Basal Cell Carcinoma at a Site Not Exposed to Sun

A 53-year-old woman was told by her hairdresser to have a dermatologist look at the 1.3-cm diameter, painless nodule behind her left ear. The nodule had never bled. The patient was ostensibly in good health.

Key point: The nodule appears somewhat translucent, and coarse telangiectases are seen traversing the lesion’s surface. Despite the fact that this lesion is NOT in a sun-exposed skin site, the clinical features are typical for a basal cell carcinoma. This presumptive diagnosis was verified by biopsy. A solitary cutaneous metastasis from an internal malignancy was considered in the differential diagnosis.

Treatment: The neoplasm was removed by excision, and the defect closed by developing a flap.

Note: Non-melanoma cutaneous cancers may arise in relatively sun-protected sites.