Dermatology Case Studies

A is for Asymmetry

• Asymmetry is characteristic of most skin cancers, however, BCC can be symmetrical hence difficult to differentiate from a benign lesion via this feature alone
• In this case you can see the lesion is relatively symmetrical

B is for Border irregularity

• The most common type of BCC is nodular and this typically has a pearly rolled border due to having a central depression (or ulceration) as seen in the photograph
• An indistinct/ irregular border is consistent among BCCs, however, some BCCs can present as flat irregular plaques rather than raised as is seen in the photograph

C is for Colour variability and/or Changing colour

• BCC can be skin coloured, pink or pigmented as can benign lesions
• However, in this case the photo depicts there are >2 shades of these colours which is a concerning feature

D is for Different

• A pigmented lesion that is obviously different from the others is sometimes called an 'ugly duckling', 'black sheep', 'lone ranger', or 'odd-mole-out' and must be considered suspicious even if it does not fulfil the ABCDE criteria

E is for Evolving (changing)

• Change in size, colour, shape, or structure may be noted over months to years
• In this case the patient is telling you that this lesion seems to be getting bigger and has started spontaneously bleeding
• All changes are a cause for concern