Section: Pathology

Original Research Article HISTOPATHOLOGICAL AND CLINICAL SPECTRUM

OF BASAL CELL CARCINOMA : OBSERVATIONAL
STUDY IN A TERTIARY CARE CENTER

Received : 10/10/2023
Shubhangi Vinayak Agale1, Manjusha Shripad Dhawle2, Vanita
Received in revised form : 05/11/2023 Vinodkumar Rathi3, Arva Ali Pirosha4 , Krishna Pukhraj Chandak5, Sonal
Accepted : 17/11/2023 Shreedhar Kadlag6
1
Keywords: Department of Pathology, Grant Govt Medical College & Sir J.J. Hospitals, Mumbai, India
2
Basal cell carcinoma, malignant, Department of Pathology, Grant Govt Medical College & Sir J.J. Hospitals, Mumbai, India
3
histopathology. Department of Pathology, Grant Govt Medical College & Sir J.J. Hospitals, Mumbai, India
4
Department of Pathology, Grant Govt Medical College & Sir J.J. Hospitals, Mumbai, India
Corresponding Author: 5
Department of Pathology, Grant Govt Medical College & Sir J.J. Hospitals, Mumbai, India
Dr. Arva Ali Pirosha, 64
Department of Pathology, Grant Govt Medical College & Sir J.J. Hospitals, Mumbai, India
Email: [email protected]

DOI: 10.47009/jamp.2023.5.6.93 Abstract

Background: Basal cell carcinoma is one of the most common skin cancer seen
Source of Support: Nil,
Conflict of Interest: None declared worldwide. It accounts for more than 80 % of nonmelanoma skin cancer. This
article highlights its various histological subtypes along with their clinical
Int J Acad Med Pharm
2023; 5 (6); 451-454
correlational and few new and interesting points noted in the histopathological
and clinical presentation. Materials and Methods: Retrospective observation
and detailed analysis was done of the cases of basal cell carcinoma reported in
the histopathology department of a tertiary care center during the span of one
year. Result: Eleven cases of Basal cell carcinoma were studied, male to female
ratio of incidence in our study was 0.57. The common age group involved was
between 71-80 years with median age of presentation being 59.5 years. The
commonest site of involvement was eyelid.The histological variants noted were
nodular, basosquamous, pigmented and superficial spreading. Conclusion:
Diagnosing and exact typing of Basal cell carcinoma and its variant on
histopathology plays a key role in the correct treatment of the patients.

INTRODUCTION reported in histopathological department of a tertiary

care centre from January 2022 to December 2022.
Basal cell carcinoma is the most common malignant CASES
cutaneous tumor worldwide. It is prevalent in the A total of 5 cases with histopathological diagnosis of
white skinned and industrialized western population nodular type BCC were reported.
and second most common malignancy after Case 1- A 8 years male came with swelling in the pre
squamous cell carcinoma.[1,2] It is locally invasive, auricular region since 1 year. Clinical diagnosis was
slow growing cutaneous malignancy which does not nodular BCC and histopathology confirmed
metastasize.[3,4] BCC can be caused due to chronic noduloulcerative BCC.
sun exposure, ultraviolet /ionizing radiations, Case 2- A 38 years male had a hyperpigmented
chemical carcinogenesis, burns , chronic irritation plaque with central ulceration over the right cheek
and certain inherited syndromes like Gorlin Goltz since 2 years. Clinical diagnosis was pigmented BCC
syndrome.[5] It affects mostly males above 40 years but histopathology revealed nodular BCC.
of age but can also be seen in children.[6] Case 3- A 55 years male presented with swelling on
80 % of BCC occurs in head and neck region where the upper eyelid since 1 year. Clinical as well as
nodular variant is commonly seen, while superficial histopathological diagnosis confirmed nodular BCC.
spreading type occurs on trunk.[7] There are many Case 4- A 65 years female had a noduloulcerative
histological variants of BCC. Aggressive variants are lesion on the forehead since 6 months [Figure 1].
morpheaform, metatypical, basosquamous and Clinically it was noduloulcerative BCC which was
infiltrative. confirmed on histopathology.
Case 5- A 55 years female presented with an
MATERIALS AND METHODS erythematous nodular lesion over the lower eyelid
since 3 years. Clinical diagnosis was nodular BCC.
We studied and compared various histopathological Histopathological examination revealed nodular
variants along with detailed clinical history and growth of the tumor with peripheral palisading of
presentation of eleven cases of basal cell carcinoma tumor cells suggestive of nodular BCC [Figure 2].

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A total of three cases of basosquamous BCC were The nodular and superficial variants both can be
reported. pigmented. Histologically it shows nodules of
Case 6- A 71 years female presented with ulcerative basaloid cells with presence of melanin pigment
plaque of 3x2 cm on the left temporal region since 1 within. In our study we found only one case of
year. Clinically it was diagnosed as noduloulcerative superficial BCC in which there were isolated basaloid
BCC. Histopathology revealed basosquamous nodules projecting from lower margin of the
variant of BCC consisting of biphasic tumor with foci epidermis. In most of our cases patients were treated
of neoplastic squamous differentiation [ Figure 3 & successfully by surgical excision with wide margin
4]. along with cosmetic repair and flap reconstruction as
Case 7- A 72 years female came with 2x2 cm required. One case of basosquamous carcinoma
erythematous scaly plaque over lateral part of nose developed regional lymph node metastasis and died
since 6 months. Clinical impression was superficial within six months of diagnosis. The
BCC while histopathology revealed basosquamous clinicopathological corelation of these 11 cases is
BCC. shown in [Table 2].
Case 8- A 76 years female presented with an
erythematous nodule on lower eyelid since 3 years.
Clinical impression was nodular BCC.
Histopathology favored basosquamous BCC.
Total two cases of pigmented BCC were diagnosed.
Case 9- A 70 years female had a hyperpigmented
plaque on lower eyelid since 2 years [ Fig.5]. Clinical
as well as histopathological diagnosis was pigmented
BCC.
Case 10- A 70 years female presented with
hyperpigmented nodule on the right side of cheek
since 8 months. Clinical as well as histopathological
diagnosis of pigmented BCC was made. On
histopathology basaloid tumor cells with peripheral
palisading and extracellular melanin pigment were Figure 1: Noduloulcerative skin lesion on forehead.
seen [Figure 6].
A single case of superficial spreading BCC was
reported.
Case 11- A 75 years male presented with black
coloured patch on right nasolabial fold since 10
months. It gradually increased in size and bled on
touch. Clinical as well as histopathological diagnosis
of superficial spreading BCC was given.

RESULTS
We studied 11 cases of BCC with following subtypes
Figure 2: H&E (20X)-Nodular BCC showing peripheral
[Table 1]. palisading of tumor cells.
The common age group affected in our study was
between 71-80 years (36.3%); followed by 61-70
years (27.2%). Mean age was 59.5 years. Oldest
patient in our study was 76 years while youngest was
an eight year old male child. In our study BCC was
distributed in head and neck area similar to the
finding of Malhotra et al [13]. The most common site
of involvement was eyelid (36.3%) followed by nose,
forehead and cheek (18.1%).On histopathology we
found maximum nodular variant(45.4%) followed by
basosquamous(27.2%), pigmented(18.1%) and
superficial spreading(9%).On H&E the nodular
variant showed nodules of basaloid cells with
peripheral palisading. We observed three cases of Figure 3: H&E (20X)-Basosquamous BCC showing
basosquamous BCC in our study. This variant is rare both basaloid and squamous components.
having both histological features of BCC and
squamous cell carcinoma. Basosquamous carcinoma
is locally invasive and more aggressive. Pigmented
BCC was third most common histological variant.

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ISSN (O): 2687-5365; ISSN (P): 2753-6556
Figure 4: H&E (40X)- Basosquamous BCC showing
both basaloid and squamous components. Figure 5: Pigmented lesion on lower eyelid.

Figure 6: H&E (40X)-Pigmented BCC showing

presence of pigment both within tumor cells and
extracellular as well.

Table 1: Histological variants of BCC

Histological variant of BCC Number of patients
Nodular 5
Basosquamous 3
Pigmented 2
Superficial spreading 1

Table 2: Clinicopathological spectrum of BCC

Sr No Age in Years Sex Site of tumor Clinical presentation Histopathological diagnosis
1 8 Male Preauricular Nodular swelling Nodular BCC
2 38 Male Right cheek Ulcerated hyperpigmented plaque Nodular BCC
3 55 Male Upper eyelid Nodular swelling Nodular BCC
4 65 Female Forehead Ulcerated nodule Nodular BCC
5 55 Female Lower eyelid Erythematous nodule Nodular BCC
6 71 Female Temporal region Ulcerated plaque Pigmented BCC
7 72 Female Lateral part of nose Plaque like lesion Pigmented BCC
8 76 Female Lower eyelid Hyperpigmented swelling Pigmented BCC
9 70 Female Lower eyelid Hyperpigmented plaque Basosquamous BCC
10 70 Female Right cheek Hyperpigmented nodule Basosquamous BCC
11 75 Male Nasolabial fold Black patch Superficial spreading

DISCUSSION these are rural women who work in open kitchen and
in farms exposing them to high intensity UV rays.
Basal cell carcinoma was previously also known as Female predilection might also be because of their
rodent ulcer. It is an indolent carcinoma with thin skin having low collagen density in dermis than
metastatic incidence of 0.01 to 0.028%.[8] Our study males.[11]
includes eleven patients of BCC out of which four The common age group affected in our study was
were males and seven females. The male to female between 71-80 years (36.3%); followed by 61-70
ratio was 0.57. Our findings are similar to Laishram years (27.2%). Mean age was 59.5 years which was
et al,[9] who reported female preponderance while similar to Obaidullah and
Sibel Hakverdi et al,[10] showed male preponderance. Aslam who showed mean age of 56.3 years.[12] Oldest
Females are affected more than males in our study as patient in our study was 76 years while youngest was

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ISSN (O): 2687-5365; ISSN (P): 2753-6556
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ISSN (O): 2687-5365; ISSN (P): 2753-6556