Basal cell carcinoma

Background

Normal dermal anatomy.

• 80% of skin cancers are basal cell, 16% are squamous cell, and 4% are melanomas
• 5% to 10% of basal cell carcinomas are aggressive, invade and destroy skin and surrounding tissues, sometimes reaching bone
• Rarely a metastatic process

Risk Factors

• UV radiation
• Chronic arsenic exposure
• Ionizing radiation
• Immunosuppression
• Age and skin colour (light tone)
• Also known of a certain genetic predisposition (higher in people from the northern hemisphere)

Clinical Features

Ulcerated basal-cell carcinoma affecting the skin of the nose in an elderly patient.

• Slow growing
• Usually head and neck
• About 20% appear on areas less exposed to the sun, such as chest, back, extremities and scalp.
• Only where hair follicles exist
• Pearly nodule with telangiectatic vessels, rolled border and central ulceration

Differential Diagnosis

Other Rash

• Acute generalized exanthematous pustulosis
• Allergic reaction
• Aphthous stomatitis
• Atopic dermatitis
• Coxsackie
• Dermatitis herpetiformis
• Exfoliative erythroderma
• Impetigo
• Pellagra
• Pityriasis rosea
• Serum Sickness
• Tinea capitus
• Tinea corporis
• Vitiligo

Evaluation

• Clinical examination by trained clinician (dermatology referral)
• Skin biopsy

Management

• Not typically managed within ED

Disposition

• Discharge with derm follow up

See Also

• Squamous cell carcinoma