- 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.
- 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 can usually be made from the history and examination, especially if contents can be expressed.
- If in doubt, excise and send for histology.
- 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
- 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.
- Incisional biopsy will confirm the diagnosis.
- 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.