower than typical arborising vessels of a solid BCC in which vessels tend to start off with a wider calibre that gets narrower as the vessels branch); occasionally peripheral parallel finely-looped vessels (for more information on vessels refer to the chapter Vessel patterns in dermoscopy)
   
• Features against the lesion being a superficial BCC (favouring a solid BCC) - ulceration, arborising vessels, blue-grey clods

Patients need to be provided with options that include, in no particular order:

• No treatment - may be the best choice for asymptomatic lesions on the trunk in patients with a reduced life expectancy
   
• Topical treatments (to the lesion and 4 mm of normal surrounding skin)
  • 5% 5-fluouracil cream BD for 6 weeks
  • Imiquimod 5% cream (Aldara ®) 5 times a week for 6 weeks
     
• Cryosurgery - only suitable for small lesions (two freeze-thaw cycles of 30 seconds to the lesion and 4 mm of normal surrounding skin)
   
• Surgery - excision with a 4 mm margin or double curettage & cautery 
   
• Photodynamic therapy

For  more information on the management of BCC refer to the British Association of Dermatologists Guidelines.