Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

Nonmelanoma Skin Cancers: BCC 1061

■Often indistinguishable from small BCC. Usually faster-growing,

more common on dorsum of hands, involve vermillion surface of

lower lip. Horny keratotic material not seen with BCC.

Nevus:

■Softer, non-ulcerated, no bleeding or telangiectasia and longer dura-

tion

Sebaceous hyperplasia

■Yellowish nodules with depressed center. No bleeding or crusting.

Scar or morpheaform:

■Usually no bleeding, crusting or progression of size

Seborrheic keratosis

■Waxy, brown with “stuck-on” appearance

Malignant melanoma

■May be indistinguishable from pigmented variety. No translucent

appearance or telangiectasia.

Psoriasis/chronic dermatitis:

■Easily mistaken for superficial BCC (do not clear with topical treat-

ment)

management

■Treatment depends on age, size, type of lesion, previous treatment,

cosmetic concerns, medical status.

■Prophylaxis (sun safety recommendations):

➣Seek shade between 10 AM&4PM.

➣Wear light-colored, tightly woven, protective clothing.

➣Apply sunscreens with a SPF of at least 15 and reapply frequently,

esp. with prolonged sun exposure, sweating, or swimming.

specific therapy

Excision:

■Ideal for lesions 5–7 mm or less with discrete clinical borders

Curettage/C&D:

■Small nodular lesions not in central facial areas

■Superficial lesions, esp. on trunk

■Poor for large, recurrent or sclerotic types

Mohs micrographic surgery (MMS):

■Highest cure rate, esp. for recurrent tumors and poorly defined

margins, tissue sparing, allows for immediate repair with clear

margins

■Tumors in the “H zone” of the face (nose, nasolabial folds, periorbital,

periauricular areas)