Nejm 2006;354:2262

Cause:Idiopathic; actinic

Older patients, though incidence in under 50-yr-old population is increasing rapidly (Jama 2005;294:681); associated with sun UVB and/or tanning salon exposure, and light complexion; arsenical rx and arsenical keratoses of palm; >500 000/yr in US, increasing rapidly; 4+ × as common as squamous cell Ca

Si:Exposed areas; telangiectasias, pearly raised borders, no increased keratin; may be a pit if marked stromal reaction; central ulceration occasionally; occasionally pigmentation, often stippled

Slight incr risk of other cancers (5-20%) (Ann IM 1996;125:815); in those dx'd under age 60 yr, risk incr for testicular, breast, and nonHodgkins lymphoma

r/o CONGENITAL BASAL CELL NEVUS SYNDROME (Nejm 1986;314:700); genetic, autosomal dominant; in young patients w pitted palms, large head with frontal bossing and wide eyes, who have multiple basal cell carcinomas; cmplc: jaw cysts, ovarian fibromas, medulloblastoma; rx w topical 5-FU and tretinoin (J Am Acad Derm 1992;27:842)

Lab: Path:Excisional biopsy

Rx:

• Excision
• Electrodesiccation and curettage, least traumatic but avoid around eyes, ears, nose, scalp, or if >2 cm or recurrent
• Radiation w 3000-6000 rad total dose @ 300 qd, 89% successful, or w radium needles also possible, avoid in basal cell nevus syndrome since can be carcinogenic
• Cryotherapy
• 5-FU topically on penis or if multiple lesions, usually is only palliative

Refer for Mohs microsurgery or for surgical excision if aggressive histopathology, recurrent, >2 cm, or involves ears, temples, midface triangle, or scalp