Clinical Analysis Of Basal Cell Carcinoma In 147 Patients

Objective:Understand the clinical,histopathological and dermoscopic characteristics of basal cell carcinoma(BCC).Reduce the misdiagnosis rate and improve the level of diagnosis and treatment.Methods:Analyzed 147 cases from July 2011 to September 2016 in our hospital retrospectively,which were all diagnosed BCC through histopathological biopsy.We analyzed the informations of 147 patients,such as gender,age,disease duration,location,size of lesions,clinical manifestations,histopathological typing,dermoscopic features and others.Combined with a preliminary diagnosis of clinicians,the clinical characteristics,diagnosis and differential diagnosis were analyzed and understood.Results:Analysis of 147 cases showed that BBC occurred in the elderly over the age of 50(88.44%),and no significant correlation with gender(male:female= 0.69:1).Lesions were mainly single(95.92%),the diameter was about 0.1?5cm(99.32%),occurred in the exposed parts of the body(88.40%),especially common on nose(38.10%)and cheek(15.65%).The clinical manifestations were diverse.Several types of BCC are recognized including nodular ulcerative type,pgimented,fibrotic type(or morphea-like)and superficial.The nodular ulcer type(48.30%)and pigmented type(41.50%)were more common.The four types were particularly occurred in women,the elderly over the age of 50,and on head and face.According with histopathological characteristics by HE stain,147 cases were all diagnosed with BCC,including the types of nodular(solid),pgimented,keratotic,superficial,cystic,adenoid,and fibrotic,while sclerosing was not found.Among them,nodular(solid,58.50%)and pigmented(20.41%)were more common.Among 147 patients,61 patients were examined by dermato scope.All of them did not contain pigment net,which coincidence to the negative criteria for the diagnosis of BBC which is a classical diagnostic model And at least one positive standard such as maple-like structure,spoke-like structure,ulcer,blue-gray oval-shaped nest,multiple blue-gray pellets,and branch-shaped capillaries could be observed.Dermatoscopy is helpful to improve the diagnostic rate of BCC.Among 147 patients,89 cases had skin lesions with ulcers.Man(75.00%)were more than woman(50.57%).elderly over the age of 50(63.85%)were more than the younger(35.29%).Also,lesions with ulcer had higher incidence on head and face(63.57%),in nodular ulcer type of clinical manifestations(77.46%),and nodular type of histopathology(solid type,67.44%),Over all it is suggested that the incidence of ulcer was significantly correlated with age,sex and location.There were 52 patients misdiagnosed as other disease at preliminary diagnosis,involved other cases in the initial diagnosis,including pigmented nevi,malignant melanoma,squamous cell carcinoma,Bowen's disease,seborrheic keratosis,solar keratosis,sporotrichosis,Keloid and fibroids.The total misdiagnosis rate about 35.37%,and superficial lesions were most likely to be misdiagnosed(72.73%).Conclusion:In this study,we found that the patients were lack of familiarity to BBC,and with the slow development of the disease and weak invasiveness,Leading to treatment is not timely.The course was as long as several years to several decades,the longest up to 60 years.Therefore,we should raise the public awareness of the prevention of BCC,take care of original lesions,especially on the head and face of the nodular ulcer or pigmented lesions,such as prolonged or short-term appearance of size,shape and other changes,should be treated in regularly hospital on time.Early detection is great significance to prevention,control and reduce mortality of BCC.At the same time,BCC is commonly occoured on exposured skin,suggesting that the disease may be related to ultraviolet radiation with long-term exposured sunlight.So reducing exposuring to sunlight is an effective measure to prevent this disease.To the suspected BCC cases,dermatoscopy should be used before histopathological examination.Then,according to the clinical manifestations,histopathological and dermoscopic features of the lesions,differential diagnosis will be done compared with other cutaneous diseases.These could improve the diagnosis level of BBC,provide guidance to the prevention and treatment of this disease.