At a Glance - Epidermoid cyst vs nodular BCC

Contributed by Dr Nigel Stollery, GP, Kibworth, Leicestershire and clinical assistant in dermatology at the Leicester Royal Infirmary.

Epidermoid cyst 

 

 

 

 

 

Presentation

  • Slow growing nodules with normal skin overlying.
  • Punctum may be visible on closer inspection.
  • May increase or decrease in size.
  • Sebum can often be expressed if the nodule is squeezed which has a distinctive cheesy smell.
  • Not usually painful unless they become infected.

Aetiology

  • Cyst with a wall of keratinised squamous epithelium with abundant keratin lamellae.
  • Leakage from the cyst is common, often giving rise to a localised foreign body reaction.

Diagnosis

  • Diagnosis can usually be made from the history and examination, especially if contents can be expressed.
  • If in doubt, excise and send for histology.

Treatment

  • Smaller cysts may be left.
  • If required, they can be excised under local anaesthesia.
  • Patients need to be advised that recurrence may occur.
  • No malignant potential.

Nodular basal cell carcinoma

 

 

 

 

 

Presentation

  • Slow growing lesion, more common on sun-exposed areas.
  • Roll edge may be apparent, with central ulceration.
  • Surface telangiectasia usually present, especially when viewed with a dermoscope.
  • Not initially painful or inflamed.
  • No discharge unless the centre ulcerates.
  • Low grade malignant tumour arising from the deep basal cell layer of the epidermis.

Diagnosis

  • Incisional biopsy will confirm the diagnosis.

Treatment

  • NICE guidance advises treatment in secondary care except for small BCCs in low-risk areas on the body.
  • Excision with a 5mm margin is the usual treatment of choice.
  • In cases of very large lesions radiotherapy is an option.
  • Photodynamic therapy may be appropriate and avoids the need for surgery.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus