Imaging

Basal Cell Carcinoma

Preliminary Diagnosis: Basal Cell Carcinoma

I. What imaging technique is first-line for this diagnosis?

  • Most lesions are superficial and are not imaged.

II. Describe the advantages and disadvantages of this technique for diagnosis of basal cell carcinoma.

Not applicable

III. What are the contraindications for the first-line imaging technique?

Not applicable

IV. What alternative imaging techniques are available?

  • MRI with contrast of the area of concern

  • CT with contrast of the area of concern

  • PET/CT imaging using 18F-FDG

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of basal cell carcinoma.

MRI with contrast

Advantages

  • Highly sensitive and specific in detailing the extent of invasion of the neoplastic process, both soft tissue and/or perineural

  • MRI using fat-saturated images offers better visualization of the neoplastic process and extent of invasion.

  • Does not expose patients to ionizing radiation

Disadvantages

  • Less sensitive and specific in detailing any osseous involvement

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

CT with contrast

Advantages

  • Highly sensitive and specific in detailing and characterizing any osseous involvement and extension of neoplasm

  • Relatively fast imaging modality compared with MRI

Disadvantages

  • Exposes patients to ionizing radiation

  • Less adept in detailing perineural infiltration of tumor compared with MRI

PET/CT

Advantages

  • Highly sensitive

  • Very useful in staging cancer

Disadvantages

  • Less specific in detailing neoplastic tissue

  • Highly expensive

  • Time consuming

VI. What are the contraindications for the alternative imaging techniques?

MRI with contrast

  • Contraindicated in patients with non-MR-compatible hardware

  • Gadolinium contrast is contraindicated in patients with a GFR less than or equal to 30

CT with contrast

  • May be contraindicated in pregnant patients

  • IV contrast may be contraindicated in patients with poor renal function and elevated creatinine (institution specific) and those on nonadequate dialysis regimens

  • Relative contraindication in patients with contrast allergy.

PET/CT

  • Uses radiopharmaceuticals that may be contraindicated in pregnant or breastfeeding patients

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