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Skin cancer—basal cell carcinoma
Malignant skin tumours are among the most common of all cancers. They are more frequent in light-skinned races, and ultraviolet (UV) radiation seems to be involved in their aetiology. The incidence of non-melanoma skin cancer in caucasoids in the USA was previously estimated at 230 per 100 000 per year, compared with 3 per 100 000 for African Americans. The majority of malignant skin tumours ( Table 56.1 ) are epidermal in origin and are either basal cell or squamous cell carcinomas (p. 124) or malignant melanomas (p. 126). Premalignant epidermal conditions are common ( Chapter 55 ), but dermal malignancies are comparatively rare.
Table 56.1
A classification of malignant skin tumours and premalignant conditions
| Cell origin | Premalignant condition ( Chapter 55 ) | Malignant tumour |
|---|---|---|
| Keratinocyte | Actinic keratosis, in situ squamous cell carcinoma | Basal cell carcinoma, squamous cell carcinoma |
| Melanocyte | Dysplastic naevus | Malignant melanoma (p. 126) |
| Fibroblast | Dermatofibrosarcoma (p. 128) | |
| Lymphocyte | Lymphoma (p. 128) | |
| Endothelium | Kaposi’s sarcoma (p. 70) | |
| Non-cutaneous | Secondary spread (metastatsis) (p. 108) |
Basal cell carcinoma
Basal cell carcinomas (BCCs, rodent ulcers) are the commonest form of skin cancer and are typically seen on the face in elderly or middle-aged subjects. Although there is strong epidemiological evidence for the role of UV radiation in the pathogenesis of BCCs, the tumours do not frequently occur on the most sun-damaged sites. They arise from the basal keratinocytes of the epidermis, are locally invasive, but very rarely metastasize.
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