Non-healing ulcer of Basal cell carcinoma

A 60-year-old retired construction worker presents with a non-healing skin lesion on the back of his hand that occasionally bleeds when he gets out of the shower. The most likely diagnosis is

• A) basal cell carcinoma
• B) squamous cell carcinoma
• C) superficial spreading malignant melanoma
• D) actinic keratosis
• E) keratoacanthoma

The answer is A. (Basal cell carcinoma)

Basal cell carcinoma is the most common form of skin cancer. The lesions are induced by ultraviolet radiation in susceptible individuals. Risk factors include age older than 40, light complexion, positive family history, and male sex. The lesion in the photo has pearly, raised borders with telangiectasia and a central ulcer that may crust. Sun-exposed areas are most commonly affected. Diagnosis is achieved with shave or excisional biopsy.

Treatment is accomplished with excision, electrodessication and curettage, liquid nitrogen application, Moh's surgery, radiation treatment, and topical 5-fluorouracil cream. Almost 50% of patients with basal cell carcinoma will have another within 5 years.