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Skin Cancer Nodular Basal Cell Carcinoma

Nodular BCC is the most common form. The lesion begins as a pearly white or pink, dome-shaped papule resembling a molluscum contagiosum or dermal nevus. The mass extends peripherally. The lesion may remain flat. Traction on the surrounding skin accentuates the pearly border. Telangiectatic vessels become prominent and easily recognizable through the thin epidermis as the lesion enlarges. The growth pattern is irregular, forming an oval mass and the surface may become multilobular. The center frequently ulcerates and bleeds and subsequently accumulates crust and scale. Ulcerated BCCs were formerly designated rodent ulcers.

Ulcerated areas heal with scarring, and patients often assume their conditions are improving. This cycle of growth, ulceration, and healing continues as the mass extends peripherally and deeper. Masses of enormous size may be attained.

BCCs may present as nonhealing leg ulcers. Biopsy specimens should be taken of leg ulcers that do not respond to treatment. The tissue mass of a nodular BCC has a distinctive consistency that can be appreciated during curettage or biopsy. It has poor cohesive forces and collapses or breaks down when manipulated with a curette. This is an important diagnostic feature that supports the clinical impression during the biopsy procedure.