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A 70-year-old man presented with a small ulcer on the nasal tip that he noticed while washing his face. The lesion bled easily, and on occasion the bleeding was hard to stop (Figure 177-1). He noticed it first about 6 months ago, and at times it seemed to almost heal. A photograph was taken to document the location of the lesion. Histology from a shave biopsy confirmed an infiltrative basal cell carcinoma (BCC), and he was referred for Mohs microsurgery for excellent margin control.

FIGURE 177-1

Ulcer on the nasal tip is the most obvious warning sign for this infiltrative BCC. (Reproduced with permission from Richard P. Usatine, MD.)


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


  • BCC is the most common skin cancer, with more than 2 million cases diagnosed annually.1

  • Incidence increases with age, related to cumulative sun exposure.

  • Nodular BCCs—Most common type (70%) (Figures 177-2, 177-3, 177-4).

  • Superficial BCCs—Next most common type (Figures 177-5 and 177-6).

  • Sclerosing (or morpheaform) BCCs—The least common type (Figures 177-1, 177-7 and 177-8).

FIGURE 177-2

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

FIGURE 177-3

Large ulcerated nodular BCC on the mid-chest of a homeless man. The authors excised this in a free clinic located in a church basement. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 177-4

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

FIGURE 177-5

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 on the edges. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 177-6

Large superficial BCC located on the back. Note the thready pearly border and small areas of pigmentation—both common features in superficial BCCs. (Reproduced with permission from Richard P. ...

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