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Nodular basal cell carcinoma
See also in: External and Internal Eye,Anogenital,Hair and Scalp
Other Resources UpToDate PubMed

Nodular basal cell carcinoma

See also in: External and Internal Eye,Anogenital,Hair and Scalp
Contributors: Gaurav Singh MD, MPH, William M. Lin MD, Sarah Hocker DO, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Basal cell carcinoma (BCC) is the most common cancer in humans and the most common cancer of the skin. Two million Americans are diagnosed with BCC every year. It is a neoplasm of basal keratinocytes that is found more frequently in men than women. Rates of BCC have been increasing over the last several decades, particularly in young women. BCCs can be seen at almost any age. Nonetheless, the malignancy has greater incidence in older individuals, with a median age at diagnosis of 68 years.

There are many subtypes of BCC, including nodular, superficial, infundibulocystic, fibroepithelial, morpheaform (sclerosing, desmoplastic), infiltrative, micronodular, and basosquamous. Nodular BCC is the most common subtype overall and accounts for half of all lesions. In Black and Hispanic patients, BCCs are more often pigmented.

Nodular BCC is typically seen on the face, most commonly on the cheeks, nose, melolabial fold, forehead, and eyelids. Although BCCs typically arise in hair-bearing areas, they can rarely be seen in hairless genital mucosa for an unknown reason.

The greatest risk factor contributing to the development of BCCs is sun exposure, and people with light skin phototypes are at higher risk. Intermittent sun exposure is more associated with the development of BCCs than cumulative ultraviolet (UV) exposure. Other risk factors for BCCs include environmental exposure (ie, ionizing radiation, indoor tanning, chemicals such as arsenic, psoralen plus UVA, and coal tar), phenotype (freckling, red hair, light skin that always burns and never tans), immunosuppression such as organ transplantation (which results in a 5-10 times higher risk of BCCs than the general population), and various genetic syndromes including xeroderma pigmentosum, oculocutaneous albinism, Muir-Torre syndrome, basal cell nevus syndrome (Gorlin syndrome), Rombo syndrome, and Bazex-Dupré-Christol syndrome. The gene most frequently altered in BCCs is the PTCH1 gene, followed by the TP53 gene.

Although BCCs are almost never fatal, local tissue destruction and disfiguration occur. The metastasis rate of BCCs is approximately 1 in 35 000. Metastasis is rare and typically occurs through perineural spread, lymph node metastasis, and then lung / bone metastasis.


C44.91 – Basal cell carcinoma of skin, unspecified

403911008 – Nodulo-ulcerative basal cell carcinoma

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Cutaneous squamous cell carcinoma
  • Keratoacanthoma
  • Sebaceous hyperplasia
  • Molluscum contagiosum
  • Squamous cell carcinoma in situ (Bowen disease)
  • Trichoblastoma
  • Trichoepithelioma
  • Angiofibroma
  • Common acquired nevus
  • Lichenoid keratosis
  • Dermatofibroma
  • Dermatofibrosarcoma protuberans
  • Atypical fibroxanthoma
  • Adenoid cystic carcinoma (see Adenoid cystic carcinoma of ear)
  • Merkel cell carcinoma
  • Eccrine gland carcinoma
  • Microcystic adnexal carcinoma
  • Basosquamous carcinoma of skin

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:11/07/2021
Last Updated:01/29/2023
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Patient Information for Nodular basal cell carcinoma
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Nodular basal cell carcinoma
See also in: External and Internal Eye,Anogenital,Hair and Scalp
A medical illustration showing key findings of Nodular basal cell carcinoma : Telangiectasia, Sun-exposed distribution
Clinical image of Nodular basal cell carcinoma - imageId=204149. Click to open in gallery.  caption: 'A reddish plaque with telangiectasias and a raised, shiny, rolled border at the anterior hairline.'
A reddish plaque with telangiectasias and a raised, shiny, rolled border at the anterior hairline.
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