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Rodent ulcer
- 3. 08-05-20173 The tumour enlarges in size by burrowing and destroying the tissue locally like a rodent, hence the name rodent ulcer.
- 4. 08-05-20174 Definition It is a low grade, locally invasive carcinoma arising from basal layer of skin ( or adnexal basal layer of hair follicle) or muco-cutaneous junction. It does not arise from mucosa.
- 5. 08-05-20175 Etiology 1. It is the commonest malignant skin tumour(70%). 2. Common in places where exposure to UV light is more. 3. More common in white-skinned people than blacks. 4. Common in males , middle-aged than elderly. 5. Other causes- Arsenics, Coal Tar, Aromatic hydrocarbons , Skin tumour syndromes.
- 6. Pathogenesis 08-05-20176 • No apparent precursor lesion • Hard to culture • Resist transplantation • Clinical Course Nodulo-ulcerarive type begins as a flesh coloured waxy nodule with telangectasia→ enlarges → central ulceration → deepens → rolled out, beaded edges → destroys structures locally as deep as bone/ cartilage → aptly named rodent ulcer Rare metastasis(17%), but recurrence known after inadequate treatment.
- 7. 08-05-20177 Location • Common site is face-above the line drawn between angle of mouth and ear lobule(90%)-Onghren’s line. • It is called as tear cancer as it is commonly seen in the area where tear rolls down. Common Sites 1. INNER CANTHUS OF EYE 2. OUTER CANTHUS OF EYE 3. NOSE 4. ON AND AROUND NASOLABIAL FOLD 5. ON THE FORE HEAD
- 8. Gross Pathology 08-05-20178 1. Pearly papule 2. Nodular telangiectasias 3. Central ulceration with rolled margins.
- 9. Histopathology 08-05-20179 Ovoid cells in nests with single outer Palisading layer
- 11. Clinical Features 08-05-201711 Middle aged man Non-tender Dry Slow growing Non mobile Raised and beaded edges with central scab No lymphatic or hematogenous spread High Risk BCC •Size : >2cms •Location: eye,nose,ear •Ill defined margins •Recurrent •Immunosuppressed individuals
- 13. Investigation 08-05-201713 1. Wedge Biopsy 2. X-Ray 3. CT Scan
- 14. 08-05-201714 Management •SURGICAL • Excision • Mohs Micrographic Surgery • Two stage surgery •NON SURGICAL • Curettage • Electrodessication • Laser Vaporization •RADIOTHERAPY Indications for surgery 1. Rodent ulcer eroding bone or cartilage 2. BCC close to eye 3. Recurrence
- 15. 08-05-201715
Editor's Notes
- NOTES FOR PRESENTERS: There are a range of different clinical presentations and histological variants of BCC. Superficial BCCs are important to distinguish clinically from other types of BCCs because they can frequently be managed medically, avoiding the need for excision. Nodular: Commonly on the face, cystic, pearly, telangiectasa, may be ulcerated, micronodular and microcystic types may infiltrate deeply. Superficial: Often multiple, usually on upper trunk and shoulders, erythematous well-demarcated scaly plaques, often larger than 20 mm at presentation, slow growth over months or years, may be confused with Bowen’s disease or inflammatory dermatoses, particularly responsive to medical rather than surgical treatment. Morphoeic: Also known as sclerosing or infiltrative BCC, usually found in mid-facial sites, skin-coloured, waxy, scar-like, prone to recurrence after treatment, may infiltrate cutaneous nerves (perineural spread). Pigmented: Brown, blue or greyish lesion, nodular or superficial histology, may resemble malignant melanoma. Basosquamous: Mixed BCC and squamous cell carcinoma (SCC), potentially more aggressive than other forms of BCC.
- Radiotherapy not performed when lesion is near eye,ear or close to lacrimal canaliculi,or once it erodes bone or cartillage.