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A 71 year old man with a facial lesion

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Q1: What is the diagnosis?

The diagnosis is basal cell carcinoma; this is the most common form of skin cancer. Basal cell carcinoma is the commonest malignancy in white people with incidence rates of 300/100 000 reported in the USA.1 Rates are increasing at over 10% per year leading to a lifetime risk of 30%. Although mortality is low, the disease is responsible for considerable morbidity and places a substantial burden on the health service provision in the UK. It is induced by chronic sun exposure. The incidence is rising, especially in younger age groups and although they do not metastasise, they are a major source of morbidity due to local invasion and tissue destruction. Grossly neglected lesions may invade underlying cartilage and bone. The criteria for aggressiveness appear to be2: (1) initial diameter greater than 1 cm, (2) more than two recurrences despite all tentative conclusions of adequate treatment and (3) extension to any extracutaneous structure.

There are four types: nodular, cystic, morphoeic, and superficial. All present as slowly enlarging, glistening, yellow or white lesions which often appear translucent with fine telangiectasia coursing across the surface. The morphoeic type can resemble a scar.

Q2: Discuss treatment for this condition

Any suspicious lesion should be referred to a dermatology department for biopsy and appropriate treatment planning.3Lesions situated on important anatomical areas (for example, medial and lateral canthi, nose, and ears) are especially important to pick up as they can cause extensive tissue destruction with profound cosmetic disability if neglected.

Final diagnosis

Basal cell carcinoma.


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