Monthly Archives: April 2011

Superficial Basal Cell Carcinoma – A closer look

Superficial basal cell carcinoma (SBCC) is a growth pattern of basal cell carcinoma (BCC) which accounts for approximately 10-30% of all BCCs.


SBCC presents typically as a reddish (erythematous) patch ranging in size from approximately 3 to >10 mm. They often have a fine pearly border with central superficial erosions. Pale areas within the lesion can be a clue to regression and the lesion may have a history of bleeding. SBCCs are most commonly found on the trunk.


SBCC is seen as superficial collections of atypical basaloid cells originating from the bottom layer (basal layer, stratum basale) of the epidermis and projecting down into the papillary dermis. These collections are typically surrounded by a loose myxoid (mucin-like) stroma. Although histologically they have an apparent multifocal appearance recent 3D imaging techniques have found that a huge majority of these foci are truly interconnected and therefore not multifocal. Remember SBCC is also usually seen in conjunction with other BCC growth patterns such as nodular and infiltrative.


Due to its superficial nature, SBCC has a very good prognosis and there is a wide range of treatments available. SBCC does have a high recurrence rate due to its margins being difficult to assess (this is attributed to its apparent multifocal appearance histologically). Treatments include topical chemotherapy (eg. aldara), photodynamic therapy (PDT) and curettage.

Thanks for reading and I welcome any comments.

Keep an eye out for COMING SOON

Follow me on twitter (@skinpathology)


Tags: , , , , , , , , , , , , , , , , , , , , , ,

Solar Keratosis and It’s Subtypes

Solar Keratosis is defined by the World Health Organization as ‘a common intraepidermal neoplasm of sun-damaged skin characterized by variable atypia of keratinocytes.’

Subtypes that are recognised are hypertrophic, atrophic, acantholytic, pigmented. lichenoid and bowenoid. All subtypes usually display the common features of hypogranulosis, parakeratosis along with keratinocyte atypia confined to the bottom two layers of the epidermis (basal and spinous). Below is some of the histological features commonly seen in the subtypes apart from the features mentioned above.


This variant exhibits hyperkeratosis, acanthosis, papillomatosis, rete ridge elongation, telangiectasia and parakeratosis. The parakeratosis can be seen alternating with the hyperkeratosis.


This variant exhibits epidermal atrophy, basal epidermal budding with adnexal extension


This variant exhibits exocytosis, keratinocytic vacuolation, keratinocytic apoptosis, colloid bodies, band-like superficial dermal lymphocytic infiltrate and pigment incontinence.


This variant exhibits acantholysis (with possible extension down adnexae), suprabasal clefting and dyskeratosis.


This variant exhibits increased pigmentation of atypical keratinocytes with associated dermal melanophages.


Although most pathologists consider this Bowen’s disease, some say bowenoid solar keratosis exhibits less than full thickness atypia and sparing of follicles.

Thanks for reading.

Follow me on twitter (@skinpathology)

Keep an eye out for my website


Tags: , , , , , , , , , , , , , , , , , , , , , ,

Basal Cell Carcinoma and It’s Histological Growth Types

Basal cell carcinoma (BCC) is the most common skin malignancy and it’s incidence is on the increase. Below is a description of the four main different histological growth types and what is features are associated with each of them.


Superficial BCC presents as a scaly, reddish patch ranging in size from a few mm to over 100mm. Due to this clinical appearance there is often confusion with psoriasis. Superficial BCCs are most commonly found on the trunk and account for 10-30% of all BCCs. Histologically they are characterised by superficial collections of atypical basaloid cells projecting from the epidermis or from the sides of adnexal structures such as hair follicles or eccrine ducts. Due to the 2 dimensional processing of histology specimens most superficial BCCs appear multifocal but recent studies using digital imaging techniques show that the tumours nests are actually all interconnected. Truly multifocal superficial BCCs do occur but these are less common.


Nodular BCC most commonly appear as pale, pearly nodules often with macroscopically visible dilated blood vessels coursing over the top of the lesion. Nodular BCCs are most often found on the more sun exposed areas of the body (eg. face and neck). Histologically they are characterised by large, solid lobules of atypical basaloid cells exhibiting a peripheral palisade and often invading as far as the reticular dermis.  Other commons features including the classical BCC retraction artefact and tumour cystic degeneration.


Micronodular BCC most often present as slightly elevated/flat pale lesions. They are most commonly found on the back. Histologically, micronodular BCC appears as an invasive BCC with the tumour islands between 3-10 cells in width (approximately the size of a hair bulb). These smaller tumour islands commonly exhibit perineural invasion. Compared to nodular BCC, the excision margins of micronodular BCC can be more commonly underestimated leading to a higher recurrence rate.


Infiltrating BCC presents most commonly as an indurated, pale lesion whose clinical margins appear poorly demarcated. They are mostly found on the face and upper trunk. Histologically they appear as diffuse cords, strands, columns of atypical basaloid cells infiltrating deep into the dermis and that rarely exhibit a retraction artefact or peripheral palisade. Due to the highly diffuse infiltrating nature of this tumour perineural invasion is extremely common therefore recurrences are common.

Many thanks for reading and I welcome any comments or questions.

Keep an eye out for COMING SOON.

My email is for any correspondence.

Follow me on twitter (@skinpathology)


Tags: , , , , , , , , , , , , , , , , , , , ,