Basal-cell carcinoma (BCC)
Basal-cell carcinoma is the most common type of skin cancer in Sweden. It occurs slightly more often in men than in women, and especially after the age of 40. It is a slowly but destructively growing skin tumor that occurs mainly on sun-exposed surfaces but is unlikely to spread to distant areas or to result in death.
There are four classifications of BCC according to histopathology.
Nodular basal-cell carcinoma, type IA according to Glas
Low aggressive and accounts for 50% of all BCC. Individuals with a basal-cell carcinoma typically present with a shiny, pearly skin nodule with small blood vessels in the edge of the nodule, sometimes with ulceration.
Superficial basal-cell carcinoma, type IB according to Glas
Low aggressive and accounts for 20 to 25% of all BCC. It occurs most commonly as an erythematous and scaly skin lesion.
Infiltrative basal-cell carcinoma, type II according to Glas
Rather aggressive and accounts for 10 to 20% of all BCC. It occurs as a firm skin lesion most commonly not erythematous nor scaly.
Morpheaform basal-cell carcinoma, type III according to Glas
Highly aggressive and accounts for 10 % of all BCC. It can present as a skin thickening or scar tissue and can be difficult to delimit to healthy skin. It may extend into the subcutis, cartilage, muscles and bone. The patient should always be referred to a dermatologist.
Consider a skin biopsy for histopathology and then a standard surgical excision of the whole skin lesion using sufficient margins depending on the type of BCC: 2-3 mm for Glas IA and IB, 5-7 mm for Glas II and III, and send the sample for histopathology.
If the excision is easily done in its entirety, by a 2-3 mm margin, this can of course be made as the first step. Always send the skin lesion for histopathology to decide type of BCC, radicality and for possible additional treatment.
Having a BCC is a risk factor for developing additional BCC, why it is important to check the whole body for more skin tumors and to inform the patient of self-checks in low-risk basalioma (type IA and IB according to Glas).
Squamous cell carcinoma (SCC)
Squamous-cell carcinoma is the second most common skin cancer after BCC. SCCs arise from squamous cells in the outer layers of the skin. It mainly occurs after prolonged sun exposure but also in hard-to-heal lower leg ulcers (Marjolin's ulcer). Clinically, squamous cell carcinoma occurs as an irregular, solid tumor with a central ulceration and/or crust. The emergence of turgid tissue at the edge of an ulcer should arouse the suspicion of SCC and lead to a biopsy. Squamous cell carcinoma is locally destructive and can metastasize.
The diagnosis is assessed by a skin biopsy. The patient must be referred to a dermatologist. Squamous cell carcinoma is treated by radical excision.