Invasive Basal Cell Carcinoma

March 14, 2013

While it might be tempting to dismiss this as a picker's nodule, lesion's thickness suggested the need for a biopsy, which revealed that the lesion was an infiltrative, invasive basal cell carcinoma. The lesson? Never hesitate to biopsy when the slightest uncertainty exists as to the correct diagnosis.

A 56-year-old man sought medical attention for a nodule on his ear. He admitted to frequently picking at the somewhat eroded lesion. His past medical history was non-contributory.

Key point: While it might be tempting to dismiss this as a picker’s nodule (also known as prurigo nodularis), the palpable thickness of the lesion suggested that a biopsy was in order. The latter revealed that the lesion was, in fact, an infiltrative, invasive basal cell carcinoma.

Treatment: The tumor was removed using Mohs micrographic surgery and the resulting defect was resolved by primary sutured closure.

Note: Both basal cell and squamous cell carcinomas may mimic benign entities. Never hesitate to perform a skin biopsy when the slightest uncertainty exists as to the correct diagnosis.