lekha bcc paper
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BASAL CELL CARCINOMA
INVOLVING NOSEDR.S.LEKHA POST GRADUATE
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- ULCER OVER THE DORSUM OF NOSE- 4 X 3 CM
- BLACK COLOURED- ROLLED OUT EDGES
- EXTENDING TO SUPRATIP AND TO BOTH ALAE
OF NOSE LATERALLY AND ABOVE UPTO THE
BRIDGE OF THE NOSE.- ANOTHER ULCER OVER LEFT INFRAORBITAL
REGION OF 0.5CM SIZE.
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HPE PROVED
INVASIVE BASAL CELL CARCINOMA
PROCEDURE
NEAR TOTAL EXCISION OF NOSE WITH PRIMARYRECONSTRUCTION WITH RIGHT PARAMEDIANFOREHEAD FLAP AND THE SATELLITE LESIONEXCISED AND RECONSTRUCTED WITH SPLIT
SKIN GRAFT FROM RIGHT THIGH, IN THE SAMESITTING.
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BASAL CELL CARCINOMA WITH
SATELLITE LESION IN THE LEFT
INFRAORBITAL REGION ARE QUITERARE.
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INCIDENCE IN THE GENERAL
POPULATION
The incidence rate of BCC was estimated to be 1041
per 100,000 in men, and 745 per 100,000 in women.
70% of basal cell carcinoma occur on head and neck
,of which 25% occur in nose, specifically over the
nasal tip and alae.
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RISK FACTORS
GENETIC PREDISPOSITION.
ENVIRONMENTAL EXPOSURE
SUN EXPOSUREIONISING RADIATION
CHEMICAL EXPOSURE
IMMUNE SUPRESSION
PREMALIGNANT LESION
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Nodular basal cell carcinoma
Superficial basal cell carcinoma-present aserythematous macular lesion
Pigmentedcontains melanin causing confusionwith melanoma
Morphoeic- usually indurated with irregularborders, behave agressively.
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The tumours may be locally destructive, but veryrarely metastasise.
There is an increased risk of local recurrence forlarge, deep or ulcerated tumours, especially if
incompletely or narrowly excised, tumours of
micronodular, infiltrating, fibrosing (morphoeic) or
superficial multifocal type.
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SURGICAL MANAGEMENT
BCCs can be cured in the vast majority of cases bycomplete excision.
Surgical excision provides excellent five year cure rates
estimated at between 90 and 98% for previously untreatedtumours.
The margins of excision should be wide enough to
completely excise the tumour.
A 2 - 3mm margin is probably adequate for the majority ofsimple BCCs.
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Local flap repair providing cover with skin ofappropriate colour and texture is the preferred method
of closure when direct closure is not possible.
At times skin grafting will be necessary and full
thickness grafts are used choosing skin from an
inconspicuous donor site with similar skin
characteristics.
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RADIOTHERAPY
USEFUL ALTERNATIVE TO SURGERY FOR
ELDERLY OR MEDICALLY UNFIT PATIENTS
REPORTED CURE RATE OF 92%.
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OTHER METHODS
ELECTRODESSICATION AND CURETTAGE
CRYOSURGERY
PULSED CO2 LASER.
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Approximately 66% of people will develop a secondBCC within three years of a BCC excision.
Local Recurrence is rare (
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