A common clinical scenario. By all means try a potent steroid for a couple of weeks for something that looks as if it might be excema, but if it doesn’t clear in 2 weeks, ask yourself why. Basal cell cancer often presents like this. It is not a dangerous tumour on the body (the face can be much more trouble) as it never spreads and grows very slowly, but catching it sooner means a smaller scar.
Why won’t this eczema get better with treatment? Because its a basal cell cancer. Eczema rarely appears as a single lesion like this, usually its much more widespread, and it usually responds to treatment. A slowly growing lesion that looks like nothing else on the skin must always be suspect whatever the colour. This lesion had been slowly growing for 4 years and was now scabbing regularly. Basal cell cancer often presents as a slowly growing spot or patch of funny skin that forms scabs which drop off and then re-form, always scabbing but never healing. I’ve heard that story a couple of hundred times in clinic. People sometimes say it started after knocking their head on a garage or cupboard door, but logically the tumour must have been present prior to the knock, whatever they believe. The minor trauma just started it bleeding. Once the surface of a BCC is broken, it will never heal, hence the story of a scab that continually re-forms.
Its a pink plaque (patches are flat, plaques are raised) with some scale and a few scabs. I am tensioning the skin to make the pearly edge more visible. I don’t have a dermoscopic image, but it isn’t necessary in an obvious case like this.
PS For the learners on the South Coast skin lesion and dermoscopy course that is about to begin, we will do lots of dermoscopy later but basic skin lesion recognition comes first. I am currently in the mood to post lots of pictures of basal cell skin cancers as they are the most common sort. For non medics interested in, perhaps worried about, skin cancer-if you have something on your skin that is new, changing, odd looking, then its never wrong to seek advice from your doctor. I can’t offer individual advice. I’m really aiming this site at doctors and nurses who want to improve their diagnostic skills, but also trying to write responsibly and informatively for the interested public.