Review Question - QID 107871

This patient is presenting with a pearly, shiny papule on her face concerning for basal cell carcinoma. Mohs micrographic surgery is the most appropriate treatment modality for this patient's malignancy that is in a cosmetic location.

Basal cell carcinoma is a common skin malignancy that usually occurs secondary to sun exposure. It typically presents with a pearly/shiny papule with telangiectasias. The best initial step in management is a biopsy to confirm the diagnosis. After a biopsy has been performed, surgical excision can be performed. Mohs microsurgery is the preferred procedure as it reduces scarring in cosmetic areas (such as the face) and has a high cure rate. To prevent this malignancy, patients should be counseled in wearing sun protective clothing.

Figure A is a pearly, shiny papule with telangiectasias which is commonly seen in basal cell carcinoma.

Incorrect Answers:
Answer 1: Broad surgical excision is a treatment option for basal cell carcinoma; however, it is less preferred when compared to Mohs microsurgery, in particular, in a cosmetic area.

Answer 2: Chemotherapy is a systemic treatment that is generally not indicated in a localized basal cell carcinoma.

Answer 3: Cryotherapy may be appropriate to treat warts from human papillomavirus.

Answer 4: Curettage is the scraping of a lesion to remove what is present but would not adequately treat a malignancy.

Bullet Summary:
The treatment of basal cell carcinoma is surgical excision (with Mohs microsurgery as the preferred treatment).