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13-25: Basal Cell Carcinoma

J. Matthew Hardin

Clinical Summary

Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer. BCC can present anywhere but is most common on sun-exposed areas. The typical lesion begins as a pearly papule with telangiectasias (nodular BCC). The lesion may ulcerate and bleed. Other forms of BCC include superficial BCC (pink, scaly plaque with pearly border), pigmented BCC (appears as a nodular or superficial BCC with dark brown to black center), and morpheaform BCC (appears as a rapidly expanding scar).

FIGURE 13.66

Basal Cell Carcinoma. Nodular basal cell carcinoma consists of a firm, centrally ulcerated (rodent ulcer) nodule with a raised, pearly, telangiectatic border. (Photo contributor: Department of Dermatology, Wilford Hall USAF Medical Center and Brooke Army Medical Center, San Antonio, TX.)

In a patient with a basal cell carcinoma there is a single, round, depressed lesion with central ulceration and erythematous raised edges on the face.
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FIGURE 13.67

Pigmented Basal Cell Carcinoma. Translucent, brownish-black, flat papule, easily confused with melanoma. (Photo contributor: Department of Dermatology, Wilford Hall USAF Medical Center and Brooke Army Medical Center, San Antonio, TX.)

A pigmented basal cell carcinoma is a single, round, elevated, blackish nodular lesion with an irregular surface and border.
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Management and Disposition

After ensuring a secondary infection is not present, prompt outpatient dermatologic referral is indicated.

Pearls

  1. The metastatic potential of BCC is very low (0.1%) but higher on the ears, periocular area, nose, and lips. Do not miss the opportunity to refer patients with questionable lesions.

  2. BCC occurs in darker skinned persons (a common misperception).

  3. Early identification and treatment of basal cell carcinomas, especially around the eyes, ears, and nose, will reduce potential morbidities.

FIGURE 13.68

Basal Cell Carcinoma. A superficial basal cell carcinoma is frequently disregarded. Note the flat, erythematous, scaly plaque with its elevated, irregular border. (Photo contributor: Department of Dermatology, Wilford Hall USAF Medical Center and Brooke Army Medical Center, San Antonio, TX.)

A basal cell carcinoma is a single, flat, red, scaly lesion with an elevated, irregular border. .
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FIGURE 13.69

Basal Cell Carcinoma. This chronic, erythematous papule and crusted ulcer appeared 2 years prior to presentation. (Photo contributor: J. Matthew Hardin, MD.)

In a patient with a basal cell carcinoma there is a single, elevated, round, red lesion with a black crusted, ulcerated area in the periphery of the lesion beside the mouth.
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