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July 4, 2012 / molehunter

Basal cell cancers near the eye

Basal cell cancers do not metastasise (*) except for very rare subtypes (basisquamous, metatypical) and they grow quite slowly, so are the most easily cured of all cancers. However, due to their tendency to appear on the face, they can present difficulties due to local invasion, especially when close to the eye or nose. Picking up these tumours at , say, 3 or 4 mm diameter can mean much less invasive surgery than picking them up at 7 or 8 mm. Here are 2 examples of BCCs appearing near the eye, a surgically tricky site. Its also difficult to apply the dermoscope here due to the concavity of the space between eye and nose. ALWAYS scan this space carefully when seeing elderly white patients for any reason, if you get into the habit it takes literally no time at all.

This is another case where the observant doctor or nurse without a dermoscope will outperform the expert dermoscopist who is less alert. I post these images (and I have dozens more like them) to underline the point that the dermoscope, valuable as it can be, is not the be all and end all of skin cancer diagnosis.

A fairly substantial nodular BCC with typical ‘doughnut’ contours, pink background and telangiectatic vessels. A tricky operation will be required, it would have been easier if it had been picked up at half the size.

Another nodular BCC close to the eye, requiring challenging surgery to get it out with a clear 4mm margin, necessary to avoid local recurence, without pulling the lower eyelid down. A skin graft may be necessary. Be very suspicious of even the tiniest new pink spot at this site in an older white person. Note the scab and fine vessels.

(*) to metastasise means to spread to distant parts of the body through the blood or lymphatics. Melanoma and (more rarely) squamous cell cancer can do this, basal cell cancers can not.

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