Symptoms of Basal Cell Carcinoma
The key symptoms to look for in basal cell carcinoma (BCC) include a pearly or shiny papule with rolled borders, telangiectatic vessels, ulceration, and diverse morphological presentations such as nodular, cystic, superficial, morphoeic (sclerosing), keratotic, and pigmented variants. 1
Clinical Presentations
Common Appearances
- Shiny, pearly papule with smooth surface and rolled borders 2
- Arborizing telangiectatic surface vessels (branching blood vessels visible on the surface) 3
- Slow-growing, locally invasive lesion that may ulcerate centrally 1
- Diverse morphological presentations including nodular, cystic, superficial, morphoeic (sclerosing), keratotic and pigmented variants 1
Location Patterns
- Most commonly appears on sun-exposed areas, particularly the head and neck 1, 4
- More than 50% of eyelid BCCs initially occur on the lower lid 5
- Frequently develops on sites previously exposed to radiation (either sun or therapeutic) 1
Specific Variants and Their Appearance
- Nodular BCC: Most common type, appears as a pearly papule or nodule 1, 6
- Superficial BCC: Appears as a scaly, erythematous patch or plaque 1
- Morphoeic/Sclerosing BCC: Presents as a firm, scar-like, yellowish plaque with ill-defined borders 1
- Pigmented BCC: Contains melanin, may be confused with melanoma 1
- Basosquamous carcinoma: Exhibits features of both BCC and squamous cell carcinoma, with higher metastatic potential than typical BCC 1
Dermatoscopic Features
- Diffusely distributed, branching blood vessels 3
- Asymmetric and narrow blood vessels distributed deeper in the dermis 3
- Milky-red corona with superficial wide blood vessels 3
- In pigmented variants, blue-gray ovoid nests and globules may be visible 3
Warning Signs of Aggressive Behavior
- Poorly defined clinical margins 1
- Rapid growth of the lesion 1
- Neurologic symptoms (pain, burning, stinging, anesthesia, paresthesia) suggesting perineural invasion 1
- Lesions in high-risk locations (central face, eyelids, eyebrows, periorbital skin, nose, lips, chin, mandible, ears) 1
- Recurrent lesions in previously treated areas 1
Risk Factors to Consider
- Fair skin, red or blond hair, and light eye color 1
- History of extensive sun exposure, especially in childhood 1
- Increasing age 1
- Immunosuppression 1
- Previous radiation therapy 1
- Personal history of previous skin cancers 1
Clinical Pitfalls and Caveats
- BCC rarely metastasizes (less than 0.1%) but can cause substantial local destruction and disfigurement if left untreated 1
- Histologic subtypes with aggressive growth patterns (micronodular, infiltrative, sclerosing, morpheaform) are more likely to recur than nodular and superficial types 1
- Biopsy remains the definitive diagnostic tool, as some BCCs may not demonstrate characteristic clinical findings 3, 2
- Patients with one BCC are at significantly increased risk of developing subsequent BCCs at other sites 1, 2
- Basosquamous carcinomas have metastatic capacity more similar to squamous cell cancer than typical BCC 1