Internal Medicine

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

1060 Nongranulomatous Systemic Vasculitis Nonmelanoma Skin Cancers: BCC

■HSP

➣GI complications, including intussusception, obstruction, bleed-

ing, infarction, perforation

➣Progressive renal failure (rare)

■CS

➣Deafness, visual loss, heart failure

NONMELANOMA SKIN CANCERS:

BASAL CELL CARCINOMA

ROGER I. CEILLEY, MD

history & physical

■80% of non-melanoma skin cancers

■Increasing incidence with age; most >40 years of age

■Usually begins as a small, slow-growing, waxy, semi-translucent nod-

ule with central depression and telangiectasia

■May appear as reddish eczematous patch (superficial type) an irreg-

ular pigmented nodule (pigmented type) or as a waxy white sclerotic

plaque (morphea or sclerotic type)

■Most often on head, neck and other sun-exposed areas of fair-

skinned individuals with light-colored hair and eyes

■Ulceration, crusting and bleeding on slight injury common

■Usually history of extensive sun exposure, also seen in old burn scars,

vaccination sites, previous x-ray treatment areas, immunosuppres-

sion and chronic arsenic exposure

■Genetic and congenital factors: basal cell nevus syndrome (Gor-

lin syndrome), Bazex syndrome, albinism, epidermolysis bullosa

dystrophica, nevus sebaceus of Jadassohn and xeroderma pigmen-

tosum

tests

Biospy:

■Tangential (shave) if lesion is elevated

■Saucerization if lesion is flat

■Excision or punch biopsy if sclerotic or recurrent

Full body examination to detect other cancerous or precancerous

lesions

Palpate regional nodes

differential diagnosis

SCC