lekha bcc paper

8/3/2019 Lekha BCC Paper

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BASAL CELL CARCINOMA

INVOLVING NOSEDR.S.LEKHA POST GRADUATE


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- ULCER OVER THE DORSUM OF NOSE- 4 X 3 CM

- BLACK COLOURED- ROLLED OUT EDGES

- EXTENDING TO SUPRATIP AND TO BOTH ALAE

OF NOSE LATERALLY AND ABOVE UPTO THE

BRIDGE OF THE NOSE.- ANOTHER ULCER OVER LEFT INFRAORBITAL

REGION OF 0.5CM SIZE.


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HPE PROVED

INVASIVE BASAL CELL CARCINOMA

PROCEDURE

NEAR TOTAL EXCISION OF NOSE WITH PRIMARYRECONSTRUCTION WITH RIGHT PARAMEDIANFOREHEAD FLAP AND THE SATELLITE LESIONEXCISED AND RECONSTRUCTED WITH SPLIT

SKIN GRAFT FROM RIGHT THIGH, IN THE SAMESITTING.


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BASAL CELL CARCINOMA WITH

SATELLITE LESION IN THE LEFT

INFRAORBITAL REGION ARE QUITERARE.


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INCIDENCE IN THE GENERAL

POPULATION

The incidence rate of BCC was estimated to be 1041

per 100,000 in men, and 745 per 100,000 in women.

70% of basal cell carcinoma occur on head and neck

,of which 25% occur in nose, specifically over the

nasal tip and alae.


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RISK FACTORS

GENETIC PREDISPOSITION.

ENVIRONMENTAL EXPOSURE

SUN EXPOSUREIONISING RADIATION

CHEMICAL EXPOSURE

IMMUNE SUPRESSION

PREMALIGNANT LESION


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Nodular basal cell carcinoma

Superficial basal cell carcinoma-present aserythematous macular lesion

Pigmentedcontains melanin causing confusionwith melanoma

Morphoeic- usually indurated with irregularborders, behave agressively.


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The tumours may be locally destructive, but veryrarely metastasise.

There is an increased risk of local recurrence forlarge, deep or ulcerated tumours, especially if

incompletely or narrowly excised, tumours of

micronodular, infiltrating, fibrosing (morphoeic) or

superficial multifocal type.


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SURGICAL MANAGEMENT

BCCs can be cured in the vast majority of cases bycomplete excision.

Surgical excision provides excellent five year cure rates

estimated at between 90 and 98% for previously untreatedtumours.

The margins of excision should be wide enough to

completely excise the tumour.

A 2 - 3mm margin is probably adequate for the majority ofsimple BCCs.


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Local flap repair providing cover with skin ofappropriate colour and texture is the preferred method

of closure when direct closure is not possible.

At times skin grafting will be necessary and full

thickness grafts are used choosing skin from an

inconspicuous donor site with similar skin

characteristics.


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RADIOTHERAPY

USEFUL ALTERNATIVE TO SURGERY FOR

ELDERLY OR MEDICALLY UNFIT PATIENTS

REPORTED CURE RATE OF 92%.


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OTHER METHODS

ELECTRODESSICATION AND CURETTAGE

CRYOSURGERY

PULSED CO2 LASER.


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Approximately 66% of people will develop a secondBCC within three years of a BCC excision.

Local Recurrence is rare (


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THANK YOU

lekha bcc paper

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