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Patient Case: Basal Cell Carcinoma (Rodent Ulcer)

Patient Case: Basal Cell Carcinoma (Rodent Ulcer)

Discussion

A 72-year-old retired fisherman presents to the dermatology clinic with a slowly enlarging ulcerated lesion on his right cheek. He first noticed a small, pearly bump about 18 months ago, which gradually increased in size and developed a central ulcer with crusting. The lesion is painless but occasionally bleeds when he washes his face.

The patient has a history of extensive sun exposure from years spent working outdoors. He has fair skin and reports that he rarely used sun protection. There is no history of previous skin cancer, but he recalls a neighbor having a "rodent ulcer" removed from his nose.

On examination, there is a raised, pearly, telangiectatic lesion with rolled borders and a central ulcer on the right cheek. A dermoscopic examination reveals arborizing blood vessels and ulceration. A punch biopsy confirms nodular basal cell carcinoma (BCC).

The patient is counseled on treatment options, including surgical excision, Mohs micrographic surgery, cryotherapy, and topical therapies, depending on lesion size and location. He is advised on sun protection and regular follow-up for skin cancer surveillance.

Questions
  1. What is the primary cause of basal cell carcinoma?
    a) Chronic sun exposure and UV radiation
    b) Bacterial skin infection
    c) High-fat diet
    d) Genetic mutation without environmental influence
  2. Which of the following best describes the clinical features of basal cell carcinoma?
    a) A rapidly growing, painful, black lesion with irregular borders
    b) A slow-growing, pearly nodule with telangiectasia and central ulceration
    c) A flat, scaly, red plaque that resolves spontaneously
    d) A cluster of painful blisters with surrounding erythema
  3. What is the most appropriate first-line treatment for basal cell carcinoma?
    a) Oral antibiotics
    b) Wide local excision or Mohs micrographic surgery
    c) Corticosteroid creams
    d) Radiation therapy as first-line treatment
  4. Why is early treatment of basal cell carcinoma important?
    a) It has a high risk of distant metastasis
    b) It can cause significant local tissue destruction if left untreated
    c) It is highly contagious and spreads through direct contact
    d) It typically resolves without treatment
Reveal answers

Answers

  1. (a) Chronic sun exposure and UV radiation
    • Basal cell carcinoma is strongly linked to prolonged sun exposure, particularly in fair-skinned individuals with outdoor occupations or hobbies.
  2. (b) A slow-growing, pearly nodule with telangiectasia and central ulceration
    • The classic presentation of BCC includes a pearly nodule with rolled edges and visible small blood vessels (telangiectasia). Over time, it may ulcerate, earning the name "rodent ulcer."
  3. (b) Wide local excision or Mohs micrographic surgery
    • Surgical excision is the gold standard for most BCC cases. Mohs micrographic surgery is preferred for lesions on cosmetically sensitive or high-risk areas, as it maximizes tissue preservation while ensuring complete removal.
  4. (b) It can cause significant local tissue destruction if left untreated
    • While BCC rarely metastasizes, it can cause extensive local invasion, leading to disfigurement and damage to underlying structures, including bone and cartilage.

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