Basal Cell Carcinoma: Five Varieties

Basal cell carcinoma (BCC) is the most common cancer in the United States; more than 1 million cases are reported annually. BCC is a carcinoma of aging and usually manifests in areas of chronic sun exposure. It grows slowly and rarely metastasizes. BCC can cause significant local destruction and disfigurement if it is neglected or inadequately treated.

BCC usually occurs on the face, ears, scalp, neck, and upper trunk. The lesions typically feature a pearly surface with prominent telangiectasias and a crust of serum. Consider biopsy for any crusted lesion on the skin (especially the face) of an elderly white person if there is no relevant history of trauma.

The varieties of BCC include nodular (A), pigmented (B), cystic (C), superficial (D), micronodular, morpheaform (E), and infiltrating. Superficial BCC may mimic actinic keratosis, Bowen disease, or an inflammatory dermatosis such as psoriasis.

Superficial BCC may be treated with electrodesiccation and curettage,cryotherapy, or imiquimod cream. Other types of BCC are usually excised. Patients with facial or morpheaform BCC are best referred for Mohs surgery.