Types of Basal Cell Carcinoma (BCC) and Complications Associated With It

In a previous article, the nonmelanoma cancer basal cell carcinoma was introduced; its prevalence, clinical features, and treatment methods were discussed.

Basal cell carcinoma (BCC) is one of the most common forms of skin cancer. Quite often, patients diagnosed with BCC have more than one primary tumour formed over time.

A few distinct clinical types of BCC have been identified, along with more than 20 histological growth patterns.

Clinical Types of Basal Cell Carcinoma

Nodular BCC, also known as nodulocystic carcinoma, is the most common type of facial BCC. It appears as a shiny or pearly nodule with a smooth surface. The edges appear rolled because central depression or ulceration is found in the middle of the lesion. Microcystic, micronodular, and infiltrative types are classified as aggressive subtypes.

Superficial BCC is the most common type diagnosed in younger adults. It is usually found on the shoulders and upper trunk. It appears as a slightly scaly, irregular plaque with a thin, translucent, and rolled border. Multiple microerosions are observed.

Morphoeic BCC, also known as morphoeiform or sclerosing BCC, is found in mid-facial sites. It is described as a waxy, scar-like plaque with distinct borders. It has wide and deep subclinical extension.

Basosquamous carcinoma involves two forms of cancer: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). It is considered the most aggressive form of skin cancer in comparison with other BCC forms.

Complications Associated With Basal Cell Carcinoma

The complications associated with basal cell carcinoma are classified into three groups: recurrent BCC, advanced BCC, and metastatic BCC.

Recurrent BCC

After initial treatment, recurrence of BCC may arise. This may be triggered by incomplete excision or the presence of very narrow margins at primary excision. The head and neck are the most vulnerable sites where recurrent BCC is found. Micronodular, morphoeic, and infiltrative subtypes are associated with recurrence of BCC.

Advanced BCC

Advanced BCCs involve large and neglected tumours. These lesions may be a few centimetres in diameter and may deeply infiltrate tissues below the skin's surface. It is quite challenging, and in some cases impossible, to treat advanced BCCs surgically.

Metastatic BCC

Metastatic BCC is very rare but can lead to fatal results. The primary tumour is usually large, recurrent, or neglected, and is typically located on the neck and head. Metastatic BCC may form on sites that were previously exposed to ionizing radiation.

Treatment Considerations

The treatment for BCC is determined based on its type, location, and size, as well as patient-specific factors. The majority of cases are treated surgically. Regular long-term follow-ups are scheduled to monitor for recurrence and the formation of new lesions.

The most commonly administered treatment methods include excision biopsy, Mohs micrographically controlled surgery, superficial skin surgery, and cryotherapy. Further details on these approaches are available on the basal cell carcinoma treatment page.