Basal Cell Carcinoma (BCC) 101 - Dermpath Basics Explained by a Dermatopathologist

Sample Pathology Report Templates for Basal Cell Carcinoma: kikoxp.com/posts/5093
A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
List of entities discussed:
(Many thanks to my pathology resident, Dr. Sahrish Shah, for typing up the topics and timestamps!)
Introduction: 0:00 - 1:02
Classic Features of Basal Cell Carcinoma: 1:03 - 3:18
Basal Cell Stroma: 4:55 - 6:07
Patterns of Basal Cell Carcinoma: 3:19 - 36:48
Nodular - BCC 3:35 - 4:04 and 21:43 - 22:40
Superficial - BCC: 6:08 - 7:46
Basaloid Squamous Cell Carcinoma: 7:48 - 9:25 and 26:51 - 29:14
Nodular and Superficial - BCC: 11:00 - 12:40
Infiltrative - BCC: 12:40 - 21:38
Pigmented - BCC: 22:41 - 24:48
Adenoid - BCC: 24:52 - 26:50
Fibroepithelioma of Pinkus type - BCC: 29:20 - 31:20
Granular Cell variant - BCC: 32:52 - 34:10
Clear Cell variant - BCC: 34:15 - 34:52
Amyloid deposition in BCC: 34:56 - 35:41
Metastatic Melanoma in BCC: 35:43 - 36:48
Pleomorphism in BCC: 31:22 - 32:49
Seborrheic Keratosis in BCC: 36:50 - 37:34
Many thanks to my friend, Dr. Mitul Modi, for typing up a transcript of this video to allow for better closed captions/subtitles! Download a copy of the subtitles/transcript of this video here (Word .doc): www.dropbox.com/s/k51c4by8yko... CELL CARCINOMA - TRANSCRIPT - PROJECT - 1 Mitul Modi.docx?dl=0
This is a basic overview of the pathology findings in basal cell carcinoma. It is geared toward medical students, pathology or dermatology residents, or practicing pathologists or dermatologists. Of course, this video is for educational purposes only and is not formal medical advice or consultation.
Presented by Jerad M. Gardner, MD. Please subscribe to my channel to be notified of new pathology teaching videos.
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Snapchat: JMGardnerMD
Twitter: @JMGardnerMD
Instagram: @JMGardnerMD
Facebook: / jmgardnermd

[@sahrishshah5084]

Thank you Dr. Gardner for the great educational videos. Basal Cell Carcinoma Introduction: 0:00 - 1:02 Classic Features of Basal Cell Carcinoma: 1:03 - 3:18 Basal Cell Stroma: 4:55 - 6:07 Patterns of Basal Cell Carcinoma: 3:19 - 36:48 Nodular - BCC 3:35 - 4:04 and 21:43 - 22:40 Superficial - BCC: 6:08 - 7:46 Basaloid Squamous Cell Carcinoma: 7:48 - 9:25 and 26:51 - 29:14 Nodular and Superficial - BCC: 11:00 - 12:40 Infiltrative - BCC: 12:40 - 21:38 Pigmented - BCC: 22:41 - 24:48 Adenoid - BCC: 24:52 - 26:50 Fibroepithelioma of Pinkus type - BCC: 29:20 - 31:20 Granular Cell variant - BCC: 32:52 - 34:10 Clear Cell variant - BCC: 34:15 - 34:52 Amyloid deposition in BCC: 34:56 - 35:41 Metastatic Melanoma in BCC: 35:43 - 36:48 Pleomorphism in BCC: 31:22 - 32:49 Seborrheic Keratosis in BCC: 36:50 - 37:34

[@MyCesarFrancisco]

Very proper duration of the video. The content is very very important for Pathologists.

[@pierregullam7636]

I wish youtube recommended this before 😭

[@JMGardnerMD]

Glad you liked it. You may find these other intro videos helpful. SCC and AK: kzbin.info/www/bejne/r2qyq4FpYrSfibc. Nevus: kzbin.info/www/bejne/oHy9daSAmt9soNk. Melanoma: kzbin.info/www/bejne/bn-Teo2QpatrqtU. Also if you like my videos, check out ‪my #dermpath Survival Guide book: bit.ly/2Te2haB ‬

[@Tamaralynn0480]

Going for MOHS on Wednesday - being the type of person I am, I like to completely understand my health issues (eg. in this case, what they found in my biopsy for BCC). Thank you!

[@JMGardnerMD]

Glad this helped! Hope your Mohs procedure goes smoothly and you recover quickly.

[@missknowall]

I have been going through your videos again and every time I see them I learn something new.

[@Faizan1876]

Excellent video for beginners Dr Jerad , this has been so helpful !

[@oskarwinters1873]

Another wonderfully informative video, i wish i'd found this series earlier !

[@johnfazio2892]

Very nice review of BCC. You are a gifted educator.

[@shashikantpatne1157]

Very informative video on BCC... Wonderful indeed!!!

[@user-zt8fq9cu9i]

Thank you! Great educational video!

[@missknowall]

Simply superb 👏👏👏

[@yesarieroksuz6964]

Perfect slides and great explanations. Thank you ..

[@libian723]

very nice! Thank you for your wonderful video.Expect more presentations.

[@dangthinh90]

Great great great lecture ever! Thank you so much!

[@johnfazio2892]

Excellent review of basal cell carcinoma.

[@fayghazvini]

It is an excellent presentation. Thanks.

[@meliemelie9085]

Thank you so much for this, I have an upcoming biopathology test and those videos have been more than helpful.

[@schnooksdad136]

awesome and comprehensive job...great presentation.

[@kuldeepverma990]

Excellent demonstration sir

[@toptennies7281]

Excellent. Thank you very much, Sir

[@adhyatm1]

Excellent explanation

[@ThePaleRider100]

Superb video, thank you professor

[@BZaks]

you are amazing- dermatology resident

[@DerrickAdamsdermatologist]

Great review

[@KyrieW]

Thank you from a Pathology resident on mat leave! This was super helpful! :)

[@wallendegen1]

I'm also on mat leave, find these very helpful for keeping in touch.

[@Eswar99918]

Good quality HPE images... good explanation.. Thank you sir...

[@46Palladium106]

Just want to point out your professional and academic excellency in this video - chapeau to that! Looking forward to some more great )video) material from you.

[@JMGardnerMD]

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).

[@blogger529]

Awesome truly

[@chrisfisichella6659]

Thank you very much. This was very interesting and relevant.

[@nadiahv]

Thank you very much for the video, it was very helpful

[@m.h27-12]

Excellent explanation .Thank you very much for such informative Vedios.

[@DrAppy01]

amazing video indeed. looking forward to a video about adnexal tumors and how to distinguish trichoepithelioma vs BCC! Thanks a lot. Great teacher and mentor Dr. Gardner!

[@JMGardnerMD]

Thanks! check out our skin adnexal tumors made simple paper in @ArchivesPath: www.archivesofpathology.org/doi/pdf/10.5858/arpa.2018-0189-RA. Also discuss this in my new Dermpath survival guide book coming out this month: bit.ly/2Te2haB

[@bouhnikdjalil7094]

Thank you so much Sir

[@joeblow9295]

I have had 9 basal cell carcinomas removed only one with the light mohs incision no stitches just a little divot scoop no stitches needed the other eight needed a lot of stitches one basal cell I let go thinking it would a small divot scoop I let go but it was much worse the Dr said it looked like it was going on in center of my chest for over five years but it only started to get a scab and crack and bleed for less than a month before I went to get it removed That was so foolish he had to make what looked like the mark of zoro in the middle of my chest over 25 stitches to close the Z.lol since then I get checked every 6 months with no malignancies for 31/2 years then after 3 1/2 years I just had my 9th basal cell removed got about a 2 inch scar on my right neck by the clavicle it took about 7 or eight very close stitches but I really want to say I have been taking Nicotinamide 1000 mg a day 500 mg 2 x a day 1 500 mg before breakfast and another 500 mg pill after lunch and I have only had 1 basal cell in 3 1/2 years I feel the Nicotinamide has helped keeping away the extra malignant basal cells I mostly just get pre -cancer cells that I have frozen off and that's a lot better than surgery last year the Dermatologist prescribed my with 5-fluorouracil (5-FU) but I only put the cream on my upper chest and shoulders front and back that stuff made me look like a went through a fire but I did not put enough on my neck area and that is where my last basal cell was The 5-fluorouracil (5-FU) is a very unsightly treatment and causes a lot of discomfort but the Dr Said it removed many furture pre cancers and cancers from forming .So I will keep taking the Nicotinamide and keep getting 6 month check ups and have these basal cells removed ASAP from now on good luck to all those who are suffering with life long skin cancers . But the sooner they are removed the smaller the scar . I learned the hard way you can say I got fooled by the small Mohs procedure I had the first time best of luck to all your friend Zoro lol

[@rositaroz5310]

very well explained 😊

[@znrsmsaa3655]

Thank you so much dear doctor

[@ncorry8491]

Excellent as always 👍. Would you consider doing a video on distinguishing clear cells tumours of the skin in the future?

[@shamoliyasmin699]

EXCELLENT TEACHING

[@medhachem5943]

Thank you sir Dr

[@anacernaianu]

You are a gift from god

[@drprajwalpudasaini7387]

great one

[@shilpasood5677]

excellent

[@darkxel1]

Súper 🙌🏻🙌🏻🙌🏻🙌🏻

[@Omar-vv3fp]

Thank you sir

[@kazuhisatsuruda8806]

So informative. I had bcc removed by my dermatologist only a few weeks ago.

[@Peachypooh377]

How are you doing today? Just found out today my fiancé has it

[@swimmygo]

I have my BCC surgery on nose on 2-16. I'm a little scared, but not surprised since my grandmother and aunt died of skin cancer. My late dad had skin cancer too, but never had to have surgery like me. I think that's what scares me.

[@JMGardnerMD]

I’m sorry you are going through this and that you feel scared. Surgery can be a scary experience for anyone. There are many types of skin cancer, not all of them behave the same or are treated the same. the good news is that BCC has an excellent prognosis when treated correctly. Although it can grow back if it is not completely removed with negative margins, it is EXTREMELY rare for it to spread to other parts of the body (metastasize) or cause death. I diagnose multiple cases of BCC every day but I’ve only see 3 cases of metastatic BCC in my entire career! So try not to be too anxious about that. Did your grandmother and aunt have melanoma? That is the kind of skin cancer that is sometimes fatal and it is totally unrelated to BCC. Best wishes for successful surgery and quick healing for you!

[@swimmygo]

@@JMGardnerMD Thank you for responding and your encouragement. I'm uncertain what kind of skin cancer my grandmother had. All my aunts, uncles, and parents have passed so I have nobody to ask. In addition, my aunt's daughter has passed so I cannot ask her either. I know my grandmother had a skin cancer above her eye and didn't have it looked at it in a timely matter. The cancer spread into her eye and she had to have her eye removed. Hopefully, it was melanoma for her and my aunt. I'm Irish so I know I'm more prone to skin cancers as well as my dad, grandmother, and aunt. I do have a wonderful dermatologist and hoping he can perform his magic on my nose without too much deformity. I've got to be strong and deal with it.

[@mohammad3674]

Wonderful presentation. Thank you very much from the skin cancer capital of the world!

[@BZaks]

Sydney?

[@woloabel]

"Middle East..."?

[@Bussnusen]

Awesome presentation! /swedish opthalmologist

[@drbonitaborah6752]

words are not enough to thank

[@indrojitbahalia821]

very nice sir.. would like to see some vesicobulous hp slides

[@agustincarrara4678]

Love your videos Dr. Jerad. Do you know any other youtube pathology channel like yours? Really like the way you teach and your expertise on the subject, thank you for sharing it. I'm an argentinian med student that appreciate your work.

[@JMGardnerMD]

Thanks! Try these: kzbin.info. kzbin.info

[@agustincarrara4678]

@@JMGardnerMD thank you Dr.!

[@veramae4098]

"Dr. John Campbell" (retired, PhD in nursing education) has a series on body parts. (Edit: "Anatomy", that's the word. Sorry, I just turned 70 and my brain has decided to retire too.) I was an elementary school librarian. I dropped by because I'm interested in everything -- which is fairly common amongst librarians. He's become somewhat famous for his work on explaining and staying up to date on Covid, including a willingness to state he was previously wrong when new research comes out, and several snarky vids on gov't response to Covid. Shortly after he started, conspiracy theorists and various trolls showed up, but he's won them over by his meticulous work. In fact, he was onto Covid before almost anyone because two doctors in China (who had studied his vids) emailed him about a dangerous new disease, info of which was being suppressed by the gov't. (Emails that added "don't use our names" which he never has. His other videos are full of rave reviews world wide from nursing and medical students.

[@ps1365]

I would like to give you a hug 😊🌸

[@azgonz56]

While Stage IV (Metastatic) Melenoma is the ultimate francoanaplasia according to medical consensus, a Basal Cell Carcinoma (BCC) is fairly underrated as such is primordial cellular malignancy, the Stem Cells of the skin in my personal reckoning. Furthermore, such is the anaplasia that it is infiltrative while undergoing typical cellular differentiation deep into the dermis and hypodermis even. The metastatic, late- staging of a basal cell malignancy should be when it has infiltrated while forming keratosis (Basosquamous Carcinoma Mimic) and mimicing a Squamous Cell Carcinoma (SCC) as if it was under normal maturation morphology. Otherwise, I suspect a most clear and serious neoplasia is systematically being mal-appraised for what it cytologically is, a cellular lesion of serious and fatal genetic Aetiology....lol

[@LHA100]

Thank you for your informative video! Could you share your approach to coding when dealing with cases of mixed types of basal cell carcinoma?

[@dbinod]

Sir thank you for such wonderful videos. Can you post adnexal tumors videos?

[@JMGardnerMD]

Thank you. It's my pleasure. You are in luck...I'm working on an adnexal tumor review article for Archives of Pathology & Laboratory Medicine. I plan to create some videos to go along with the paper. Hope to have these out in the next few months.

[@nosrac95]

Thanks for the great series of videos, they're extremely helpful! What is the main difference in differentiating between cystic basal cell carcinoma and adenoid basal cell carcinoma? I'm looking at the image in Rapini's Practical Dermatopathology (2005) and I'm not seeing a stark difference between your example of adenoid BCC (26:00) and Rapini's example of cystic basal cell carcinoma. Some clarification would be greatly appreciated, keep up the great work!

[@JMGardnerMD]

Thank you! Adenoid cystic carcinoma has very sharply punched out perfectly round spaces, whereas in adenoid BCC they are usually much more irregular. Sometimes you can find areas that at high power look very similar between the two tumors, but from low power they are easy to tell apart with practice. Adenoid BCC usually has other classic BCC features like mucin filled cleft artifact. Primary cutaneous adenoid cystic carcinoma is usually indolent (different from its salivary gland counterpart), much like BCC.

[@Rock_Girl_Daze]

Sadly, I was not able to see my GP during lockdown. I had a growth that got very large. Just waiting for Mohs.

[@KhuyenNguyen-zb8nd]

Dear Prof. BCC with glandular differentiation, i don't know BCC has this subtype?

[@drsandhyaramachandran4821]

Awesome as always ! thank you. At 7:15, the peripheral inked margin is positive? in the superficial BCC. If yes, does that have to be mentioned in the report? TIA.

[@JMGardnerMD]

I prefer not to report “margins” on shave biopsy of BCC and SCC as they are not reliable. A significant subset of cases with apparently negative margins are actually positive. But I will report them if requested by a dermatologist as a courtesy. Here’s our paper on this topic: www.archivesofpathology.org/doi/full/10.5858/arpa.2015-0313-OA

[@SandhyaRamachandran]

@@JMGardnerMD thank you!

[@khangle7480]

Thank you for a wonderful video and helpful knowledge! By the way, Dr. Jared, can I ask a question: can we use p40 and p63 IHC to differentiate the BCCs with granular cells or clear cells with other metastatic carcinoma?

[@JMGardnerMD]

P63 and p40 will stain BCC but is negative in most metastatic adenocarcinoma. So it can definitely help in that specific context

[@khangle7480]

@@JMGardnerMD Thanks for your explanation! Really love your comprehensive educational and 5-minute videos!

[@MrMihnead]

Thank you for the wonderful video Dr. Gardner. What is your experience with BCC in the pediatric group? Have you seen such cases in children? I have such a case right now, a superficial BCC in a 14yo boy. I haven't checked with the treating clinician yet to see if there are any genetic syndromes present, but the location is strange to me, as it is on the trunk.

[@JeradGardner]

Mihnea Derban yes I see BCC in kids occasionally, usually in association with Gorlin or other syndromes.

[@phillipjohnpaul6596]

Multiple basal cell carcinoma - gorlin syndrome... probably present with various tumors and conditions

[@zhengxiaomin3638]

Great presentation. Dr. Gardner: could you talk about squamous cell carcinoma and AK? Thanks

[@JMGardnerMD]

Yes, I am working on a video for that in the near future.

[@hafidag2593]

i want to know what happens in molecular level ..the mecanism i mean ... at the level of the chromosome?

[@Iseeyou12332]

What about mentioning Superficial Radiation Therapy as a treatment?

[@biljanad.1571]

Hi Dr.Gardner! My friend was recently diagnosed with basal cell adenocarcinoma parotid gland. She had biopsy done by her dermatologist which slowed basal cell adenocarcinoma... she has not had parotidectomy yet...since the biopsy her tumor has shrunk by 60%!!!!!! It is still shrinking! Is it normal for basal cell adenocarcinoma tumor to be shrinking after biopsy without any surgery or radiation? Is it possible that she was misdiagnosed ?

[@JMGardnerMD]

I'm sorry, I don't know much about basal cell adenocarcinoma as it is a salivary gland tumor. It is different than basal cell carcinoma of the skin. I'm a skin pathologist, so I don't handle many cases of salivary gland tumors. Best wishes for health and healing for your friend and peace for you both.

[@rimakattea2237]

❤❤❤

[@phillipjohnpaul6596]

Sir. Does immunotherapy provides a good response in basal cell carcinoma

[@JMGardnerMD]

I don’t know. I’ve never heard of checkpoint inhibitors being used for BCC. For superficial BCC, topical imiquimod is sometimes used which is kind of like a form of immunotherapy I guess. It enhances immmne response towards tumor locally. For advanced or metastatic BCC, vismodegib hedgehog pathway inhibitor may be used.

[@operationgetthugs232]

No discussion as to whether BCC differentiates toward hair follicles?

[@sujangautam2315]

Can you please help explain what borst jadassohn phenomenon

[@JMGardnerMD]

I think I talk about it in this IFK video kikoxp.com/posts/4379

[@kitten100]

👍👍

[@nurulaimiabdulrahman7271]

Hi do u have ovarian tumors HPE teaching?

[@JMGardnerMD]

sorry I do not. I don't practice ovarian tumor or other gyn pathology in my practice (aside from vulvar skin and soft tissue lesions)

[@larryfaught1771]

Is it normal to wait a month before removing a basal cell skin cancer

[@JMGardnerMD]

They are slow growing tumors. I often see several weeks or even a month or longer between date of original biopsy and date of excision surgery to fully remove the tumor.

[@AirtonsennaMr]

I m from Brazil. We study by your video. Could you please attach the subtitles in English?

[@JMGardnerMD]

Yes I’m working on adding English subtitles to all of my videos. My medical students have been volunteering to help with this but it takes a lot of time so it’s slow going. BCC is one of the next ones coming up on the list so hopefully it will have subtitles soon. Also my videos are open for public contributions for subtitles via KZbin. So if you have friends who are Portuguese speakers who want to listen to the video and transcribe it into Portuguese they can submit that through KZbin and it will let me approve it to add to the video.

[@amaliyadipita6906]

👍🏾👍🏾👍🏾👍🏾👍🏾❤️❤️

[@valeb2640]

Pleeeeeeease subtitles!!!!!!!

[@JMGardnerMD]

Thank you for letting me know they were missing. I added them before but for some reason they didn’t save. I’ll upload them again. For now, here is the transcript. www.dropbox.com/s/k51c4by8ykorvyh/BASAL%20CELL%20CARCINOMA%20-%20TRANSCRIPT%20-%20%20%20%20%20PROJECT%20-%201%20Mitul%20Modi.docx?dl=0

[@JMGardnerMD]

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology). Sample pathology report templates for BCC: kikoxp.com/posts/5093 (includes examples of how I sign out various types of BCC along with a lot of commentary).

[@woloabel]

Dermatologists Gardner and Singh together will turn neoplasia into what it was really intended by nature: Make cellular geneneration infinate and thus making mankind ETERNAL....lol

[@drsaradindudas5859]

Thank you Sir