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Basal Cell Carcinoma

Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓

 

Doctor Instruction:


You are a doctor working in a dermatology department. Your next patient is Louis Bell – a 55-year-old gentleman who has been referred for querying skin cancer. Please take a history and perform an appropriate examination.



 

Patient History:


Louis Bell – 35-year-old gentleman – pilot


You came in today as you have been referred by your family doctor, Dr Philips. You noticed a slow-growing lesion on the left side next to your nose. It has been there for 1-2 years – you only started noticing it as you heard more about skin cancer on the radio - telling you to see a doctor for any suspicious skin changes. It looks quite red, and the lesion can be tender when you touch it. It doesn’t appear to be swollen to you. It is not pigmentated. It is not bleeding. No discharge. No weight loss. No night sweats. No other systemic symptoms otherwise.


You are not normally an outdoor person, so you rarely put on any sunscreen. However, you remember you get sunburned easily as a child because you generally have fair skin.


Idea, Concern, Expectation:

  • You have no idea what this is. You are concerned that this is skin cancer, and you heard skin cancer is one of the major killer cancers for young people. You would like to have the lesion removed and confirm what it is.


Past Medical History:

  • Nil


Drug History:

  • Nil

  • NKDA


Family History:

  • You remember your mum has something called xeroderma…. Something like that – which is when she has very sun-sensitive skin. She luckily found a type of skin cancer early, and she was treated before it had the chance to spread.


Social History:

  • You work as a pilot for OSCEFinals Airline, and fly commercially.

  • Live alone - often in hotels.

  • Don't drink or smoke alcohol.


 

Examination Findings:

  • Skin type 1-2.

  • Raised 5mm diameter, pearly/shiny, indurated and rolled edge, erythematous lesion with central ulceration located at the left lateral side of the nose. Evidence of telangiectasia.

  • No keratosis. No other unusual lesions. No lymphadenopathy.


 

Differentials:

  1. Basal Cell Carcinoma

  2. Fibrous papule

  3. Sebaceous hyperplasia

  4. Intradermal naevus

  5. Molluscum contagiosum


 

Investigations:

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