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Nonmelanoma skin cancers – 10 cases

This quiz will test your diagnostic skills for nonmelanoma skin cancers.

The epidermis is made up of actively dividing cells, the keratinocytes. These are constantly exposed to environmental mutagens and immune modulating agents, particularly ultraviolet radiation. We have a genetically susceptible population with fair skin that burns easily and tans poorly yet enjoys an outdoor lifestyle. It is not surprising therefore that epidermal cell cancers are by far the most common of all cancers, estimated to account for 45,000 new cases in New Zealand each year.

Nonmelanoma skin cancer and its precursors are relatively easy to recognise, and straightforward to treat when small and/or located away from the mid-face and lower legs. Yet their management is sometimes complex, requiring extensive surgery or expensive non-surgical treatment for multiple and/or recurrent tumours. Early diagnosis of enlarging, spontaneously bleeding, ulcerated or scaly nodules and plaques is essential. Promote active primary and secondary prevention – stay in the shade, wear a broad-brimmed hat and covering clothing and apply broad spectrum SPF30+ sunscreen to otherwise unprotected skin.

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

Case 1

Nodular basal cell carcinoma (BCC)

  • Presents as a slowly growing pearly nodule or plaque with prominent arborizing vasculature.
  • Most often located on the head and neck. The inner canthus is a common site.
  • Ulceration is common, hence alternative name, rodent ulcer.

Excision biopsy is recommended with a 3 to 4 mm margin. Mohs microscopically controlled surgery is indicated for recurrent, ill-defined and large tumours of the mid-face.

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