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By Lawrence A. Schiffman, DO, and Stephen M. Schleicher, MD
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CASE:
A 24-year-old woman presents with a lesion on
her right lower eyelid. She states that it first
appeared nine months ago and occasionally
bleeds. She denies excessive sun exposure or
childhood sunburns. Her family history is positive for skin cancer in a grandparent. Physical
examination reveals a fair-skinned woman with
a pearly, pinkish, telangiectactic nodule with a
central crust on the lower lid margin.
WHAT IS YOUR DIAGNOSIS?
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Basal cell carcinoma (BCC) is the most common skin
cancer, but it is usually diagnosed in middle-aged
or older individuals, many of whom give a history
of chronic sun exposure. Occasionally, BCC appears
in sun-protected areas and in individuals who have
had little or no sun damage. The typical BCC, as
exemplified by this case, is called a “rodent ulcer,”
which refers to the central depression and erosion.
Many BCCs respond favorably to simple curettage,
cryosurgery, or radiation therapy. The treatment of
choice in difficult cases is Mohs’ surgery. |
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Dr. Schiffman is a dermatology resident at St. John’s Episcopal Hospital in Far Rockaway, New York. Dr. Schleicher is director of DermDx Centers and a
clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia
University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 38(10):61-62, 2006
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