Basal Cell Carcinoma

Clinical Presentation: AKA Basalioma. The most common form of skin cancer. It is slow-growing and very rarely metastasizes, but it is locally destructive if left untreated.

Classic Clues (Nodular BCC):

• Pearly Appearance: A waxy, translucent, or "pearly" papule or nodule.
• Telangiectasia: Fine, branching blood vessels visible on the surface.
• Rodent Ulcer: A central depression or ulceration with "rolled" or "heaped-up" borders.
• Bleeding: The patient may report that the lesion "bleeds with minor trauma" and never fully heals.

Sebaceous Hyperplasia

• The Clue: Small, yellowish papules with central umbilication (often looks like a tiny doughnut).
• Vs BCC: Sebaceous hyperplasia is usually multiple, soft, and lacks the distinct pearly-white translucency and branching telangiectasia of BCC.

Squamous Cell Carcinoma (SCC)

• The Clue: More rapid growth, thicker keratotic scale, and may be painful. Often arises from actinic keratosis.
• Vs BCC: SCC lacks the pearly border and telangiectasia. SCC carries a higher risk of metastasis compared to BCC.

Primary Care Action:

• Suspicious Lesion: Refer to Dermatology for Diagnostic Biopsy

⚠️ Clinical Pearl: BCC is often described as "the sore that won't heal." If a patient has a crusting facial lesion for >3 weeks that bleeds with washing, maintain a high index of suspicion for BCC.

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