Diagnosis: Basal-cell carcinoma
Title Basal Cell Carcinoma Description A red, ulcerated lesion surrounded by a white border on the skin of the right ear. Ulcerated basal cell carcinoma with characteristic pearly rim. Topics/Categor. Clinical photograph sourced from Wikimedia Commons (Public domain). Attribution: Kelly Nelson (Photographer).
Nodular (most common): pearly, translucent papule/nodule with rolled borders and telangiectasia, may ulcerate (rodent ulcer). Superficial: erythematous scaly patch, often trunk. Morpheaform/infiltrative: scar-like, ill-defined. Pigmented: brown-black, mimics melanoma.
Risk factors: cumulative UV exposure, fair skin, prior radiation therapy, immunosuppression, arsenic exposure, Gorlin syndrome (multiple BCCs at young age). Most common on sun-exposed areas (head/neck). Rarely metastatic but locally destructive.
Mohs micrographic surgery (highest cure rate, tissue-sparing — preferred for face/high-risk). Standard excision with 3-4mm margins. Superficial BCC: topical imiquimod, 5-FU, photodynamic therapy. Advanced/metastatic: hedgehog pathway inhibitors (vismodegib, sonidegib).
Squamous cell carcinoma, Melanoma, Sebaceous hyperplasia, Intradermal nevus, Merkel cell carcinoma, Trichoepithelioma
Mohs surgery has 99% cure rate for primary BCC. The hedgehog signaling pathway is constitutively activated in BCC — PTCH1 mutations are key. Gorlin syndrome patients need lifelong surveillance. Superficial BCCs on trunk respond well to topical therapies.
Tags: BCC, basal cell carcinoma, skin cancer, nonmelanoma, UV damage