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June 15, 2016 / molehunter

Another basal cell cancer

A small pink lesion on the back of the arm of an older white person.

imageBasal cell cancers (BCCs) are the most common of all human cancers. Most are found on sun exposed skin in older white people. They typically grow slowly and reveal themselves by scabbing. Colour is usually pink, as here, with scabbing and surface erosion and eventually ulceration as the lesions progress. These tumours almost never metastasise (spread to other parts of the body) and are usually treated by surgery, although other treatment options include topical treatments and radiotherapy.

Dermoscopy confirms the diagnosis.

imageBCCs have 5 typical dermoscopic features.

pink background

-sharply focused curved (serpentine, arborising) vessels

-micro erosions (see here as yellow fibrin clot and red scabs)

-irregular pigmented structures (blue/grey clods, spoke wheels, absent here)

-shiny white streaks/ clods (formerly known as chrysalis sign)

You won’t often see all 5 features in the same lesion, and don’t need them all for a diagnosis. This BCC shows the first 3 features named above, and maybe also some shiny white clods between 10 and 12 o’clock. These structures represent dermal collagen and can also be seen in some melanomas and dermatofibromas.

Dermoscopy is not always necessary to diagnose BCCs, but can be very helpful for smaller lesions.

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