Basal cell carcinoma differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
There are differential diagnosis for patients with basal cell carcinoma within the following clinical variants: nodular, superficial, pigmented, and sclerodermiform (morpheiform).
Basal Carcinoma Differential Diagnosis
The following table summarizes common differential diagnosis for basal cell carcinoma[1]:
| Disease/condition | Differentiating signs/symptoms | Differentiating tests |
| Microcystic adnexal carcinoma | AKA sclerosing sweat duct carcinoma; simulate morpheaform variants of BCC; higher recurrence rate than BCC | Histopathology: there are more ductal structures lined by a cuticle of keratin, which are not prevalent in BCCs; it will occasionally be positive with cytokeratin 7 and CEA (usually negative in BCCs)[2] |
| Trichoepithelioma/trichoblastoma | There is a formation of papillary-mesenchymal bodies (follicular units that simulate bulb of the hair follicle); a characteristic stroma-stroma split; a lower apoptotic and mitotic rate than seen in BCC[3] | Histopathology: the characteristic stroma-epithelium split and increase in apoptotic bodies and mitotic figures is not seen; Immunohistochemical: a characteristic perinuclear dot-like pattern and high molecular weight cytokeratin cocktail |
| Merkel cell carcinoma | This is a highly malignant neoplasm derived from cutaneous neuroendocrine cells[4] | Histopathology: opaque nuclei, no nucleoli, and increased nuclear/cytoplasmic ratio, peripheral palisading might be present |
| Squamous cell carcinoma (SCC) | It may impossible to distingish between BCC and SCC[5] | Histopathology: larger cells with prominent nucleoli, foci of keratinization and formation of squamous whorls where the neoplastic cells tightly wrap around each other |
The following are other differential diagnosis for patients with basal cell carcinoma:
- Nodular BCC:
- Intradermal naevus
- Sebaceous hyperplasia
- Fibrous papule
- Molluscum contagiosum
- Keratoacanthoma
- Superficial BCC:
- Discoid eczema
- Psoriasis
- Actinic keratosis (solar keratosis)
- Lichen simplex
- Bowen's disease
- Seborrhoeic keratosis
- Pigmented BCC:
- Melanoma
- Sclerodermiform (morpheiform) BCC:
- Scar tissue
- Localized scleroderma
| Clinical variant | Differential diagnosis |
| Nodular BCC | Intradermal nevus
Sebaceous hyperplasia Fibrous papule Molluscum contagiosum Keratoacanthoma |
References
- ↑ https://online.epocrates.com/u/2935269/Basal+cell+carcinoma
- ↑ Smeets NW, Stavast-Kooy AJ, Krekels GA, Daemen MJ, Neumann HA (2003). "Adjuvant cytokeratin staining in Mohs micrographic surgery for basal cell carcinoma". Dermatol Surg. 29 (4): 375–7. PMID 12656816.
- ↑ Ackerman AB, Gottlieb GJ (2005). "Fibroepithelial tumor of pinkus is trichoblastic (Basal-cell) carcinoma". Am J Dermatopathol. 27 (2): 155–9. PMID 15798443.
- ↑ Massari LP, Kastelan M, Gruber F (2007). "Epidermal malignant tumors: pathogenesis, influence of UV light and apoptosis". Coll Antropol. 31 Suppl 1: 83–5. PMID 17469758.
- ↑ Raasch BA, Buettner PG, Garbe C (2006). "Basal cell carcinoma: histological classification and body-site distribution". Br J Dermatol. 155 (2): 401–7. doi:10.1111/j.1365-2133.2006.07234.x. PMID 16882181.