Ulcerated basal-cell carcinoma affecting the<unk>  of the nose in an elderly individual To diagnose basal-cell carcinomas, a<unk>  biopsy is performed for histopathologic analyses. The most common method is a shave biopsy under local anesthesia. Most nodular basal-cell<unk> s can be diagnosed clinically; however, other variants can be very difficult to distinguish from benign lesions such as intradermal naevus, sebaceomas, fibrous papules, early acne scars, and hypertrophic scarring. Exfoliative cytology methods have high sensitivity and specificity for confirming the diagnosis of basal cell carcinoma when clinical suspicion is high but unclear usefulness otherwise. Characteristics High-magnification micrograph of basal-cell carcinoma. Basal-cell carcinoma cells appear similar to epidermal basal cells, and are usually well differentiated. In uncertain cases, immunohistochemistry using BerEP4 can be used, having a high sensitivity and specificity in detecting only BCC cells. Main classes Basal-cell carcinoma can broadly be divided into three groups, based on the growth patterns. # Superficial basal-cell carcinoma, formerly referred to in-situ basal-cell carcinoma, is characterized by a superficial proliferation of neoplastic basal-cells. This tumor is generally responsive to topic chemotherapy, such as imiquimod, or fluorouracil, although surgical treatment is better able to ensure complete removal and confirm that there is not an underlying more aggressive subtype that was not sampled in the initial biopsy. # Infiltrative basal-cell carcinoma, which also encompasses morpheaform and micronodular basal-cell<unk> , is more difficult to treat with conservative methods, given its tendency to penetrate into deeper layers of the<unk> . # Nodular basal-cell carcinoma includes most of the remaining categories of basal-cell<unk> . It is not unusual to encounter heterogeneous morphologic features within the same tumor. Nodular basal-cell carcinoma Basal-cell carcinoma with nodular pattern. Nodular basal-cell carcinoma (also known as "classic basal-cell carcinoma") accounts for 50% of all BCC. It most commonly occurs on the sun-exposed areas of the head and neck. Histopathology shows aggregates of basaloid cells with well-defined borders, showing a peripheral palisading of cells and one or more typical clefts. Such clefts are caused by shrinkage of mucin during tissue fixation and staining. Central necrosis with eosinophilic, granular features may be also present, as well as mucin. The heavy aggregates of mucin determine a cystic structure. Calcification may be also present, especially in long-standing lesions. Mitotic activity is usually not so evident, but a high mitotic rate may be present in more aggressive lesions. Adenoidal BCC can be classified as a variant of NBCC, characterized by basaloid cells with a reticulated configuration extending into the dermis. File:Palisading in basal cell<unk> .Palisading File:Nodular basal cell<unk>  with cleft.Cleft. Other subtypes Other more specific subtypes of basal-cell carcinoma include:<unk> Histopathology Other characteristics Image Cystic basal-cell carcinoma Morphologically characterized by dome-shaped, blue-gray cystic nodules. 150px Morpheaform basal-cell carcinoma (also known as "cicatricial basal-cell carcinoma", and "morphoeic basal-cell carcinoma") Narrow strands and nests of basaloid cells, surrounded by dense sclerotic stroma. Aggressive 150px Infiltrative basal-cell carcinoma Deep infiltration. Aggressive Micronodular basal-cell carcinoma Small and closely spaced nests. 150px Superficial basal-cell carcinoma (also known as "superficial multicentric basal-cell carcinoma") Occurs most commonly on the trunk and appears as an erythematous patch. 150px Pigmented basal-cell carcinoma exhibits increased melanization. About 80% of all basal-cell carcinoma in Chinese are pigmented while this subtype is uncommon in white people. Rodent ulcer (also known as a "Jacob's ulcer") Nodular, with central necrosis. Generally a large<unk>  lesion with central necrosis. Fibroepithelioma of Pinkus Anastomosing epithelial strands in a fenestrated pattern Most commonly occurs on the lower back. 150px Polypoid basal-cell carcinoma Exophytic nodules (polyp-like structures) Generally on head and neck. Pore-like basal-cell carcinoma Resembles an enlarged pore or stellate pit. Aberrant basal-cell carcinoma Absence of any apparent carcinogenic factor, and occurring in odd sites such as the scrotum, vulva, perineum, nipple, and axilla. Aggressiveness patterns There are mainly three patterns of aggressiveness, based mainly the cohesion of<unk>  cells: Low-level aggressive pattern Moderately aggressive pattern Highly aggressive pattern File:Low-level aggressive basal-cell carcinoma.Cohesive nodular File:Micrograph of superficial basal-cell carcinoma.Superficial File:Micrograph of basal-cell carcinoma with fibroepitheliomatous pattern.Fibroepitheliomatous pattern (anastomosing basaloid epithelial strands enclosing round islands of fibrous stroma) File:Moderately aggressive basal-cell carcinoma.Moderate cohesion File:Morpheaform basal-cell carcinoma.Narrow strands and nests of basaloid cells. "Cicatricial" or "morphoeic" pattern. Differential diagnoses +Main histological differential diagnoses of basal cell carcinoma: Differential diagnosis Pathological Features Image Hair follicles Peripheral sections may look like nests, but do not display atypia, nuclei are smaller, and serial sections will reveal the rest of the hair follicle. 190px Squamous-cell carcinoma of the<unk>  Squamous-cell carcinoma of the<unk>  is generally distinguishable by for example relatively more cytoplasm, horn cyst formation and absence of palisading and cleft formations. Yet, a high prevalence means a relatively high incidence of borderline cases, such as basal-cell carcinoma with squamous cell metaplasia (H&E stain at left in image). BerEP4 staining helps in such cases, staining only basal-cell carcinoma cells (right in image). 190px Trichoblastoma Absence of cleft, rudimentary hair germs, papillary mesenchymal bodies. 190px Adenoid cystic carcinoma Lack of basaloid cells disposed in peripheral palisades; adenoid-cystic lesion without connection to the epidermis; absence of artefactual clefts 190px Microcystic adnexal carcinoma Bland keratinocytes, keratin cysts, ductal differentiation. BerEp4- (in 60% of cases), CEA+, EMA+ File:Micrograph of microcystic adnexal carcinoma - superficial follicular keratin-filled cysts.jpg File:Micrograph of microcystic adnexal carcinoma - infiltrative aggregates.jpg Trichoepithelioma Rims of collagen bundles, calcification, follicular/sebaceous/infundibular differentiation and cut artefacts. Cytokeratin (CK)20+, p75+, Pleckstrin homology-like domain family A member 1 + (PHLDA1+), common acute lymphoblastic leukemiaantigen + (CD10+) in tumor stroma, CK 6-, Ki-67- and Androgen Rceptor- (AR-) 190px Merkel cell carcinoma Cells arranged in a diffuse, trabecular and/or nested pattern, involving also the subcutis. Mouse Anti-Cytokeratin (CAM) 5.2+, CK20+, S100-, human leukocyte common antigen- ( LCA-), thyroid transcription factor 1- (TTF1-) 190px Radicality Comparison H&E stain (left) with BerEP4 immunohistochemistry staining (right) on a pathological section having BCC with squamous cell metaplasia. Only BCC cells are stained with BerEP4. In suspected but uncertain BCC cells close to the resection margins, immunohistochemistry with BerEp4 can highlight the BCC cells.
types of Skin cancer
symptom of Skin cancer
symptom of Melanoma
Clyde cancer cluster
medical cause of Mucosal melanoma
types of Mucosal melanoma
symptom of Psoriasis
causes of Mucosal melanoma