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Chapter 29: Basal Cell Carcinoma

INTRODUCTION

KEY POINTS

  • While basal cell carcinomas are most commonly seen in those with lighter skin, they can indeed happen in darker skin, and missed and delayed diagnoses can contribute to disease morbidity and even mortality.

  • Basal cell carcinomas in darker skin are often pigmented and can mimic melanoma. They can also be mistaken for inflammatory processes.

  • The subclassifications of basal cell carcinomas that are seen in lighter skin can also be seen in darker skin. These include superficial, nodular, ulcerative, and morpheaform.

image

FIGURE 29-1.

Well-circumscribed pink pearly telangiectatic papule lateral to the right commissure on the face. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 110-28. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows a round pinkish nodule with visible streaks of blood vessels, present close to the corner of mouth.
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FIGURE 29-2.

Close-up of a pink pearly plaque with rolled borders, central ulceration, and overlying hemorrhagic crusting consistent with an ulcerated nodular basal cell carcinoma. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 177-3. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows a large ulcerated nodule with raised borders and bloody crusts.
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FIGURE 29-3.

Well-circumscribed black-gray nodule representing a pigmented basal cell carcinoma on the right cheek, mimicking a nodular melanoma. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 177-11. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows a blackish round basal cell carcinoma with raised borders, in the cheek.
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FIGURE 29-4.

Well-circumscribed black-gray ulcerated plaque with rolled borders representing a pigmented basal cell carcinoma on the right lower eyelid. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 179-23. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows a black pigmented carcinoma with pearly raised borders.
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FIGURE 29-5.

Atrophic violaceous-pink plaque representing a pigmented basal cell carcinoma on the right upper cutaneous lip of a Black woman. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 46-2.)

A patient with brown skin exhibits an indented hyperpigmented purple to dark brown plaque lateral and inferior to the nose.
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FIGURE 29-6.

Atrophic scar-like pink plaque representing a sclerotic basal cell carcinoma on the superior to right lateral eyebrow. (Reproduced with permission from Soutor C, Hordinsky MK. Clinical Dermatology. New York, NY: McGraw Hill; 2013, Figure 17-6.)

A light skinned patient with an indented bright pink to red plaque above and lateral to the right eyebrow. Lines extend from the plaque.
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FIGURE 29-7.

Well-circumscribed, violaceous-pink, atrophic ulcerated plaque with black ...

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