A Sore Subject
DISCUSSION
The pathology report confirmed the suspected diagnosis: noduloulcerative basal cell carcinoma (BCC). By far the most common type of skin cancer in the world, noduloulcerative BCCs are caused by overexposure to the sun.
As obvious as this diagnosis seemed to be, biopsy was warranted to confirm it and to rule out several other items in the differential. The latter include squamous cell carcinoma (which has far more harmful potential than BCC), sebaceous carcinoma, Merkel cell carcinoma, and melanoma.
Not all BCCs are created equal—certain clinical and histologic characteristics predict a more aggressive course. While most BCCs require surgical excision, other treatment options do exist. In this patient’s case, the size and location of the lesion lent it to curettement and healing by secondary intention. Other methods could have included immunotherapy with imiquimod, antitumor creams (eg, 5-fluorouracil), or even radiation therapy. Her lesion was small and well-defined enough that Mohs surgery was not indicated—though some might disagree with that assessment.
TAKE-HOME LEARNING POINTS
,- Like all basal cell carcinomas (BCCs), ulcerative BCC—the most common type—is caused by overexposure to the sun.
- BCCs are often mistaken for infection or other sore, which delays the diagnosis.
- Nonhealing lesions should be considered cancerous until proven otherwise.
- Though this diagnosis was fairly obvious, biopsy is necessary to rule out other items in the differential—some of which (ie, Merkel cell carcinoma, melanoma) are potentially fatal.
