00:01
Here’s our first neoplastic
condition of the skin.
00:05
It is the most common cancer
worldwide or, in other words,
it’s the most common cancer
in the human species.
00:14
Welcome to basal cell carcinoma.
00:16
Let’s talk about this
in greater detail.
00:18
Chronic intermittent UV exposure
might be a possible risk.
00:23
Next, work with me here, what
does the basal layer mean to you?
The basal layer will be the bottom
most layer of your epidermis, right?
Bottom most layer.
00:33
Morphology:
Pearly papule
or a nodule.
00:38
Stop there and make sure
you know the description
morphologically for
basal cell carcinoma.
00:43
Often,
often with central ulceration
umbilication on sun-exposed skin.
00:48
And as a rule of thumb, BCC usually
will appear above the upper lip
and usually by the nose,
by the nasolabial type of fold
as I should show you soon.
01:00
But really, it could be any area of the
skin in which there is exposure to UV rays.
01:06
Now with BCC, very, very low
risk of going on to metastasis.
01:11
For all intent and purposes, can
we just say, it’s null and void.
01:14
Granted, it could be 0.05%
risk of going on to --
a 0.05% risk of going
on to malignancy.
01:23
But with that said,
just because it’s a benign condition, it
does not mean that it’s not dangerous.
01:28
And I’ve talked to you
about this earlier.
01:30
Meaning to say that you could
have a benign condition
in which, my goodness,
it’s locally aggressive.
01:35
So say that there is an
umbilicated type of lesion
that is pearly and papule
that is located here,
with the exposure of UV rays
in a Caucasian patient.
01:45
What are you worried about?
You’re worried about that benign papule
which is going to grow, grow,
grow very, very quickly.
01:50
And what’s it going to do?
Might encompass the entire nasal region
and destroy everything in its path,
completely disfiguring the
face of your patient.
01:59
Not good, okay?
So just because you don’t
say that it metastasizes
and the fact that this particular--
in terms of benign
and malignancy,
let’s just air on the
diagnosis and malignancy.
02:13
The chance of metastasis
is extremely rare,
but locally extremely aggressive to the
point where it may disfigure your face.
02:22
Something you want to keep in mind.
02:24
So on BCC, what may happen?
Well here’s a picture of exactly
of what I’m referring to.
02:30
Here’s a picture in which a BCC
which almost never metastasizes,
if it grows locally
very quickly,
it is then going to start
disfiguring the face.
02:41
The demographics, it is most
common cancer of all mankind.
02:46
Big deal.
02:49
Occurs on sun-exposed
areas of older adults.
02:53
Locally aggressive, although slow-growing.
02:56
And can be disfiguring
with extension,
growth and as I said, very
rarely does it metastasize,
less than 0.05%.
03:07
Now with BCC,
there are couple of histologic descriptions
that you’re very much want to keep in mind.
03:13
Proliferation of the basophilic
cells arising where?
Basal cell carcinoma from the basal
epidermis infiltrating the dermis.
03:23
So if you’re already so
incredibly close to the dermis
and you have involvement
of the basal cells already
undergoing neoplastic proliferation,
do you see as to how easy
it is to go in the dermis?
As you see in the
histologic picture here.
03:38
Whereas cells also resembled the stratum
basale of normal skin as you can imagine.
03:45
Basal cell carcinoma, allow the
name to speak to you, please.
03:49
Management:
Superficial forms.
03:52
So we'll talk about the
different forms a little bit
and quickly as to how you
want to manage these.
03:56
Curettage and perhaps
electrodessication,
superficial form.
04:00
Excision or maybe
perhaps Imiquimod Cream
is all part of management
of the superficial form.
04:08
The all other forms of
basal cell carcinoma:
Excision and consider
micrographically controlled surgery
if we’re talking about BCC which
is becoming incredibly aggressive.