Basal Cell carcinoma - Neonatal Disorders

What is Basal Cell Carcinoma?

Basal Cell Carcinoma (BCC) is the most common type of skin cancer, originating from the basal cells in the epidermis. While it's predominantly seen in adults, it can occasionally occur in pediatric patients.

How Rare is BCC in Children?

BCC is extremely rare in children, accounting for less than 1% of all BCC cases. The low incidence in this population is due to the longer latency period required for the development of UV-induced DNA damage, which is the primary cause in adults.

What are the Risk Factors for BCC in Pediatrics?

Several risk factors can predispose children to BCC. These include:

Genetic predisposition - Conditions like Nevoid Basal Cell Carcinoma Syndrome (Gorlin syndrome) increase the risk.
Radiation exposure - Previous radiation therapy for other conditions.
Immunosuppression - Conditions or treatments that lead to immunosuppression.
Excessive UV exposure - Prolonged exposure to UV rays, often due to outdoor activities or tanning.

What are the Clinical Features of Pediatric BCC?

BCC in children can present similarly to adults. Common presentations include:

Pearl-like nodules with a rolled edge.
Ulcerated lesions or sores that do not heal.
Flat, scaly patches.
Lesions with visible blood vessels (telangiectasia).

How is BCC Diagnosed in Children?

The diagnosis of BCC starts with a thorough clinical examination, followed by a skin biopsy to confirm the type of cancer. Dermoscopy can be a valuable tool for assessing suspicious lesions. Early diagnosis is crucial for effective treatment and better outcomes.

What are the Treatment Options for Pediatric BCC?

Treatment options for BCC in children are similar to those in adults and include:

Surgical excision - The primary treatment, aiming to completely remove the tumor.
Curettage and electrodessication - Often used for small, superficial lesions.
Mohs micrographic surgery - Provides high cure rates with minimal tissue removal, suitable for facial or recurrent BCC.
Topical treatments - Including imiquimod and 5-fluorouracil for superficial lesions.
Radiation therapy - Rarely used due to the potential long-term risks in children.

How Can Pediatric BCC Be Prevented?

Prevention strategies are essential and include:

Educating families on the importance of sun protection.
Encouraging the use of broad-spectrum sunscreen with SPF 30 or higher.
Wearing protective clothing, hats, and sunglasses during outdoor activities.
Avoiding peak sun hours (10 AM to 4 PM).
Regular skin checks, especially for children with a family history of skin cancer or genetic syndromes.

What is the Prognosis for Children with BCC?

The prognosis for children with BCC is generally very good, especially when diagnosed early and treated promptly. BCCs are typically slow-growing and rarely metastasize. However, close follow-up is essential to monitor for recurrences or new lesions.