Basal cell carcinoma: solid (syn. nodular / cystic)

LAST UPDATED: Jun 05, 2026

Patient Information Leaflet
Link: Basal cell carcinoma

https://www.pcds.org.uk/patient-info-leaflets/basal-cell-carcinoma

Introduction

The solid basal cell carcinoma (BCC), sometimes referred to as nodular or cystic, is the most common type of basal cell carcinoma.

This chapter is set out as follows:

Aetiology

For more information refer to the related chapter Basal cell carcinoma - an overview.

Clinical findings

Distribution

  • Any site can be involved; the head and neck are the most commonly affected
  • The medial canthus and behind the ears are not uncommon sites; a thorough skin examination is required 

Morphology

  • Commonly raised; can be flat
  • Shiny / translucent, rolled edge, telangiectasia (more peripheral)
  • With time the nodule becomes more irregular and ulcerates
  • Very firm

Dermoscopic features (hover over terminologies for description)

  • Pinky white translucent or gelatinous background
     
  • Sharply focused arborising (branching) vessels (for more information on vessels refer to the chapter Vessel patterns in dermoscopy)
     
  • Ulcerations or erosions
     
  • Blue / grey clods (sometimes referred to as ovoid nests) or dots. Never a pigment network
     
  • Shiny white structures - strands (streaks) or blotches, seen primarily in the polarised mode
     
  • MAY globules - multiple aggregated yellow-white globules (clods). These differ from milia-like cysts as they are grouped and observed equally with non-polarised and polarised light (milia-like cysts are best seen with non-polarised light). MAY globules are positively associated with deeper-seated and histologically higher-grade tumour subtypes (eg micronodular), and negatively associated with superficial BCC

BCC in skin of colour

  • The diagnosis of BCC in skin of colour can be difficult due to its rarity and pigmentation
  • More than 50% of such cases are pigmented with a ‘pearly’ brown or black appearance and a rolled border
  • Nodular BCC are the predominant subtype; infiltrative BCC are uncommon
  • In a study of 66 BCC in skin phototypes IV or V the most common dermoscopic features were pigmented peripheral clods (61.7%), blue-white structureless areas (53.4%), ulceration (48.4%), and short arborising vessels (46.7%)

Clinical Images

Please refer to notes on image rights at bottom of the page with regards to individual image ownership.

BCC - a very typical appearance Copied with…
1
BCCCopied with kind permission from South Tees…
2
Dermoscopic appearance of previous…
3
Solid BCC right side of nose Copied with…
4
Dermoscopic appearance of previous figureArrow…
5
BCCCopied with kind permission from South Tees…
6
Dermoscopic appearance of previous…
7
Some BCC don't need a dermatoscope for…
8
Dermoscopic appearance of previous…
9
Another BCC with arborising vessels visible to…
10
Dermoscopy can be so helpful in early…
11
BCC can grow along skin creases giving a linear…
12
Dermoscopic appearance of previous figureSubtle…
13
Basal cell carcinoma in a tattooTattoos…
14
Dermoscopic appearance of previous figure
15
BCC on dorsum of hand BCC can affect any part…
16
Dermoscopic appearance of previous figure
17
BCC and AK nose - crust, scale or…
18
As previous figure - arborising vessels in…
19
BCC and sebaceous gland hyperplasia (SGH)This…
20
Same patient - SGH (left image) and BCC (right…
21
Basal cell carcinomaCopied with kind permission…
22
Dermoscopic appearance of previous…
23
BCC Copied with kind permission from Dr…
24
Dermoscopic appearance of previous…
25
BCC Copied with kind permission from South…
26
Dermoscopic appearance of previous figureEven…
27
A solid BCCAnother relatively flat lesion; the…
28
BCC right side of nose
29
Dermoscopic appearance of previous…
30
BCC shinThis lesion had grown slowly, was firm to…
31
Dermoscopic appearance of previous figureArrow…
32
BCC - heavily pigmentedCopied with kind…
33
Dermoscopic appearance of previous…
34
BCC in skin of colour - a pigmented rolled…
35
Dermoscopic appearance of previous figureMany…
36
Multiple BCCMultiple BCC are common and patients…
37
Dermoscopic appearance of previous figure - left…
38
Same patient - right sided lesionGelatinous…
39
Solid BCC right upper noseIt is not uncommon for…
40
Dermoscopic appearance of previous figureArrows…
41
BCC - non-polarised modeArborising vessels and…
42
Same lesion - polarised modeMultiple shiny white…
43
BCC - MAY globulesVisible in polarised and…
44
BCC - MAY globules
45
Multiple BCCThe upper lesion (thick black arrow)…
46
Dermoscopic appearance of previous figure (upper…
47
BCC under ear - ulcerated This lesion had a…
48
A solid and infiltrative BCCDon't assume that all…
49
BCC - neglectedIncisional biopsies were needed as…
50
Same patient as previous figure
51
Same patient - post radiotherapyIn such cases,…
52
As per previous figure
53
Melanoma - full cutaneous examinations are…
54

Management

Disclaimer - the author PCDS cannot accept responsibility for any misleading or incorrect statements, and the management of individual patients remains the direct responsibility of the individual doctor. We do however hope that visitors to this site can contact us regarding comments that are considered misleading or incorrect so that we can continue to improve the site.

Image Rights - The PCDS would like to thank Dermatoweb, DermQuest (Galderma), and others who have contributed images. All named individuals and organisations maintain copyright for the relevant images.

Related Chapters

Download the Patient Information Leaflet PDF

Download

Quick Links

ALL
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z

Medical Images

It is important for the PCDS to build its own image bank, as such we welcome original images from our readers, especially in skin of colour:

The following pharmaceutical companies have had no involvement in the content of this website or in our conference programmes

Almirall
Galderma
Glenmark
Johnson & Johnson
La Roche-Posay
LEO Pharma
Pierre Fabre
Schuco

View all sponsors