Diagnosis: Basal-cell carcinoma
Title Basal Cell Carcinoma Description Small, reddish/brownish papule, often with telangiectatic blood vessels. May appear transluscent, and when it is, described as "pearly" in color. May have a cent. Clinical photograph sourced from Wikimedia Commons (Public domain). Attribution: Unknown 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