American ca societi

Introduction
This booklet is designed to give you information about having a Basal
Cell Carcinoma near your eye and the care you will receive before,
during and after your operation. We hope it will answer some of the
questions that you or those who care for you may have at this time. It
does not replace the discussion between you and your doctor but helps
you to understand more about what is discussed.


What is a basal cell carcinoma (BCC)?
This is the most common type of skin cancer and it is estimated that
over 50,000 people in England and Wales are diagnosed with this every
year. The most likely sites are exposed skin, such as face, ears, head
or neck. The appearance of a BCC varies from just a small nodule to a
much larger ulcerated area if left untreated for a long period of time.
BCCs grow very slowly and hardly ever spread to other parts of the
body. However, if left untreated, they can damage the surrounding parts
of the body and are generally easiest to treat when they are smaller.
When near the eye, these lesions themselves or the treatment required,
can damage delicate tissues around the eye, as well as the eye itself.

What causes a BCC?
The most common cause is extensive sun exposure over many years.
This can be the result of an outdoor job, gardening, time spent abroad or
pursuit of an outdoor sport. However, some people are more
susceptible to BCCs than others, and these reasons may not apply in all
cases.
Basal cell carcinoma
This is not only the most common type of skin cancer, but the most common type of
cancer in humans. About 8 out of 10 skin cancers are basal cell carcinomas (also called
basal cell cancers). When seen under a microscope, the cells in these cancers look like
cells in the lowest layer of the epidermis, called the basal cell layer.
These cancers usually develop on sun-exposed areas, especially the head and neck. Basal
cell carcinoma was once found almost entirely in middle-aged or older people. Now it is
also being seen in younger people, probably because they are spending more time in the
sun.
These cancers tend to grow slowly. Its very rare for a basal cell cancer to spread to other
parts of the body. But if a basal cell cancer is left untreated, it can grow into nearby areas
and invade the bone or other tissues beneath the skin.
After treatment, basal cell carcinoma can recur (come back) in the same place on the
skin. People who have had basal cell cancers are also more likely to get new ones
elsewhere on the skin. As many as half of the people who are diagnosed with one basal
cell cancer will develop a new skin cancer within 5 ye

What are the risk factors for basal and
squamous cell skin cancers?
A risk factor is anything that affects your chance of getting a disease such as cancer.
Different cancers have different risk factors. Some risk factors, like smoking and excess sun
exposure, can be changed. Others, like a persons age or family history, cant be
changed.
But having a risk factor, or even many risk factors, does not mean that you will get the
disease. And some people who get the disease may have few or no known risk factors.
Even if a person with basal or squamous cell skin cancer has risk factors, its often very
hard to know how much those risk factors might have contributed to the cancer.
The following are known risk factors for basal cell and squamous cell carcinomas. (These
factors dont necessarily apply to other forms of non-melanoma skin cancer, such as
Kaposi sarcoma and skin lymphoma.)

































H i s t o p a t H o l o g i C a l f i n d i n g
BCC is an epithelial malignant tumour with a low malignant potential, consisting of cells which
look like the basal epidermis layer (3). The diagnostic histological features, common for all types
of the tumour, are basaloid cells with a thin pale cytoplasm surrounding round or oval nuclei with
a rough granulated chromatin pattern. The peripheral borderline cell layers are characterised by
pali-
sade arrangement and the surrounding stroma is often separated by artificially created slits,
whereas
the internal arrangement of the cells is rather chaotic. Most tumours originate in the epidermis and
invade the dermis in the form of solid or cystic nodules or streaky projections creating various
growth
patterns. Mitoses may be rare or multiple; often, especially in greater tumour nodules, there are
central
necroses (3). Intercellular bridges may also be present; these are less significant than in squamous
cell
carcinoma and cannot be evaluated in an examination by a light microscope (1,2,4,5).
H i s t o p a t H o l o g i C a l C l a s s i f i C a t i o n s
up to now, there have been many histopathological types of BCC described by various authors.
The highest number, twenty-six, was described by Wade and Ackerman (6) in 1978.
Most authors use two basic criteria in the creation of classifications of histological types, the
histological growth pattern and histological differentiation. Most authors agree that the histologi-
cal growth pattern is of the greatest biological significance. Classification based on the histological
growth pattern is useful during the creation of the concept of low-risk and high-risk types of BCC
(2,7,8,9,10,11). A greater probability of subclinical spread, aggressive local behaviour of the tumour
with a more frequent occurrence of local recurrences and incomplete excision are characteristic of
high-risk types (5,7,9,10). high-risk types include infiltrative (Fig. 1, Fig. 2) and superficial types (Fig.
3); a representative of the low-risk type of BCC is the nodular type (Fig. 4), in which many histological
variants were described (2,7,8,9,11,12).
The criterion of cell differentiation obtained less support for classification. The significance of
the squamous differentiation of BCC is controversial. There is no accord of views regarding the type
of basosquamous carcinoma. This type is most frequently described as the simultaneous presence of
basal cell and squamous cell carcinoma (1,3,5,13,14); some authors report further items, keratotic
car-
cinoma (3,5,14) and metatypical carcinoma (5,12). Regardless of this unclear definition, some
authors
expressed the opinion that BCC associated with moderate or severe squamous cell atypia or
malignity
is associated with a higher occurrence of local recurrences and metastatic spread (2,5,9,13,14). In
BCC
with follicular differentiation there are usually less squamous cell atypias, however with no
significance
for the biological behaviour of the tumour (9). The classification by Sexton (4) and Rippey (2) does
not
include the variants with squamous cell differentiation as special types of BCC.