Basal cell carcinoma
Also called BCC, rodent ulcer
The most common human cancer: a slow, locally destructive tumour of sun-exposed skin that essentially never metastasises. The classic nodular form is a pearly translucent papule with arborising telangiectasia and a rolled border, often centrally ulcerated.
How it looks
A 7 mm pearly, translucent papule with rolled borders and fine arborising telangiectasia on the nasal ala, with early central ulceration.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
Pigmented BCC, brown-black rather than pearly, is the more common variant in deeply pigmented skin and is easily mistaken for melanoma; the translucent rolled edge is the residual clue.
Symptoms & course
- A sore that bleeds, crusts, and never quite heals
- Slow growth over months to years
Diagnostic approach
- Dermoscopy: arborising vessels, no pigment network
- Biopsy confirms subtype and guides treatment
Differential, and how to separate them
- Squamous cell carcinoma
Favours it: Keratotic, crusted, faster-growing, tender
Against it: BCC is pearly and smooth-edged with visible vessels
- Melanoma
Favours it: Pigment chaos and evolution
Against it: Classic BCC's translucency and arborising vessels; biopsy settles pigmented lesions
Management principles
- Surgical excision with clear margins; Mohs for high-risk facial sites
- Topical/destructive options for low-risk superficial subtypes
Clinical pearl: Stretch the skin: the pearl and its vessels declare themselves under tension.
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