At a glance: Psoriasis vs superficial basal cell carcinoma

Psoriasis

Clinical features

  • Single or often multiple plaques.
  • A red surface with a thick scale is typical.
  • Predilection for extensor surfaces.
  • Lesions are often symmetrical.
  • Involvement of the face is rare but the nails can be affected.

Management

  • Topical emollients, tar, salicylic acid, topical steroids, dithranol, calcipotriol or UV light.
  • Systemic PUVA, retinoids, cytotoxics, systemic steroids, ciclosporin if severe.

Superficial basal cell carcinoma (BCC)

Clinical features

  • Most commonly arise on the trunk.
  • Usually present as a single lesion.
  • Slow-growing pink or brown scaly plaque with a fine whipcord edge.
  • Can grow to greater than 10cm in diameter.
  • Usually mistakenly diagnosed as psoriasis or eczema but fail to respond to conventional therapy.
  • Thought to be associated with prolonged sun exposure.
  • Also occur in scars caused by X-rays, vaccination or trauma.

Management

  • Treatment is ideally by excision, curettage and cautery or cryotherapy, or radiotherapy where appropriate.
  • In general the cure rate is >95 per cent.
  • Regular follow up is important to detect recurrence and new lesions.

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