Basal Cell Carcinoma of the Skin

Snaoshot

• A 52-year-old woman with fair skin is concerned about a pink pearly lesion that is growing slowly on her cheek. She is a varsity water polo coach at her local high school and spends many hours under the sun. She admits to not using sunscreen consistently.

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

• 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, and cosmetic considerations
• Surgical excision
• Mohs surgery
• reported cure rate between 97-99%

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