A slow-growing, destructive skin tumor, basal cell epithelioma or carcinoma usually occurs in persons older than age 40; it’s more prevalent in blond, fair-skinned males and is the most common malignant tumor affecting whites.
Prolonged sun exposure is the most common cause of basal cell epithelioma, but arsenic ingestion, radiation exposure, burns, immunosuppression and, rarely, vaccinations are other possible causes.
Changes in epidermal basal cells can diminish maturation and normal keratinization. Continuing division of basal cells leads to mass formation.
There are three types of basal cell epithelioma:
❑ Nodulo-ulcerative lesions occur most commonly on the face, particularly the forehead, eyelid margins, and nasolabial folds. In early stages, these lesions are small, smooth, pinkish, and translucent papules. Telangiectatic vessels cross the surface, and the lesions are occasionally pigmented. As the lesions enlarge, their centers become depressed and their borders become firm and elevated. Ulceration and local invasion eventually occur. These ulcerated tumors, known as rodent ulcers, rarely metastasize; however, if untreated, they can spread to vital areas and become infected. If they invade large blood vessels, they can cause massive hemorrhage.
❑ Superficial basal cell epitheliomas are often numerous and commonly occur on the chest and back. They’re oval or irregularly shaped, lightly pigmented plaques, with sharply defined, slightly elevated threadlike borders. Because of superficial erosion, these lesions appear scaly and have small, atrophic areas in the center that resemble psoriasis or eczema. They’re usually chronic, but they don’t tend to invade other areas. Superficial basal cell epitheliomas are related to ingestion of or exposure to arsenic-containing compounds.
❑ Sclerosing basal cell epitheliomas (morphea-like epitheliomas) are waxy, sclerotic, yellow to white plaques without distinct borders. Occurring on the head and neck, sclerosing basal cell epitheliomas often look like small patches of scleroderma.
All types of basal cell epitheliomas are diagnosed by clinical appearance, an incisional or excisional biopsy, and histologic study.
Depending on the size, location, and depth of the lesion, treatment may include curettage and electrodesiccation, chemotherapy, surgical excision, Moh’s micrographic surgery, irradiation, cryotherapy, chemosurgery, topical chemotherapy, or intralesional interferon.
❑ Curettage and electrodesiccation offer good cosmetic results for small lesions.
Clinical tip Topical fluorouracil is commonly used for superficial lesions. This medication produces marked local irritation or inflammation in the involved tissue but no systemic effects.
❑ Microscopically controlled surgical excision carefully removes recurrent lesions until a tumor-free plane is achieved. After removal of large lesions, skin grafting may be required.
❑ Irradiation is used if the tumor location requires it or if the patient is elderly or debilitated and might not withstand surgery.
❑ Cryotherapy with liquid nitrogen freezes and kills the cells.
❑ Chemosurgery may be necessary for persistent or recurrent lesions. Chemosurgery consists of periodic applications of a fixative paste (such as zinc chloride) and subsequent removal of fixed pathologic tissue. Treatment continues until the tumor has been completely removed.
❑ Instruct the patient to eat frequent small meals that are high in protein. Suggest eggnog, pureed foods, or liquid protein supplements if the lesion has invaded the oral cavity and is causing eating problems.
❑ Tell the patient that to prevent the disease from recurring, he needs to avoid excessive sun exposure and use a strong sunscreen or sunshade to protect his skin from damage by ultraviolet rays.
❑ Advise the patient to relieve local inflammation from topical fluorouracil with cool compresses or corticosteroid ointment.
❑ Instruct the patient with nodulo-ulcerative basal cell epithelioma to wash his face gently when ulcerations and crusting occur; scrubbing too vigorously may cause bleeding.
Review other book chapters online related to Rodent ulcer:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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