Nodular Type Basal Cell Carcinoma of the Nose

Basal Cell Carcinoma of the Nose

Basal cell carcinomas (BCC) are abnormal uncontrolled growth or lesions of the basal cells, the deepest layer of the epidermis (the outermost layer of the skin). Basal cell carcinoma can usually be seen as open wounds, red spots, pink formations, shiny surface nodules or scars. Generally, prolonged or intense exposure to UV rays is the cause of basal cell carcinoma. If they are not treated and they grow, they can cause damage to the tissues in the area where they are, but they almost never metastasize. Only in extremely rare cases it can spread to other parts of the body and can be life threatening.

Basal cell carcinomas are the most common of all types of cancer. Skin cancer is one of every three new diagnosed cancers and the majority of skin cancers are basal cell carcinomas. Approximately 75 (75%) of all 100 non-melanoma skin cancer cases are basal cell skin cancers. This type of cancer occurs mostly in areas exposed to the sun, but it can also be seen on your back or at the bottom of your legs. It is often diagnosed at middle or advanced age.

Subtypes of basal cell carcinomas

Basal cell carcinoma fortunately accounts for 80% of all skin cancers. Fortunately I say because it looks much better than other types of skin cancer. Light color is more common in skin and UV contact areas. Most types of familial predisposition are not observed. However, some variants are seen as familial predisposition in diseases such as Bazex syndrome, Gorlin syndrome, xeroderma pigmentosum. Basal cell carcinoma originates from the basal cell layer of the skin in the epidermis layer.

They can be seen as macular, nodular, ulcerative and scattered patches according to their types. They are usually colored formations. Around it lies telangiectasia.

Nodulo-ulcerative type basal cell carcinoma

It is the most common type. It starts as a small pearl-like transparent papule, it grows, turns into a nodule, the skin on it becomes thinner, telangiectasia can develop thin veinings, ulcers become ulcerated in the middle of the nodule and ulcers can make bleeding. There is an ulcer in the form of a fully developed, a hard, bright relief in the environment and a clear border.

Micronodular basal cell carcinoma

They are seen as many small round nodules in the form of a miniature of the nodular type. Lesions are usually seen with other nearby nodular tumors.

Pigmented type basal cell carcinoma

Nodulo-ulcerative type of this type of hyper pigmented and dark brown or blackish color is called this. Large amounts of melanin in and around the tumor cause this black appearance.

Morphea-like basal cell carcinoma

It is usually seen as a hard, bronze or yellow, atrophic rubbery patch. Tumors are flat and more easily seen when fibrotic skin reaction is evident. They may become more pronounced by stretching the skin or pressing on a slide. Its limits are almost always wider than clinically seen. In their pure form, the lesions tend to progress superficially to the lateral and show little penetration into the dermis. It resembles a cicatricial or scarred tissue and may become ulcerated too late. Since the boundaries are not fully evident, they should be removed very wide.

Superficial type basal cell carcinoma

Single or multiple, usually flat lesions with superficial ulceration, red, dandruff, fine lines. The limits are not apparent. May have pearl-like, curved edges. On examination, they may resemble eczematous dermatitis. It may be difficult to determine the edge of the lesion because the lesion may be clinically beyond its appearance. Large lesions (more than 15 mm in diameter) often have infiltrative components. Many tumors may contain a different type of tumor in the middle with the superficial type component at the edges. There is no spread.

Ulcerative type basal cell carcinoma

It is similar to the nodular-ulcerative type, but it is not the nodules in the periphery of the lesion and the edges are almost cut with staples. There is a clear boundary between this and the intact leather.

Nodular type basal cell carcinoma

It is one of the most common types. It begins in the form of a pearly papule with thin veins on and around the telangiectasias, itchy and occasionally bleeding. In the course of time, an ulcer develops and returns to the nodulo-ulcerative type.

Adnexial type basal cell carcinoma

It is very rare and seen in the elderly. It exhibits slow inversion and local invasion and takes its origin from basal cells in sweat glands. Despite treatment, repetition is common in the same place.

Mixed type basal cell carcinoma

More than one type of tumor is seen in one sample. In fact, pure tumor forms are rarely seen. Any combination of tumor types previously described can be seen, but the most common is the nodular-micronodular configuration. Combination of these types together is the irregularity in tumor growth centers, which cause the formation of round nodules of different sizes.

Bazo-flat epithelial carcinoma

Histologically, these tumors are both basal cell and squamous cell carcinoma. This variant can evolve with the growth characteristics and pace of NDSC (faster and more aggressive than a typical RCC). The lesion may have metastatic potential, such as AEH, and this metastatic potential depends on the more anaplastic cell type in this heterogeneous population.

Recurrent basal cell carcinoma

It is more difficult to recognize as it may be hidden on or near the previously surgically removed area. Recurrence or signs of excision of inadequate surgical application may be ulceration, bleeding or redness in the skin. These lesions may develop years after the primary tumor and any changes in the scars should be performed on a biopsy.

Basal Cell Nevus Syndrome

BCC' s consist of small puncture-palmar pitting, bone anomalies, odontogenic keratocysts and multiple epidermal skin cysts in the jaw bones. It is familial. Syndrome is quite rare in black race.

Symptoms of basal cell carcinoma

Two or more of the following symptoms are seen in basal cell carcinomas. In addition to these, it reminds skin diseases such as psoriasis and eczema. Only a physician can make a diagnosis of the disease. If you are experiencing some alarming changes in your skin, consult your doctor immediately.

- Hemorrhagic open wounds or crusting and healing in a few weeks and then re-opened and bleeding non-healing permanent wounds are the earliest sign of basal cell cancers.

- Formations in the form of fried patch or irritated skin seen on the face, chest, shoulders, arms and legs. sometimes these patch-shaped lesions may be crusty and itchy. But at other times they do not cause any other discomfort.

- Usually pearl or translucent, pinkish, red or white can be seen in the form of a bright lump or nodule.

- It can be seen as a pink formation around the middle and a crusty and crusted pink skin. The growth is slow and the capillary blood vessels can be seen on the surface.

- It can be seen as a white, yellow or waxy structure, the skin is bright and stretched and the edges are not very clear.

What are the causes of basal cell carcinoma?

Basal cell carcinoma occurs when a mutation occurs in a DNA of the basal cells of the skin. The basal cells are located at the bottom of the epidermis, which is the outermost layer of the skin, and produce new skin cells. New skin cells produced in the basal cells push the aged skin cells to the outer surface of the skin, and these old cells die and are poured. The process of making new skin cells is controlled by the DNA of the basal cells. A mutation in the DNA normally undergoes aging and death of the skin cells that need to be spilled and the resulting abnormal cells form cancer.

Ultraviolet light and other causes

DNA damage in basal cells is thought to be the result of excessive sunlight and ultraviolet (UV) radiation in commercial tanning lamps or solarium.

Almost all of the basal cell carcinomas occur in the areas of the body exposed to excessive sunlight, especially the face, ears, neck, scalp, shoulder. In rare cases, tumors may also develop in non-solar areas. Occasionally, contact with arsenic, radiation exposure, PUVA treatment, unhealed open wounds, chronic inflammatory skin diseases, burn complications, scars, infections, vaccines, even tattoos are factors that can cause basal cell carcinoma formation.

Treatment of basal cell carcinoma

MOHS micrographic surgery

With local anesthesia, the physician removes the cancerous skin tissue in a very thin layer. The layer is immediately checked under a microscope. If cancerous cells continue to be seen, a thin layer is removed and this process continues until a healthy tissue is seen in the microscope. With this technique, the least amount of damage to healthy tissue is given and the success rate is approximately 98 percent and over. It is often used for recurrent recurrent tumors such as eyes, nose, lips and ears. After the procedure, wound healing can be left in its natural course or reconstructed by plastic surgery.

Excisional surgery

Under local anesthesia, surgical removal of the cancerous tissue with a safety zone around it. The wound is then closed and the removed tissue is sent to the pathology laboratory for examination. The success rate is around 90%.

Curettage and electrocautery

Under local anesthesia, the cancerous area is scraped with a curette and the bleeding areas with electrocautery are burned. It is not useful in aggressive cancers and risky areas.


It is the treatment that is done without radiotherapy and anesthesia and surgery. Requires practice several times a week for several weeks. It is applied in people who are at risky areas and who are not able to handle surgical procedures and who are ill and have health problems. success rate is around 90%.


The cancerous tissue is freeze-dried with liquid nitrogen without the need for surgery or anesthesia. The resulting crusting usually falls within a week. Cryotherapy is the treatment of choice for patients with extensive tumors, bleeding disorders or anesthesia intolerance. This method is used less commonly today, and has a success rate of 85-90 percent.

Photodynamic therapy (PDT)

PDT can be useful when there is more than one basal cell carcinoma in the patient. In the first stage, a light-sensitive substance such as topical 5-aminolevulinic acid (5 - ALA) is applied to the cancerous cells. The next day cancer cells are killed with a special light. Very little damage to normal tissues. It is approved in superficial and nodular basal cell carcinomas. Success rates range from 70 to 90 percent. Patients should stay away from sunlight for 48 hours after treatment.

Laser surgery

It can be applied as a secondary treatment when other treatments fail.

Local drugs

Local cream or ointments such as FU iimquimod or 5 - fluorouracil (5 - FU) can be used in very superficial basal cell cancers. Success rates are between 80-90%. Treatment lasts 3-6 weeks.

Similar links >> Basal Cell Carcinoma of The Nose Tip Skin / Resection of Basal Cell Carcinoma of the External Auditory Canal

Source links >> Nodular Basal Cell Carcinoma / Case Report: An ulcerated nodule on the nose

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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