Basal cell carcinoma differential diagnosis
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 :
|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)|
|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||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||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||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
|Superficial BCC||Discoid eczema
Actinic keratosis (solar keratosis)
|Sclerodermiform (morpheiform) BCC||Scar tissue
- 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.