What are the other Names for this Condition? (Also known as/Synonyms)

• Infiltrating Basal-Cell Cancer of Skin
• Infiltrating BCC of Skin

What is Infiltrating Basal Cell Carcinoma of Skin? (Definition/Background Information)

• Basal Cell Carcinoma (BCC) of Skin is a malignant skin condition. It is a slow-growing tumor generally observed in older individuals, in both men and women
• This malignant tumor, which may be present as a lesion on the sun-exposed areas of the body, has the potential to metastasize (spread) to the lymph nodes
• Infiltrating Basal Cell Carcinoma of Skin occurs as an irregular plaque with a tendency to infiltrate deep into the body tissue, making them difficult to treat. It is an uncommon subtype of BCC of Skin
• Some lesions may grow to large sizes and ulcerate. They can also infiltrate into the adjoining soft tissues and nerves. Larger tumors have a greater tendency to recur after treatment
• Infiltrating Basal Cell Carcinoma of the Skin has three types microscopically: Morpheaform, sclerosing, and micronodular
• The cause of Infiltrating Basal Cell Carcinoma of Skin is unknown, but factors such as chronic sun exposure, smoking, and ionizing radiation are known to contribute towards its development. Also, fair-skinned Caucasians have a greater risk than dark-skinned Africans and Asians for this condition
• Any combination of chemotherapy, radiation therapy, and invasive procedures (surgery) may be used to treat Infiltrating Basal Cell Carcinoma of Skin. Small-sized tumors and tumors that have not metastasized can be cured through appropriate skin surgery
• The prognosis for metastatic tumors depends upon many factors including the stage of the tumor, health status of the individual, and treatment response. In general, the prognosis may be guarded

Who gets Infiltrating Basal Cell Carcinoma of Skin? (Age and Sex Distribution)

• Infiltrating Basal Cell Carcinoma of Skin is an uncommon skin cancer that generally affects elderly adults; some cases rarely develop in children too
• It can occur in both males and females; however;
  • Among the older age group, males are affected more than females
  • In the younger age group, females are affected more than males, which may be attributed to their tendency to acquire sun-tanned bodies or visit skin tanning parlors more
• This condition is observed worldwide across all racial and ethnic groups; however, lighter-skinned individuals (especially Caucasians) are more prone to Infiltrating BCC of Skin than darker-skinned individuals (such as Asians and Africans)

What are the Risk Factors for Infiltrating Basal Cell Carcinoma of Skin? (Predisposing Factors)

The risk factors that contribute to Infiltrating Basal Cell Carcinoma of Skin formation include:

• Prolonged sun exposure, exposure to ultraviolet (UV) light
• Use of tanning beds and tanning parlors
• Arsenic exposure
• Ionizing radiation
• Smoking
• The presence of certain genetic syndromes, such as basal cell nevus syndrome (a rare autosomal dominant disorder), can increase the risk
• Caucasians are more vulnerable compared to other darker-skinned individuals

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Infiltrating Basal Cell Carcinoma of Skin? (Etiology)

• The exact cause of development of Infiltrating Basal Cell Carcinoma of Skin is not completely known, in a majority of cases
• Genetic mutations have been detected in basal cell carcinomas (BCCs), which are currently
• Most BCCs are sporadic in origin i.e., they occur in a random fashion

What are the Signs and Symptoms of Infiltrating Basal Cell Carcinoma of Skin?

Infiltrating Basal Cell Carcinoma of Skin signs and symptoms may include:

• Infiltrating BCC of Skin is a slow-growing malignant tumor. The tumor is a typical skin lesion, with thickened skin, presenting as a poorly-demarcated plaque
• The surface of the plaque may be red, if intact. Else, it may appear as an ulcer, if the surface is eroded
• It is typically observed on sun-exposed areas of the body; common sites include the head and neck region, arms and legs, etc.
• The tumor may be solitary or many in number. In children, if it is associated with basal cell nevus syndrome, then multiple lesions may be observed
• Some Infiltrating BCC of Skin have pigmented appearance and may resemble a melanoma
• Most lesions are less than 1-2 cm, but some may grow to larger sizes of even 10 cm
• The carcinoma has a tendency to penetrate deep into the subcutaneous tissue
• The lesion may grow in size resulting in  itching sensation, ulceration, and bleeding

How is Infiltrating Basal Cell Carcinoma of Skin Diagnosed?

Some of the tests that may help in diagnosing Infiltrating Basal Cell Carcinoma of Skin include:

• Complete physical examination with detailed medical history evaluation
• Examination by a dermatologist using a dermoscopy, a special device to examine the skin
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin or tissue biopsy: A skin or tissue biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• Differential diagnosis of other tumors should be ruled out; hence, skin biopsy is an important diagnostic tool

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Infiltrating Basal Cell Carcinoma of Skin?

The complications of Infiltrating Basal Cell Carcinoma of Skin could include:

• If the tumor becomes big, develops into a firm mass and ulcerates, it can get secondarily infected with bacteria or fungus
• Metastasis to regional lymph nodes can occur. The tumor can also infiltrate very deep into the surrounding structures
• Infiltrating BCC of Skin can cause cosmetic issues, since these skin tumors can present large ulceration (termed rodent ulceration) with their own growth. The treatments needed to treat the malignancy may leave a defect with cosmetic and functional ramifications
• Recurrence of the tumor - it is frequently common with large tumors. The risk of recurrence is  higher with Infiltrative BCC compared to other BCC subtypes
• Side effects of chemotherapy (such as toxicity) and radiation therapy

How is Infiltrating Basal Cell Carcinoma of Skin Treated?

In general, the treatment of Basal Cell Carcinoma of Skin depends upon a variety of factors including:

• The subtype of BCC
• The location of the tumor
• The number of tumors
• The size of the tumor
• Whether the tumor has metastasized

A combination of treatment methods may be used to treat Infiltrating Basal Cell Carcinoma of Skin. The type of surgery may include:

• Curettage and electrodessication. This procedure is not optimal for Infiltrating Basal Carcinoma of the Skin. The clinically uncertain margins of the tumor and infiltration into firm collagen lead to high recurrence rates
• Excision of tumor: In this procedure, the tumor and surrounding tissues are removed with an estimate of the size of excision to provide clear margins. The resultant defect is closed with sutures. Pathology examination of the specimen is done after the surgery. If margins are involved, a repeat procedure is necessary  
• Mohs surgery: In this procedure, the tumor is removed layer by layer, until clear margins are achieved. Each layer removed is flash frozen, stained, and examined under a microscope within 30 minutes of the removal, for the presence of residual tumor. The procedure is repeated until margins are clear. Following this, plans for any necessary reconstructive procedure are made
• Infiltrating BCC of the Skin can be treated with hedgehog inhibitor medication. This oral medication can shrink the tumor. Vismodegib and sonidegib are FDA-approved for BCC

In most cases, a surgical removal of the entire tumor is the preferred treatment option. This can result in a cure. However, since the tumor infiltrates deep, it is very difficult to completely remove them through a surgical excision

• If the tumor has metastasized (in rare cases), then a combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor
• Targeted therapy medications are generally used for locally infiltrative or metastatic BCCs. This therapy destroys the tumor cells by acting against the proteins that are responsible for tumor growth
• Large tumors that have infiltrated surrounding structures can be treated with radiation therapy (the use of high-energy beams to kill cancer cells)
• Large tumors after complete skin excision may need skin grafting
• Post-operative care is important: One must maintain minimum activity levels until the surgical wound heals

Other techniques to treat this skin cancer (sometimes, when surgery may not be an option) may include:

• Cryotherapy: Here the tumor tissue is destroyed through a freezing technique. Typically, liquid nitrogen is used to freeze the tumor
• Topical creams, such as 5-fluorouracil cream and imiquimod cream, may be used for topical treatment. These creams may be applied for several weeks, which slowly destroys the tumor

Note: If multiple lesions occur in children, then the possibility of basal cell nevus syndrome should be eliminated.

Generally, proper follow-up care with regular screening and check-ups are important and encouraged. In the case of large lesions, close follow-up and periodic observation is essential, since they have a tendency to recur. This is especially true in the case of Infiltrating BCC of Skin.

How can Infiltrating Basal Cell Carcinoma of Skin be Prevented?

Currently, Infiltrating Basal Cell Carcinoma of Skin is a malignant skin cancer that has no preventive measures. However, the following factors may help reduce the risk for the condition:

• Avoid or minimize sun exposure
• Limit the use of tanning beds, tanning parlors
• Smoking cessation
• If it is caused by certain underlying disorders, then treating the underlying condition may help in the treatment and early cure of Infiltrating BCC of Skin
• Regular medical screening at periodic intervals with blood tests, scans, and physical examinations are mandatory, due to its metastasizing potential and high possibility of recurrence. Often several years of active vigilance is necessary

What is the Prognosis of Infiltrating Basal Cell Carcinoma of Skin? (Outcomes/Resolutions)

• In general, the prognosis of Infiltrating Basal Cell Carcinoma of Skin is excellent, if it is detected and treated early. However, if it metastasizes to the local lymph nodes, the prognosis is guarded or unpredictable
• In such cases of metastatic BCC, its prognosis depends upon a set of several factors that include:
  • Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
  • The surgical resectability of the tumor (meaning if the tumor can be removed completely)
  • Overall health of the individual: Individuals with overall excellent health have better prognosis compared to those with poor health
  • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
  • Whether the tumor is occurring for the first time or is a recurrent tumor. Recurrent tumors have a poorer prognosis compared to tumors that do not recur
  • Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond so well to treatment
• Without treatment (or with delayed treatment), Infiltrating Basal-Cell Cancer of Skin can metastasize and this may result in a poor prognosis
• BCCs of the head that have infiltrated through the skull into the brain have poor prognosis
• Close and regular follow-up and long-term monitor for recurrence of BCC has to be maintained. The infiltrating type of BCC has a very high recurrence rate

Additional and Relevant Useful Information for Infiltrating Basal Cell Carcinoma of Skin:

There are multiple types of Basal Cell Carcinoma of Skin:

• Superficial Basal Cell Carcinoma of Skin
• Nodular Basal Cell Carcinoma of Skin
• Infiltrating Basal Cell Carcinoma of Skin
• Micronodular Basal Cell Carcinoma of Skin
• Fibroepithelial Basal Cell Carcinoma of Skin
• Basal Cell Carcinoma of Skin with Adnexal Differentiation
• Basosquamous Carcinoma
• Keratotic Basal Cell Carcinoma of Skin