Updated: 12/17/2019

Basal Cell Carcinoma

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Snapshot
  • A 42-year-old fair-skinned woman is concerned about a “pink pearly mole” on her cheek. She has no significant past medical history, but reveals that she regularly goes to tanning salons and beaches. She admits that she occasionally forgets to apply sunscreen and does not re-apply when she is outside all day.
 
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
  • Symptoms
    • typically asymptomatic, but may be tender if ulcerated
    • slow-growing
  • 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
    • histology
    • cosmetic considerations
  • Options
    • electrodesiccation and curettage (typically for non-facial tumors that are small or superficial – not used for aggressive tumors)
      • cure rate up to 92%
    • wide local surgical excision
      • cure rate up to 90%
    • Mohs micrographic surgery (especially if on high-risk and/or cosmetically sensitive areas like the face or if a recurrence)   
      • cure rate up to 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
High Yield

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(M2.ON.15.4694) A 47-year-old woman presents to your clinic with complaints of a lesion on her nose. She first noticed it more than a year ago, and it seems to have gotten larger in the past 6 months. The patient is otherwise healthy and works as a tennis coach. Physical exam is notable for the lesion in Figure A. What is the most appropriate treatment for this patient?

QID: 107871
FIGURES:
1

Broad surgical excision

0%

(0/0)

2

Chemotherapy

0%

(0/0)

3

Cryotherapy

0%

(0/0)

4

Curettage

0%

(0/0)

5

Mohs surgery

0%

(0/0)

M 7 E

Select Answer to see Preferred Response

(M2.ON.15.62) A 68-year-old male presents to your office for his annual physical exam. He has no complaints at this time and his chronic hypertension is well controlled. You notice a .5cm papule on the patient's eyelid that has a pink pearly appearance, rolled borders, and overlying telangiectasias. On further questioning, you find out the patient was a door-to-door salesman and spent a lot of time outdoors, and he did not wear sunscreen. He has fair skin and blonde hair. The patient states that he first noticed the lesion about 6 months prior, and it has grown slightly since then. What is the most likely diagnosis?

QID: 104273
1

Squamous cell carcinoma

6%

(1/17)

2

Keratoacanthoma

0%

(0/17)

3

Verrucous carcinoma

0%

(0/17)

4

Basal cell carcinoma

76%

(13/17)

5

Actinic keratosis

12%

(2/17)

M 6 C

Select Answer to see Preferred Response

(M2.ON.15.8) A 65-year-old male presents to his dermatologist to discuss treatment options. He was recently diagnosed with basal cell carcinoma located on his nose. It is currently 1 cm in diameter with a central depression (Figure A). Previous pathology findings demonstrate that it is an infiltrative sub-type. What is the most appropriate course of treatment for this individual?

QID: 104648
FIGURES:
1

Electrodesiccation and curettage

4%

(3/78)

2

Surgical excision

36%

(28/78)

3

Mohs surgery

56%

(44/78)

4

Topical 5-fluorouracil

3%

(2/78)

5

Imiquimod

0%

(0/78)

M 7 C

Select Answer to see Preferred Response

Evidence (3)
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