Cutaneous Basal Cell Carcinoma

Cutaneous Basal Cell Carcinoma

Nayela Keen, MD

Christine M. Glastonbury, MBBS

(Left) Clinical photograph shows patient who had been lost to follow-up for 8 years following excision of right ear BCCa. Large ulcerative lesion image completely erodes right auricle and extends into cheek, exposing underlying temporal bone. (Right) Axial bone CT in same patient shows extensive abnormality of squamous and petrous temporal bone with both permeative change image and gross destruction image. Middle ear is opacified with tumor, which is also partially eroding and displacing ossicles image.

(Left) Axial T2WI MR in same patient demonstrates predominantly infiltrative lesion image mildly hyperintense as compared to muscle. Tumor erodes the thickness of facial soft tissues, including muscles and right parotid gland. (Right) Axial T1WI C+ MR at a slightly higher level reveals only mild enhancement of infiltrating margins of tumor image as temporal bone and facial tissues are eroded. Note dural enhancement and thickening image, indicating intracranial extension.



  • Basal cell carcinoma (BCCa)


  • Also referred to as a “rodent ulcer”


  • Cutaneous slow growing tumor, the cells of which resemble basal cells of epidermis (outer skin layer)

    • Tendency for local tissue invasion; metastases rare


General Features

  • Best diagnostic clue

    • Enhancing cutaneous/subcutaneous mass ± deeper invasion

  • Location

    • 90% occur in sun-exposed head and neck

  • Size

    • Variable, both in superficial and deep extent

  • Morphology

    • Ulcerative lesion with heaped-up tumor margins

CT Findings

  • Soft tissue mass or skin thickening depending on size of primary tumor

  • Invasion of normal tissues, including bone erosion with more aggressive lesions

MR Findings

  • T1WI

    • Isointense to muscle; can see tumor infiltration within subcutaneous fat

  • T2WI FS

    • Heterogeneous, generally hyperintense to muscle

  • T1WI C+ FS

    • Moderate to marked enhancement

Nuclear Medicine Findings

  • PET

    • Moderately increased FDG uptake

Imaging Recommendations

Sep 20, 2016 | Posted by in HEAD & NECK IMAGING | Comments Off on Cutaneous Basal Cell Carcinoma
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