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A 52-year-old woman presented to the office with a “mole” that had been increasing in size over the last year (Figure 170-1). This “mole” had been on her face for at least 5 years. The differential diagnosis of this lesion was a nodular basal cell carcinoma (BCC) versus an intradermal nevus. A shave biopsy confirmed it was a nodular BCC and the lesion was excised with an elliptical excision.

Figure 170-1

Pearly nodular basal cell carcinoma on the face of a 52-year-old woman present for 5 years. (Courtesy of Richard P. Usatine, MD.)

Basal cell carcinoma is the most common cancer in humans. Usually found on the head and neck, it is generally slow growing and almost never kills or metastasizes when treated in a timely fashion.  However, the treatment necessary to eliminate it is often surgical and may cause scarring and changes in appearance and/or function.

  • BCC is the most common skin cancer but the exact incidence is not known.1
  • Incidence of these cancers increases with age, related to cumulative sun exposure.
  • Nodular BCCs—Most common type (70%) (Figures 170-1, 170-2, 170-3, and 170-4).
  • Superficial BCCs—Next most common type (Figures 170-5 and 170-6).
  • Sclerosing (or morpheaform) BCCs—The least common type (Figures 170-7 and 170-8).

Figure 170-2

Nodular BCC on the nasal ala of an 82-year-old woman. The nose is a very common location for a basal cell carcinoma. (Courtesy of Richard P. Usatine, MD.)

Figure 170-3

Nodular BCC on the lower eyelid. Patient referred for Mohs surgery. The differential diagnosis is a hidrocystoma. This basal cell carcinoma is a firm nodule and a hidrocystoma is fluid-filled and softer. (Courtesy of Richard P. Usatine, MD.)

Figure 170-4

Large nodular basal cell carcinoma with an annular appearance on the face of a homeless woman. (Courtesy of Richard P. Usatine, MD.)

Figure 170-5

Superficial basal cell carcinoma on the back of a 45-year-old man who enjoys running in the California sun without his shirt. Note the diffuse scaling, thready border (slightly raised and pearly), and spotty hyperpigmentation. (Courtesy of Richard P. Usatine, MD.)

Figure 170-6

Superficial basal cell carcinoma on the arm of a fair skinned welder mimicking nummular eczema. (Courtesy Jonathan B. Karnes, MD.)

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