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January 2002
Case submitted by Stephen M. Schleicher,
MD
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CASE:
A 68-year-old man has a slowly enlarging skin lesion on his
right temple. Although the growth is asymptomatic, it occasionally
bleeds when traumatized by a hair brush. He previously had
a squamous cell carcinoma that was removed from his left ear.
He also maintains a long-standing smoking habit. Examination
reveals a 0.8-cm bluish-black nodule with a telangiectatic
border. Scattered actinic keratoses are evident in other locations.
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Basal cell carcinoma is the most common form
of skin cancer; hundreds of thousands of new cases are diagnosed
each year. The tumor, which is usually flesh-colored or erythematous,
is locally invasive and destructive, but it very rarely metastasizes
and spreads. In a small number of cases, the tumor may have
a melanin hue ranging from blue to black. Such cancers are termed
pigmented basal cell carcinomas and may clinically resemble
malignant melanoma. The definitive diagnosis must be made by
biopsy. |
Dr. Schleicher is director of the DermDx Centers for Dermatology
of Northeastern Pennsylvania and a clinical instructor of dermatology
at Graduate Hospital's City Line Campus in Philadelphia, Kings
College in Wilkes-Barre, and Beaver College in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
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