BasalCellCarcinoma in afya

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''Superficial BCC''
solitary red patches with rolled / pearly edge and later a central crater, focal areas of scale may occur but rarely form keratin, have radial telangiectatic patturn
more common in fair skinned, mostly sun exposed sites but inner canthus or behind ear is common and hands / forearm is rare (most common cancer in western world)
rarely metastasize but can be locally destructive - imp near eyes, nose or ears
intermittent early life severe sun exposure highest risk factor (sim to MM)

''Other sorts''
Nodulo-ulcerative - small pink pearly to nodular with central ulceration, well defined raised, rolled, pearly edge, radial telangiectasia
Pigmented - as above but margin may be pigmented
Cystic - pearly nodule with telangiectasia - ulceration occurs late
Morphoeic - ill defined margin, elevated, smooth, firm, white, waxy plaque, usually on face, may look like a scar.
Superficial - solitary flat red patch on trunk or limbs, mistaken for eczema/psoriasis. rolled edge (esp on stretching), fragile surface, focal scale / blood
Multifocal - pale nodule which expands and apparently regresses - scar between nodules - common on head&neck

''Management''
surgery
C&C gives 50% cure so OK if <1cm, well defined, below clavicle
2cycles gives 97% 5yr cure
cryotherapy can also be used for well defined lesion on trunk / limbs
5FU can be used but isn't as good as it is for Bowens or AK, Imiquimod can be used - only for superficial BCC
Mohs - critical sites, morphoeic, infiltrative
DXT good if frail or lesions are large
Photodynamic therapy - good for superficial not for nodular

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