Nurse Practitioner Makes Correct Skin Cancer Diagnosis with VisualDx

Sam S., a nurse practitioner at Harry S. Truman Memorial Veterans’ Hospital, shares how VisualDx was used to help differentiate between nodular cell carcinoma and squamous cell carcinoma in a patient:

“I was asked to see a patient and rule out malignancy. I knew it looked like either a basal cell carcinoma or a squamous cell carcinoma but could not remember how to differentiate them. Using VisualDx, I was able to correctly diagnosis a nodular basal cell carcinoma.”

What is nodular basal cell carcinoma?

Basal cell carcinoma (BCC), also known as basal cell epithelioma, is the most common form of skin cancer. Basal cell carcinoma usually occurs on sun-damaged skin, especially in light-skinned individuals with a long history of chronic sun exposure. Although it requires treatment to prevent it from becoming too invasive, basal cell carcinoma typically does not spread to lymph nodes or other parts of the body. Nodular BCC is one of several subtypes.

What should we be aware of when making a diagnosis?

Dermoscopy can aid in diagnosing nodular BCCs. Under dermoscopy, BCCs classically have arborizing vessels. The vasculature of BCCs is typically bright red and sharply in focus compared with the surrounding skin.

Raised, rolled borders are typically present and can greatly assist diagnosis. There may also be central ulceration.

How can we treat this?

A variety of treatment options are available. These include surgical modalities (including standard surgical excision, MMS, and electrodessication and curettage [ED&C]), topical therapies, energy devices, radiation, and oral medications. Treatment should be tailored based on patient goals of care and tumor characteristics. Characteristics of interest include location (such as cosmetically sensitive and high-risk areas), size (in the context of location), definition of borders, recurrence (versus a primary lesion), history of radiation at the site, perineural invasion, and immunosuppression status.

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