Basal cell carcinoma
Basal cell carcinoma is the most common type of skin cancer. It often appears as a painless raised hard area of skin. The lesion may be shiny and may have small blood vessels running over it. It may also present as a raised area with ulceration. Basal cell cancer grows slowly and can damage the tissue around it, but it is unlikely to result in metastasis or death.

Risk factors include exposure to ultraviolet light, radiation therapy, long-term exposure to arsenic and poor immune-system function (e.g. organ transplantation). Exposure to UV light during childhood is particularly harmful.

After diagnosing by biopsy, treatment is typically by surgical removal. This can be by simple excision if the cancer is small; If the cancer is not small, Mohs surgery is generally recommended.

Basal cell carcinoma accounts for at least 32% of all cancers globally. Of skin cancers other than melanoma, about 80% are basal-cell cancers. In the United States, about 35% of white males and 25% of white females are affected by basal cell carcinoma at some point in their lives.

Diagnosis and Treatment
#Skin biopsy
#Mohs surgery
  • Ulcerated lesions affecting the skin of the nose in an elderly individual are often diagnosed as Basal cell carcinoma. The nose is a common site of occurrence for this type of skin cancer.
  • Basal cell carcinoma may present with irregular borders and ulcers.
  • Basal cell carcinoma is commonly misdiagnosed as a nevus in Asians. Pigmented basal cell carcinoma frequently occurs on the nose.
  • Basal cell carcinoma should be suspected if a hard nodule protruding at the border is observed.
  • Basal cell carcinoma has an irregular asymmetric shape. These cases are often misdiagnosed as an intradermal nevus.
  • It can be misdiagnosed as an intradermal nevus.
  • Basal cell carcinoma can be mistaken for wart.
  • Basal cell carcinoma can also appear in the form of an ulcer. In this case, It should be differentiated from squamous cell carcinoma.
  • In Westerners, Basal cell carcinoma appears as a hard nodule with telangiectasia.
  • Basal cell carcinoma has a similar shape to a birthmark, but the fact that the lesion is a hard nodule is important to distinguish it from a nevus.
  • While it may resemble an intradermal nevus (benign), it is important to note that the lesion of Basal cell carcinoma is hard.
  • In Asians, a typical case of Basal cell carcinoma appears as a solid black nodule with a protruding border
  • Basal cell carcinoma must be differentiated from melanoma as Basal cell carcinoma has a much better prognosis than melanoma.
  • If these widespread patches are firm to the touch, it strongly indicates the diagnosis of Superficial basal cell carcinoma.
  • It can be misdiagnosed as an intradermal nevus.
References Basal cell carcinoma: pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management 26029015 
Basal cell carcinoma (BCC) is the most common malignancy. Exposure to sunlight is the most important risk factor. Most, if not all, cases of BCC demonstrate overactive Hedgehog signaling. A variety of treatment modalities exist and are selected based on recurrence risk, importance of tissue preservation, patient preference, and extent of disease.
 Update in the Management of Basal Cell Carcinoma 32346750 
Basal cell carcinomas are the most frequent skin cancers in the fair-skinned adult population over 50 years of age. Their incidence is increasing throughout the world. Ultraviolet (UV) exposure is the major carcinogenic factor. Some genodermatosis can predispose to formation of basal cell carcinomas at an earlier age. Basal cell carcinomas are heterogeneous, from superficial or nodular lesions of good prognosis to very extensive difficult-to-treat lesions that must be discussed in multidisciplinary committees. The prognosis is linked to the risk of recurrence of basal cell carcinoma or its local destructive capacity. The standard treatment for most basal cell carcinomas is surgery, as it allows excision margin control and shows a low risk of recurrence. Superficial lesions can be treated by non-surgical methods with significant efficacy.
 European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023 37604067
The primary treatment for BCC is surgery. For high-risk or recurring BCC, especially in critical areas, micrographically controlled surgery is recommended. Patients with low-risk superficial BCC might consider topical treatments or destructive methods. Photodynamic therapy works well for superficial and low-risk nodular BCCs. For locally advanced or metastatic BCC, Hedgehog inhibitors (vismodegib, sonidegib) are recommended. If there's disease progression or intolerance to Hedgehog inhibitors, immunotherapy with anti-PD1 antibody (cemiplimab) can be considered. Radiotherapy is a good option for patients who can't have surgery, especially older patients. Electrochemotherapy could be considered if surgery or radiotherapy isn't an option.