Basal cell carcinoma (BCC)

            Basal cell carcinoma or malignant neoplasm basalioma is derived from basal cells of the epidermis or the hair follicle cells that can arise on haired skin. Is the most common skin cancer that is 75% of all non-melanoma skin cancers are estimated each year 500,000 new cases are found throughout duniainsiden highest in men - men compared to women. More than 80% are located in the head and neck (30% in the nose). Basal cell carcinoma is rare in the age under 50 years, but lately tend to no longer follow a certain age.

BCC grows slowly, even though the state "continues" can invade surrounding tissues such as cartilage, bone, and lead to "disability" aesthetic. BCC rarely metastasis, said metastasis occurs less than 0.05% of cases (Feig et al., 2006).

1. Clinical Overview

The classic image is known as ulcers Rodent, namely ulcer with one side shaped uneven, as if such an idea "rodent bites / rat". Usually accompanied by hyperpigmentation on the edges and the middle ulcers.

Other clinical forms encountered in BCC are:

Nodulo-ulcerative type (most often)

 first - initially shaped papules (papules) rising, "pearly" / shiny surfaces such as the "pearl", often found in the central teleangiectasia ulcerative usually experience. Sometimes scaly smooth and thin crusted and slow growing.

Type pigmented

The same picture nodulo-ulcerative only black brown, speckled or homogeneous

Kind of like or fibrosis rarely morphea

Form "plaques", yellowish, the edge is unclear, sometimes rising. On the surface it appears some hair follicles are concave and form a network such as cicatricial, and sometimes covered crusts. Ulceration rarely.

-                      Nevoid Basal Cell Syndrome (Sindroma Gortin Galzt)

-                      Sindroma Xeroderma Pigmentosum

-                      Jenis linear and generalized follicular basal cell nevi

-                      Type of generalized follicular

Accompanied by hair loss as a result of damage to a hair follicle due to tumor growth .

albinism

Sensitive to UV ( absence of " melanin " skin protector ) easily occur BCC , Squamous cell carcinoma (SCC) or melanoma .

2. Classification Histo - Pathology

a. nodular BCC

Is a classic type , shaped " pink " nodules ( in white ) , colored skin pigmentation will occur , " pearly " and sometimes there is ulceration

b . superficial BCC

Is the type that are often found in areas affected limb or exposure to sunlight , air- squama ( Scaly ) is often difficult to distinguish from SCC or Bowen disease

c . Morphea or sclerosing BCC Form

Rare form , and form nodules that induratif and no clear boundary ; often diagnosed as a network of " scar " .

d . Pigmented BCC . May be a variance of nodular BCC .

-                      e. Cystic BCC. Rarely encountered

f. Fibroepithelioma of Pinkus (PEP). Variances are rare

3. Clinical Stage (AJCC TNM, 2002, Modified, 2008)

Clinical stage of BCC will be similar to the SCC.

Quoted from Rubin and Hansen, 2008

4. Therapeutic Procedures

An objective to be achieved are:

Wide excision with adequate margins (margin -)

Defect reconstruction surgery with attention to aesthetics, function, especially if the operation is done in the face

BCC requiring surgical excision margin of safety between 0.5 - 1 cm. When radicality unattainable can be re-excision, radiotherapy or adjuvant therapy.

BCC excision of the face area, to consider "the pull of the line leather / Langer lines", to get a good cosmetic.

a. Mohs Micrographic Surgery

Well done on a comprehensive BCC with local anesthesia. Where necessary repeated tangential excision with the help of inspection "frozen section" to get a free subclinical tumor area. By engineering the network is expected to conserve more and give a better cosmetic result.

Other ablative therapies is to do kuretage, cryoytherapy and laser ablation. Cryotherapy treated for precancerous lesions and superficial BCC and SCC.

b. Defect reconstruction surgery can be performed with partial thickness skin graft, full thickness skin graft (in the face), local flaps (rotation, advancement, transposition, and or interpolation.

Large defects can be done reconstruction with flaps pedicled distant, as if a large defect in the face, for example by using a deltoid-pectoralis cutaneous flap, and if the defect is multi

-                      Then the network can be used musculocutaneus pectoralis flap, latissimus dorsi flap musculocutaneus, trapezius musculo-cutaneous flap, flap musculkocutaneus sternocleidomastoideus or platysma flap.