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.


Basal cell carcinoma must be differentiated from other common causes of skin lesions, such as squamous cell carcinoma, microcystic adnexal carcinoma, trichoepithelioma/trichoblastoma, and merkel cell carcinoma.

Basal Carcinoma Differential Diagnosis

The following table summarizes common differential diagnosis for basal cell carcinoma :[1]

Disease or Condition Differentiating Signs and 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 distinguish 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 table summarizes other differential diagnosis for basal cell carcinoma:

Clinical variant Differential Diagnosis
Nodular BCC Intradermal nevus

Sebaceous hyperplasia

Fibrous papule

Molluscum contagiosum


Superficial BCC Discoid eczema


Actinic keratosis (solar keratosis)

Lichen simplex

Bowen's disease

Seborrhoeic keratosis

Pigment BCC Melanoma
Sclerodermiform (morpheiform) BCC Scar tissue

Localized scleroderma


  2. 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.
  3. Ackerman AB, Gottlieb GJ (2005). "Fibroepithelial tumor of pinkus is trichoblastic (Basal-cell) carcinoma". Am J Dermatopathol. 27 (2): 155–9. PMID 15798443.
  4. 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.
  5. 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.