Sclerotic Basal Cell Carcinoma
Sclerotic / Morphoeic basal cell carcinoma
This lesion is deeply invasive and can be seen to extend beyond the border of the ulceration. This could also be classed as a multi-focal BCC; the difference is often not clinically apparent, and is only determined on histology.
This lesion has infiltrated deep into the underlying tissue, with the skin feeling solid and fixed well beyond the visible lesion. Here, the facial nerve lies just deep to the lesion, making for a challenging excision.
This is a closeup of the lesion shown in Figure 3. Note how the lesion is infiltrating into the deep tissue of the nose with the tumour margins at the site of the ulceration appearing slightly raised.
Features
Sclerotic lesions appear smooth and can be above or below the level of the surrounding skin. They are usually deeply invasive. Lesions tend to be pale yellow in colour with ulceration, bleeding and crusting being less common than in other types of BCC.
The extent of these lesions is hard to define, as the lesion often extends beyond the visibly affected skin. The skin feels firm on palpation beyond the visible part of the lesion. This is due to underlying infiltration of the dermis.
Incidence
Roughly 5% of BCCs are of the sclerotic type.
Differential Diagnosis
Scar tissue.
Treatment
The best forms of treatment for a primary sclerotic BCC are shown below. Note: "Large"=>2cm.
Sclerotic, small and low-risk site
Excision is the best form of treatment. Curettage and cautery, radiation therapy and cryosurgery are also reasonable options.
Sclerotic, small and high-risk site
Moh's micrographic surgery is thought to be the best form of treatment. Excision is also effective.
Sclerotic, large and low-risk site
Excision is the best form of treatment. Moh's micrographic surgery is also effective.
Sclerotic, large and high-risk site
Moh's micrographic surgery is the best form of treatment.
