Basal Cell Carcinoma

Question 1

Which of the following is the most common form of cancer?

1 - Malignant Melanoma
2 - Breast cancer
3 - Squamous Cell Carcinoma
4 - Basal Cell Carcinoma

Answer 1

4 - Basal Cell Carcinoma

Question 2

Typically how many basal cell carcinomas are there per year in the UK?

1 - 2000
2 - 20,000
3 - 200,000
4 - 2,000,000

Answer 2

3 - 200,000

Question 3

Which of the following is NOT a risk factor for basal cell carcinoma?

1 - UV radiation exposure (especially at a young age)
2 - Fair skin
3 - Age
4 - Ionising radiation
5 - Repeated micro-injuries
6 - Scars/chronic ulcers
7 - Prolonged chemical exposure
8 - Immunosuppression
9 - History of skin cancer

Answer 3

3 - Age

Question 4

What is the most common location for basal cell carcinomas to appear on an individual?

1 - back and legs
2 - head and neck
3 - arms and legs
4 - feet and legs

Answer 4

2 - head and neck

Typically those with the most exposure to the sun like the face

Question 5

Which 2 of the following mutations in the basal cells of the skin is associated with basal cell carcinomas?

1 - APC
2 - BRAF
3 - TP53
4 - PTCH

Answer 5

3 - TP53
4 - PTCH

Question 6

Do basal cell carcinomas typically metastasise?

Answer 6

• no
• typically do not move beyond the basal cells of the skin
• BUT in rare cases they can

Question 7

Of the 4 images below, which is a basal cell carcinoma?

Answer 7

• top left

Question 8

There are 3 main types of basal cell carcinomas, which of the following is NOT one of these?

1 - Bulla
2 - Superficial
3 - Nodular
4 - Morphoeic/infiltrative

Answer 8

1 - Bulla

• Superficial= just surface of skin
• Nodular = raised up with clear margins
• Morphoeic/infiltrative = margins difficult to see with some spread on surface

Question 9

Of the different types of basal cell carcinoma, which is high-risk for extensive local spread and high recurrence rates?

1 - Morphoeic/infiltrative
2 - Superficial
3 - Nodular

Answer 9

1 - Morphoeic/infiltrative

Nodular and superficial are low risk

Question 10

There are 3 main types of basal cell carcinomas, which of the these is most common?

1 - Superficial
2 - Nodular
3 - Morphoeic/infiltrative

Answer 10

2 - Nodular

Superficial is the 2nd most common

Question 11

In the image below, which type of basal cell carcinoma is this?

1 - Morphoeic/infiltrative
2 - Superficial
3 - Nodular

Answer 11

3 - Nodular
- typically they have an ulcerative centre, similar to a rodent bite

• can contain telangiectasia, where small capillaries become clear and appear like spider webs

Question 12

There are 3 main types of basal cell carcinomas (BCC), with Nodular being the most common type. Which of the following is NOT a characteristic of a nodular BCC?

1 - pearly, shiny papule appearance
2 - small arborising telangiectasias
3 - rolled borders
4 - always a depressed/ulcerative centre

Answer 12

4 - always a depressed/ulcerative centre

They can have depressive and ulcerative centres, but this is NOT always the case

Question 13

Are basal cell carcinomas sensitive and likely to bleed?

Answer 13

• Yes

Very sensitive and likely to bleed on even minor trauma

Question 14

In the image below, which type of basal cell carcinoma is this?

1 - Morphoeic/infiltrative
2 - Superficial
3 - Nodular

Answer 14

1 - Morphoeic/infiltrative
- most aggressive form of BCC

• ill defined edges and centre is eroded away
• MOHS surgery is often the preferred choice

Question 15

In the image below, which type of basal cell carcinoma is this?

1 - Morphoeic/infiltrative
2 - Superficial
3 - Nodular

Answer 15

2 - Superficial

Often appear as a plaque with:
- stretched appearance with a rolled edge
- can be shiny with some pigmentation
- can sometimes be pigmented

Question 16

Which of the following remains the main stay treatment for nodular BCC?

1 - Excision
2 - Curettage
3 - Efudix (5-FU) chemo drug
4 - Radiotherapy

Answer 16

1 - Excision
- MOHS surgery is often the preferred choice

Curettage = inject local anaesthetic, scrape and repeat

Efudix = 2 cycles typically

Question 17

What is the ONLY modifiable risk factor for skin cancer?

1 - sun exposure
2 - weight
3 - immunotherapy
4 - smoking

Answer 17

1 - sun exposure

Question 18

Avoiding peak UV times can help mitigate the risks associated with skin cancer. What are peak UV times?

1 - 9am - 1pm
2 - 11am - 12pm
3 - 11am - 3pm
4 - 1-3pm

Answer 18

3 - 11am - 3pm

Question 19

Which of the following are ways to minimise UV exposure and reduce the risk of skin cancer?

1 - Wear hats, sun glasses, clothes
2 - Sunscreen on face and as needed elsewhere
3 - Broad spectrum of >SPF30
4 - Suncream containing UVA: 4-5 stars
5 - all of the above

Answer 19

5 - all of the above

Question 20

If identified and treated early, what are the recurrence free rates of BCC?

1 - 25%
2 - 50%
3 - 65%
4 - 95%

Answer 20

4 - 95%

Question 21

Which of the following remains the main stay treatment for superficial BCC?

1 - Excision
2 - Curettage
3 - Imiquimod 5% cream 5-6 wks
4 - Efudix (5-FU) chemo drug
5 - Cryotherapy (2 cycles 20s)
6 - photo dynamic therapy (PDT)

Answer 21

1 - Excision

Curettage = inject local anaesthetic, scrape and repeat

Efudix = 2 cycles typically

PDT = cream applied to lesion and then red light applied, needs 2 treatments

Question 22

Typically what is used for high risk basal cell carcinomas such as Morphoeic/infiltrative?

1 - Excision followed by curettage
2 - Imiquimod 5% cream 5-6 wks then excision
3 - Cryotherapy (2 cycles 20s) then excision
4 - Excision followed by radiotherapy

Answer 22

4 - Excision followed by radiotherapy

Question 23

Is Mohs Micrographic Surgery or basic excision surgery more effective at inducing remission in low and high risk tumours?

Answer 23

Mohs Micrographic Surgery

Question 24

If a patient has excision of a BCC, they may also have radiotherapy afterwards. Which of the following is NOT an indication that a patient should have radiotherapy following excision?

1 - Close or positive margins
2 - Aged >65 years old
3 - Recurrence after previous resection
4 - Tumour invading bone / muscle

Answer 24

2 - Aged >65 years old