Basal cell carcinoma
Background
- 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
- 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