Basal cell carcinoma natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2] Saarah T. Alkhairy, M.D.

It is a slow-growing locally invasive lesion with an unlikely risk of metastasis. Most patients are often asymptomatic. The major complication is its recurrence and involvement of surrounding structures. With appropriate treatment, the prognosis is usually excellent.

• Patients with basal cell carcinoma are often asymptomatic^[1]
• They often report a slowly enlarging lesion which does not heal and bleeds when traumatized
• It is locally invasive and destructive so the name rodent cancer
• The overall risk of metastases is estimated to be less than 0.1%
• The risk of invasion and recurrence is based on size, duration, location and subtype (sclerodermiform/morpheaform and micronodular clinical variants have a higher risk)
• Even without a recurrence, a personal history of basal cell carcinoma increases the risk of developing all types of skin cancers

• The main complication of basal cell carcinoma is recurrence.^[2][3]
• The following are the factors associated with increased risk of basal cell carcinoma recurrence:
  • Location and size
    • >/= 6 mm in diameter in high-risk areas (eg, central face, nose, lips, eyelids, eyebrows, periorbital skin, chin, mandible, ears, preauricular and postauricular areas, temples, hands, feet)
    • 10 mm in diameter in other areas of the head and neck
    • 20 mm in diameter in all other areas (excluding hands and feet)
  • Aggressive pathologic variants
    • Morpheaform, sclerosing, or mixed infiltrative
    • Micronodular
    • Basosquamous
  • Lesions in sites of prior radiation therapy (RT)
  • Lesions with poorly defined borders
  • Lesions in immunocompromised patients
  • Perineural invasion

• Prognosis of basal cell carcinoma is usually excellent.^[4][5]
• These lesions are typically slow growing, and metastatic disease is a very rare event.
• Basal cell carcinoma will cause considerable disfigurement by locally destroying skin, cartilage, and even bone.
• Recurrence is a issue with basal cell carcinoma.
• Approximately 50% of recurrences are apparent within the first two years.

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