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Basal Cell Carcinoma

Basal Cell Carcinoma

Basal cell carcinoma on a 68-year-old man


A 68-year-old man presented with two growths on his chest, which he said had been slowly expanding over the past 2 years. They were occasionally tender and had bled with minimal trauma several times during the previous 6 months. As the owner of a large farm, he frequently worked outdoors without a shirt and did not use sunscreen. He had no history of skin cancer and no family history of melanoma.

Key points. Examination revealed poikiloderma, with hyperpigmentation, hypopigmentation, telangiectasia, and atrophy of the face, neck, and chest. On the pre-sternal chest is a 2-cm, pink, ulcerated tumor with hemorrhagic and serous crust. Overlying the right clavicle is a 1.5-cm pearly pink nodule with overlying telangiectasia.

The differential diagnosis included basal cell carcinoma, squamous cell carcinoma, amelanotic melanoma, Merkel cell carcinoma, and cutaneous metastastis from a primary visceral carcinoma.

Treatment. Biopsy of both the tumor and the nodule revealed basal cell carcinoma, with nodular and infiltrative subtypes. Because of the size and histology, the patient underwent Mohs micrographic surgery.

Note. Based on appropriate use criteria recently released by the American College of Mohs Surgery, skin cancers are stratified according to size, location, type of cancer, and histologic subtype, and coupled with patient characteristics to determine whether Mohs micrographic surgery is appropriate, uncertain, or inappropriate. These criteria will help improve quality of patient care while limiting the rising cost of health care.

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