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People over the age of 40 years, with more years of exposure to risk factors, are most susceptible to BCC. People who work in the sun are particularly vulnerable, and exposure is more important than gender considerations in this disorder. People of color and those avoiding sunlight are significantly less likely to develop BCC; darker-skinned people receive protection from the pigment melanin. Men are affected twice as often as women, possibly owing to increased

120 Basal Cell Carcinoma recreational and occupational exposure to the sun, although these differences are becoming less significant as women's lifestyles change. Whites of Celtic ancestry have the highest risk for BCC; light eye color; hair color that is red, blonde, or light brown; and freckling are strong predictors of BCC.


HISTORY. Elicit a history of skin problems, the length of time skin disorders have existed, daily routine skin care, and current medications. Ask the patient about exposure to sunlight; in particular, establish long-term patterns of exposure to sunlight, either at work or in recreational activities, and determine what form of sun protection the patient has customarily used. Record the patient's history of scars, vaccination sites, and burns. Establish a patient history of exposure to radiation or arsenic; be sure to ask about the patient's occupational history to discover if he or she has been at risk of ingesting arsenic at an industrial site.

PHYSICAL EXAMINATION. Observe the color, texture, turgor, and pigmentation of the patient's skin for deviations from normal skin parameters. Note in detail any lesions, nodules, or plaques.

PSYCHOSOCIAL. Patients with BCC at the early stages can recover with minimal intervention, although some patients may experience distress over facial lesions that alter their appearance. Patients may have to deal with changes in activities that bring them into extended contact with environmental risk factors. Patients with more advanced cancer or of an older age may have to cope with more aggressive and repeated treatments and surgery with some permanent disfigurement and poor prognosis.

Diagnostic Highlights

Clinical examination usually is sufficient to determine extent of lesion.

Abnormality with Test Normal Result Condition


Lesion biopsy Negative biopsy Positive for basal cell epithelioma

Excisional biopsy may be treatment for small tumors; during excision, intraoperative frozen section analysis occurs to confirm negative margins of lesion

Other Tests: BCCs are diagnosed by clinical appearance, histologic study, and biopsies; CT scanning may be necessary in advanced disease to determine bone involvement.

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