basal cell carcinoma variations

7/29/2019 Basal Cell Carcinoma Variations

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Basal cell carcinoma: Variations

Deba P Sarma, MDOmaha


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BCC: M 58, forehead

Basal cell carcinoma, nodular type


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A. Rounded or branched lobules of small

hyperchromatic cells in the dermis with connectionto the overlying epidermis by narrow cords or broadtrabeculae.

B. Peripheral nuclear palisading.

C. Stroma is fibromyxoid.

D. Stroma retracts from the tumor lobules due toformalin fixation.

Basal cell carcinoma, nodular type


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BCC: M 74, right arm

Basal cell carcinoma,cystic type


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Basal cell carcinoma, cystic type

A.Variation of nodular BCC showing mucinousdegeneration in the center of the nodules

giving rise to cysts.


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BCC: M 87, nose

Basal cell carcinoma, nodulocystic type


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Basal cell carcinoma, nodulocystic type

A.Combination of nodular and cystic pattern.

B. 70% of all BCCs are nodulocystic type.


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BCC: F 45, left thigh

Superficial basal cell carcinoma


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A. Buds of dark basaloid cells with prominentperipheral nuclear pallisading are attached tothe basal layer of the epidermis.

B. Basaloid buds are separated along the basallayer by normal epidermal basal cuboidalcells.

C. Superficial basal cell carcinoma constitutesabout 15% of BCC's, nodular type being themost common type (70%).

D. Superficial BCC occurs most commonly onthe trunk.

Superficial basal cell carcinoma


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BCC: M 67, left forehead

Basal cell carcinoma, pilar type ( Keratotic basal cell carcinoma)


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Basal cell carcinoma, pilar type ( Keratotic basalcell carcinoma)

A.Nodular BCC with rounded collection of redcompact keratin in the center of the nodules

(pilar differentiation).


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BCC: M 73, forehead

Sclerosing basal cell carcinoma ( Morpheaform basal cell carcinoma)


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Sclerosing basal cell carcinoma ( Morpheaform basal

cell carcinoma)

A. Narrow cords, small groups and linear single smalldark basaloid cells within dense, collagenized stroma in

the dermis.

B. Note the solid large island of typical BCC in thesuperficial part.

C. Stromal retraction around the tumor cell islands maybe absent.


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BCC, M 81, back.

Pigmented basal cell carcinoma

A. Nodular BCC.B. Melanin pigments in the tumocells and in the stroma.


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BCC: M 84, left arm

Basal cell carcinoma, trichoepithelioma type


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Basal cell carcinoma, trichoepithelioma type

In many cases in adults, basal cell carcinomamay resemble trichoepithelioma.

These cases should be treated like basal cell

carcinoma with complete removal. My preferred term for such tumor is

BCC, trichoepithelioma type.

Ref: AFIP Atlas of Tumor Pathology. 4thSeries,Fascicle 4, Nonmelanocytic tumors ofthe skin. 2006, page 80.


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BCC: F 79, nose

bcl-2 Ber-Ep4

Metatypical basal cell carcinoma


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A. Loosely circumscribed dermal proliferation of lobules ofepitheliod cells with eosinophilic cytoplasm.

B. Few giant cells.

C. Atrophic epidermis.

D. No direct connection between the epidermis and the

dermal neoplastic proliferation.

E. No clefting.F. The tumor cells are positive for pancytokertatin (AE1:3),

bcl-2, and BerEp4.

Metatypical basal cell carcinoma


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BCC: M 72, right scalp

Basal cell carcinoma, infiltrative type


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A. Infiltrative basal cell carcinoma is a hybrid between nodulocysticand morpheaform BCC.

B. Expansile nodules mixed with branched, angulated and linearbasaloid cells.

B. Epidermal ulceration and deep dermal invasion with perineuralinvasion is common.Stroma is cellular.

B. Retraction artefact around the branched and angulated basaloidinfiltrates are not present.

Basal cell carcinoma, infiltrative type


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BCC: M 82, buttock

Fibroepithelioma of PinkusBasal cell carcinoma, fibroepithelioma of Pinkus type


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A. Fibroepithelioma of Pinkus (FEP) was first described by HermanPinkus in 1953.

B. FEP is currently accepted as a variant of basal cell carcinoma (BCC).

C. Mostly male, 4060 years of age.

D. Single or multiple pedunculated or sessile nodules with broad base onthe trunk or extremities.

E. Tumor is composed of long, thin, and branching strands of basal cell

carcinoma anastomosing in fibrovascular stroma.

Basal cell carcinoma, fibroepithelioma of pinkus type

Fibroepithelioma of Pinkus


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basal cell carcinoma variations

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