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).
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.)
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.)
Management and Disposition
After ensuring a secondary infection is not present, prompt outpatient dermatologic referral is indicated.
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.
BCC occurs in darker skinned persons (a common misperception).
Early identification and treatment of basal cell carcinomas, especially around the eyes, ears, and nose, will reduce potential morbidities.
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.)
Basal Cell Carcinoma. This chronic, erythematous papule and crusted ulcer appeared 2 years prior to presentation. (Photo contributor: J. Matthew Hardin, MD.)