In the latest in his series, GP and hospital practitioner Dr Andy Jordan looks at how to differentiate two similar skin conditions
Basal cell carcinoma (BCC) and sebaceous hyperplasia may both present as umbilicated facial papules. Sebaceous hyperplasia is completely benign and incorrect diagnosis can lead to inappropriate surgery. They are both often associated with significant sun exposure and signs of solar damage.
Basal cell carcinoma
• Is the most common malignant tumour
• Tended to present in middle age but is now occurring in younger populations
• If small may be translucent or greyish and develop a pearly edge
• Is rounded, develops umbilication and eventually ulcerates and become crusted – the features are most easily seen if the skin is stretched between fingers
• Usually shows surface telangiectasia, which may be difficult to see
• May have flecks of pigmentation
• May bleed and scab but doesn’t resolve – it is locally destructive and grows inexorably, albeit slowly
• Is treated by surgical excision
• May not be isolated – the patient should be examined for other BCCs
• Reveals arborising telangiectasia on dermoscopy which are irregular (unlike sebaceous hyperplasia).
• Presents as yellow/pink papules up to 3mm diameter
• Is a benign proliferation of sebaceous glands which present in middle-aged or elderly patients
• Has a smooth surface
• Has a typical doughnut shape produced by several papules together, giving the appearance of an umbilicated centre
• Usually forms multiple lesions unlike BCC
• Usually occurs on the forehead, temples and cheeks
• Does not crust
• Does not require treatment as it has no pathological significance
• Shows up on dermoscopy as white/yellow nodules and radial crown vessels, which do not cross the centre of the lesion.
Dr Andy Jordan is a GP and hospital practitioner in dermatology in Chesham, Buckinghamshire
Basal cell carcinoma Basal cell carcinoma Sebaceous hyperplasia Sebaceous hyperplasia