A superficial BCC should be considered in the differential diagnosis if a patient presents with red, flaky patches, particularly if that patient has a history of significant sun exposure. Any person with a history of significant sun exposure should be a candidate for a complete skin examination with a dermatology professional.

Diagnosis. The diagnosis of a BCC is made by biopsy. A shave, tangential, or saucerization biopsy is adequate to make the diagnosis and treatment plan. A punch biopsy can be performed if a melanoma is in the differential diagnosis.

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Treatment. BCCs typically are treated surgically. Surgical options include excision with appropriate margins, electrodesiccation and curettage (ED&C), and Mohs micrographic surgery. ED&C, the most commonly performed treatment, is done only after the lesion has been debulked during biopsy.

This treatment may result in bleeding and scarring; patients are often left with a white or pink annular scar that is larger than the original lesion. Also, because the clinician performing the ED&C cannot discern the margins of the BCC (with no tissue being sent away for pathology in this procedure, the clinician cannot be sure that all cancerous cells are being cleared), he or she may not go wide or deep enough, or, conversely, may go wider or deeper than is necessary.

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The depth and width covered by ED&C are operator-dependent but do rely on the different feel and sound of normal tissue versus cancerous tissue during curettage: Cancerous tissue is often softer; the feel of its removal can be likened to the removal of softened butter. In comparison, normal, healthy tissue is resilient and firm.

Despite the procedure’s drawbacks, ED&C is the most cost-effective treatment option for BCC. The recurrence rate of a BCC 5 years after ED&C is 7.7%.2 Skin also may heal more easily following ED&C than following a procedure that requires stitches.

Mohs micrographic surgery should be considered as a treatment option for skin cancers that are located in cosmetically sensitive areas, are close to adjacent structures that could cause anatomical dysfunction (such as lesions that pull down on the lower eyelid, creating chronic eye-moisture issues; or lesions that pull up the lip border), are larger lesions, or are BCC subtypes with a high incidence of recurrence.

Named after the physician who invented the technique in the 1930s, Mohs micrographic surgery is a stepwise procedure in which layers of the involved tissue are removed, fixed on-site by a histology technician, and then mapped by a pathologist (often the dermatologist performing the procedure). 

This article originally appeared on Clinical Advisor