Updated: 9/29/2019

Basal Cell Carcinoma of the Skin

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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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