Basal cell carcinoma: infiltrative (syn. morphoeic; morphoeiform; sclerosing)

Patient Information Leaflet
Link: Basal cell carcinoma

https://pcds.org.uk/patient-info-leaflets/basal-cell-carcinoma

An infiltrative basal cell carcinoma (BCC) is a type of BCC in which malignant cell infiltrate the dermis in thin strands between collagen fibres, making tumour margins less clinically apparent. As a result of delayed presentation, a tendency to invade deeper tissues (sometimes muscles, nerves, and bones), and higher rates of incomplete excision, infiltrative lesions tend to be associated with greater morbidity than other subtypes of BCC. 

This chapter is set out as follows:

Distribution

• Most common on the head, especially the central face, and the upper trunk

Morphology

• Slowly expanding
• Tend to be more subtle than other BCC subtypes, often with ill-defined edges
• Can be depressed and may have surface telangiectasia
• Some present as a yellow-white waxy patch
• More advanced lesions show ulceration, crusting and fibrosis
• Firm to palpate  

Dermoscopic features (hover over terminologies for description)

• Tend to have indistinct margins
   
• Often white-pink structureless. Occasionally may see blue-grey clods or brown structures
   
• Fine branching vessels; tending to have a narrower calibre than the typical arborising vessels of solid BCC (for more information on vessels refer to the chapter Vessel patterns in dermoscopy)
   
• Sometimes a stellate pattern of vessels, shiny white lines, or skin folds radiates laterally
   
• More advanced lesions may be ulcerated
   
• Can be associated with other BCC subtypes in the same lesion; known as a mixed BCC

• Infiltrative basal cell carcinomas of the head and neck should be referred urgently to Secondary Care
   
• For more information refer to the related chapter Basal cell carcinoma - an overview