Nodular basal cell carcinoma - Anogenital in
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Synopsis
There are many subtypes of BCC, including nodular, superficial, infundibulocystic, fibroepithelial, morpheaform (sclerosing, desmoplastic), infiltrative, micronodular, and basosquamous. Nodular BCC is the most common subtype overall and accounts for half of all lesions. In Black and Hispanic patients, BCCs are more often pigmented.
The most prevalent risk factor contributing to the development of BCCs is sun exposure. Other risk factors for BCCs include environmental exposure (ie, ionizing radiation, indoor tanning, chemicals such as arsenic, psoralen plus UVA, and coal tar), phenotype (freckling, red hair, fair skin that always burns and never tans), immunosuppression such as organ transplantation (which results in a 5-10 times higher risk of BCCs than the general population), and various genetic syndromes including xeroderma pigmentosum, oculocutaneous albinism, Muir-Torre syndrome, basal cell nevus syndrome (Gorlin syndrome), Rombo syndrome, and Bazex-Dupré-Christol syndrome. The gene most frequently altered in BCCs is the PTCH1 gene, followed by the TP53 gene.
Although BCCs typically arise in hair-bearing areas, they can rarely be seen in hairless genital mucosa for an unknown reason. BCC of the penis and scrotum is exceedingly rare and defies conventional understanding of the disease, as these areas are unlikely to receive much sun exposure and BCCs on these areas arise even on non-hair-bearing skin. Despite the lack of sun exposure, the incidence of penile BCC is higher in male patients with light skin phototypes. BCC occurs with equal frequency on the penile shaft and the scrotum and is usually a solitary lesion. Less often, BCC will be found on the glans or the foreskin.
Although BCCs are almost never fatal, local tissue destruction and disfiguration occur. The metastasis rate of BCCs is approximately 1 in 35 000. Metastasis is rare and typically occurs through perineural spread, lymph node metastasis, and then lung / bone metastasis.
Codes
ICD10CM:C44.91 – Basal cell carcinoma of skin, unspecified
SNOMEDCT:
403911008 – Nodulo-ulcerative basal cell carcinoma
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Intradermal nevus
- Squamous cell carcinoma in situ (Bowen disease)
- Lichen planus-like keratosis
- Fibroepithelial polyp
- Scar
- Extramammary Paget disease
- Psoriasis
- Morphea
- Molluscum contagiosum
- Keratoacanthoma
- Syphilitic chancre
- Lichen planus
- Lymphogranuloma venereum
- Scabies
- Bowenoid papulosis
- Fordyce spots
- Basosquamous carcinoma
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:11/07/2021
Last Updated:11/01/2022
Last Updated:11/01/2022
Nodular basal cell carcinoma - Anogenital in
See also in: Overview,External and Internal Eye,Hair and Scalp