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Updated: Dec 26 2021

Basal Cell Carcinoma

  • 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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