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Updated: Dec 26 2021

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
    • Commonly affects upper lip (squamous cell carcinoma typically affects lower lip )
  • Epidemiology
    • Risk factors
      • sun exposure
      • prior ionizing radiation
      • xeroderma pigmentosum
    • Common in fair-skinned individuals
  • 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
  • studies
    • Diagnosis by skin biopsy
      • basophilic palisading cells on histology
      • nests of basaloid cells in dermis
  • Differential
    • Squamous cell carcinoma
    • Actinic keratosis
  • Treatment
    • Prevention
      • use sunscreen
      • avoid sun exposure
    • 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
    • If treated, typically very good
    • Risk of developing another basal cell carcinoma is 5-8% per year
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QID 214948 (Type "214948" in App Search)
A 44-year-old woman with a history of diabetes and hypothyroidism presents to her primary care physician for depressed mood. These symptoms have persisted for the past 10 years. Her symptoms of increased appetite and sleeping all day have been much worse. She feels as if her arms and legs are “made of lead” and incredibly heavy, making it difficult to engage in everyday tasks. Her mood is very depressed and she is very sensitive to rejection. She feels guilty that she cannot accomplish more in her life as a result. She has minimal interest in her hobbies or spending time with friends anymore. Her medical history is significant for hypothyroidism, major depressive disorder, obesity, and chronic kidney disease. Before the current visit, she was prescribed fluoxetine and paroxetine each for a 2-year period with escalating doses but has noticed no improvement in her symptoms. The patient also has a medical history of obesity, chronic kidney disease, and a seizure disorder. She has had several breakthrough seizures this past month despite consistently taking her prescribed antiepileptics. Her temperature is 98.1°F (36.7°C), blood pressure is 142/82 mmHg, pulse is 86/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical exam reveals a young woman with a depressed mood. Her neurological exam is unremarkable. Laboratory studies are ordered as seen below.
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Oncology | Basal Cell Carcinoma
  • Oncology
  • - Basal Cell Carcinoma
13:4 min
12/16/2021
70 plays
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