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Updated: Sep 29 2019

Basal Cell Carcinoma of the Skin

  • Snapshot
    • A 52-year-old woman with fair skin is concerned about a pink pearly lesion that is growing slowly on her cheek. She is a varsity water polo coach at her local high school and spends many hours under the sun. She admits to not using sunscreen consistently.
  • Introduction
    • Most common skin malignancy that rarely, if ever, metastasizes
    • Epidemiology
      • risk factors
        • sun exposure
        • prior ionizing radiation
        • xeroderma pigmentosum
      • common in fair-skinned individuals
    • Commonly affects upper lip (squamous cell carcinoma typically affects lower lip)
  • Presentation
    • Physical exam
      • pink, pearly-white, almost translucent dome-shaped nodule or papule
      • overlying telangiectasias
      • commonly develop raised or rolled border
      • commonly ulcerate, bleed, and crust in the center (a non-healing ulcer)
      • frequently on sun-exposed areas
  • Evaluation
    • Diagnosis by skin biopsy
      • basophilic palisading cells on histology
      • nests of basaloid cells in dermis
  • Differential
    • Squamous cell carcinoma
    • Actinic keratosis
  • Treatment
    • Determined by size, location, and cosmetic considerations
    • Surgical excision
    • Mohs surgery
      • reported cure rate between 97-99%
  • Prognosis, Prevention, and Complications
    • Prognosis
      • if treated, typically very good
      • risk of developing another basal cell carcinoma is 5-8% per year
    • Prevention
      • use sunscreen
      • avoid sun exposure
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