Snapshot A 42-year-old fair-skinned woman is concerned about a “pink pearly mole” on her cheek. She has no significant past medical history, but reveals that she regularly goes to tanning salons and beaches. She admits that she occasionally forgets to apply sunscreen and does not re-apply when she is outside all day. Introduction Most common skin malignancy that rarely, if ever, metastasizes Epidemiology risk factors sun exposure prior ionizing radiation xeroderma pigmentosum common in fair-skinned individuals Commonly affects upper lip (squamous cell carcinoma typically affects lower lip ) Presentation Symptoms typically asymptomatic, but may be tender if ulcerated slow-growing Physical exam pink, pearly-white, almost translucent dome-shaped nodule or papule overlying telangiectasias commonly develop raised or rolled border commonly ulcerate, bleed, and crust in the center (a non-healing ulcer) frequently on sun-exposed areas Evaluation Diagnosis by skin biopsy basophilic palisading cells on histology nests of basaloid cells in dermis Differential Squamous cell carcinoma Actinic keratosis Treatment Determined by size location histology cosmetic considerations Options electrodesiccation and curettage (typically for non-facial tumors that are small or superficial – not used for aggressive tumors) cure rate up to 92% wide local surgical excision cure rate up to 90% Mohs micrographic surgery (especially if on face or if recurrence) cure rate up to 99% Prognosis, Prevention, and Complications Prognosis if treated, typically very good risk of developing another basal cell carcinoma is 5-8% per year Prevention use sunscreen avoid sun exposure High Yield