summary Basal Cell Carcinoma is the most common skin malignancy that rarely, if ever, metastasizes. The condition most commonly occurs in patients with significant sun exposure, who present with a pink, pearly-white, dome-shaped nodule. Diagnosis is made with a biopsy showing basophilic palisading cells. Treatment is usually wide surgical resection. Epidemiology Risk factors sun exposure prior ionizing radiation xeroderma pigmentosum common in fair-skinned individuals Anatomic location 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 Prevention use sunscreen avoid sun exposure Surgical electrodesiccation and curettage indications typically for non-facial tumors that are small or superficial – not used for aggressive tumors best technique determined by size location histology cosmetic considerations outcomes cure rate up to 92% Mohs micrographic surgery indications especially if on face or if recurrence outcomes cure rate up to 99% wide local surgical excision outcomes cure rate up to 90% Prognosis If treated, typically very good Risk of developing another basal cell carcinoma is 5-8% per year