MALIGNANT CUTANEOUS TUMOURS:

Basal cell carcinoma (rodent ulcer)
Basal cell carcinomas are the most common malignant skin tumour and most relate to excessive sun exposure. They are common later in life on exposed sites although rare on the ear. They present as a slow-growing papule or nodule (or rarely be cystic) which may go on to ulcerate (Fig. 23.32). Telangiectasia over the tumour or a skin-coloured jelly-like 'pearly edge' may be seen. A flat, diffuse superficial form exists and an ill-defined 'morphoeic' variant. Basal cell carcinomas will slowly grow and erode structures if untreated but these tumours almost never metastasize.
Treatment
Treatment is usually with surgical excision with a 3-5 mm border. Radiotherapy, photodynamic therapy, cryotherapy or 5% imiquimod cream can be useful for large superficial forms but follow-up for recurrence is required. Curettage is occasionally used in older patients, although not for central facial lesions as they often recur. Recurrent tumour or morphoeic basal cell carcinoma is best treated with Mohs' micrographic surgery to ensure adequate clearance.