Basal cell carcinoma ulcerated C44.L

Basal cell carcinoma characterized by a painless, sharply defined, almost crater-shaped ulcer (as carved out) with a raised marginal wall, which has arisen from a nodular basal cell carcinoma by central decay.

The statements made here refer to the diagnosis"basal cell carcinoma" in general. No reliable epidemiological data are available for the subtypes.

Most common skin carcinoma among the Caucasian population (red-haired people have a higher risk than brown-haired people).

Incidence rates are missing for most European countries. In Germany the incidence is about 100/100,000 inhabitants/year. Known data indicate the highest incidence in Wales (112/100,000 inhabitants/year) and the lowest in Finland (49/100,000 inhabitants/year).

Men and women are equally affected.

People with actinic cheilitis and solar lentigines have a higher risk of developing basal cell carcinoma.

Only very rarely does metastasis occur (less frequently than 1:1000). In North America the incidence in the population < 40 years is higher in women than in men.

Multiplicative factors (e.g. anamnestic sunburns, sun exposure) play a role in the development.

S.u. basal cell carcinoma

S.u. basal cell carcinoma

face, forehead, nose, cheek, auricle, bald head

• Sharply defined, such as excised, painless, round or oval ulcer with clean wound base covered with crusts or red granulations, steeply sloping edges. The size of the ulcer depends on the duration of "non-treatment" and varies between 0.4-2.0 cm in diameter.
• Diagnostically important is the assessment of the peripheral area of the ulcer. This consists of a (pearl-like) marginal wall with shiny white papules which emerges when the surrounding healthy skin is stretched (this marginal wall, consisting of linearly arranged nodules, is highly typical for this basal cell carcinoma and can be removed especially under good, oblique illumination). With a 10x magnifying glass, bizarre small vessel lines can be detected on the edge wall, which show quite irregular calibre fluctuations (pathological tumour vessels, see below: basal cell carcinoma nodular).

The diagnosis of an "atypical ulcer" is consolidated by the following constellation of symptoms:

• Previous nodulation
• Atypically long duration of stock (>6 weeks)
• Painlessness
• Atypical localization (for a banal ulcer)
• Atypical structure with border wall

The diagnosis is saved by a biopsy from the marginal area! No need to take healthy surrounding skin with you!

S.u. basal cell carcinoma nodular

1. Mc Cormack et al (1997) Differences in ages and body site distribution of the histological subtypes of basal cell carcinoma. Arch Dermatol 133: 593-596
2. Peris K et al (2005) Imiquimod treatment of superficial and nodular basal cell carcinoma: 12-week open-label trial. Dermatol Surgery 31: 318-323