Definition
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Basal Cell Carcinoma (BCC): most common non-melanoma skin cancer, originating from basal cells of the epidermis.
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Rarely metastasizes but can cause local tissue destruction if untreated.
Epidemiology & Risk Factors
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Most common in fair-skinned adults >50 years.
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Chronic UV exposure is the main risk factor.
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Other risk factors:
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Immunosuppression
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Previous radiotherapy
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Genetic syndromes (e.g., Gorlin syndrome)
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Clinical Features
| Feature | Description | High-Yield Points |
|---|---|---|
| Appearance | Pearly, translucent papule or nodule with telangiectasia | Often slow-growing |
| Ulceration | Central ulcer (“rodent ulcer”) | Common in neglected lesions |
| Pigmentation | Can be pigmented in darker skin | May mimic melanoma |
| Common sites | Face (nose, eyelids), ears, neck | Sun-exposed areas |
Variants:
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Nodular (most common)
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Superficial (patchy, erythematous, often on trunk)
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Morpheaform/infiltrative (scar-like, aggressive)
💡 PLAB Tip: Nodular, pearly lesion with rolled borders and telangiectasia → classic BCC.
Differential Diagnosis
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Squamous cell carcinoma (SCC) – faster-growing, keratotic, crusted, higher metastatic potential
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Actinic keratosis – scaly, pre-cancerous, sun-exposed
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Seborrheic keratosis – “stuck-on” waxy lesion
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Melanoma – pigmented, asymmetric, ABCDE features
Investigations
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Clinical diagnosis usually sufficient.
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Biopsy (punch, shave, or excisional) if diagnosis uncertain or high-risk lesion.
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Imaging rarely required unless large or infiltrative lesion.
Management
Surgical Options (First-Line)
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Excision with clear margins (most common).
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Mohs micrographic surgery – for high-risk or facial lesions.
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Curettage & electrodessication – for small, low-risk lesions.
Non-Surgical Options
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Topical therapy: 5-fluorouracil or imiquimod (superficial BCC).
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Radiotherapy – if surgery not possible.
Follow-Up
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Regular skin checks for recurrence or new lesions.
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Sun protection counseling.
Complications
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Local tissue destruction if untreated
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Recurrence after incomplete excision
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Rare metastasis (<0.1%)
PLAB-Style Questions
Q1: A 65-year-old man presents with a slow-growing, pearly nodule on his nose with telangiectasia. Most likely diagnosis?
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A. Squamous cell carcinoma
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B. Basal cell carcinoma
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C. Melanoma
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D. Actinic keratosis
✅ Answer: B. Basal cell carcinoma
Q2: Which BCC subtype is most aggressive and likely to infiltrate surrounding tissue?
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A. Nodular
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B. Superficial
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C. Morpheaform
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D. Pigmented
✅ Answer: C. Morpheaform
High-Yield Pearls
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BCC = slow-growing, locally destructive, rarely metastasizes.
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Pearly nodule with telangiectasia = classic presentation.
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Surgical excision is first-line; Mohs for high-risk/facial lesions.
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Sun protection is critical for prevention.
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Distinguish from SCC (faster-growing, keratotic, higher metastatic risk).
