Fast Five Quiz: Skin Cancer

William James, MD


January 04, 2019

Nodular basal cell carcinoma is the most common type of basal cell carcinoma and usually presents as a round, pearly, flesh-colored papule with telangiectases. As it enlarges, it frequently ulcerates centrally, leaving a raised, pearly border with telangiectases, which aids in making the diagnosis. Fine vessels may bleed, resulting in hemosiderin deposition.

Morpheaform BCC is an uncommon variant in which tumor cells induce a proliferation of fibroblasts within the dermis and an increased collagen deposition (sclerosis) that clinically resembles a scar. Ulceration, bleeding, and crusting are uncommon and these tumors are commonly mistaken for scar tissue.

Approximately 70% of all cSCCs occur on the head and neck, most frequently involving the lower lip, external ear and periauricular region, or forehead and scalp. Consequently, the head and neck should be of particular interest in a comprehensive examination of a patient with suspected cSCC. The following features of the lesion should be noted:

  • Location (eg, lip SCC is more common on the lower lip)

  • Size

  • Character (eg, smooth/nodular, vascularity, color): SCC may appear as plaques or nodules with variable degrees of scale, crust, or ulceration

  • Presence of ulceration

Most SCCs involving the conjunctiva manifest as chronic, unilateral, localized patches of redness or more diffuse conjunctivitis. They can also present as a mass in the interpalpebral fissure at the nasal or temporal limbus with a gelatinous and velvety, papilliform, or leukoplakic appearance. Prominent feeder vessels may be seen. The corneoscleral limbus is the most common location, although the palpebral conjunctiva or cornea may be involved, particularly in the interpalpebral region.

For more on the presentation of BCCs, read here.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.