How to Tell the Difference Between Rosacea and BCC?

Since the birth of my son 10 months ago, I have developed Rosacea. I also have a history of basal cell (2 removed on my face with MOHS). I would like to prevent more or catch them early to keep facial defects to a minimum. My doctor told me both spots were Rosacea, and was wrong when I insisted on a biopsy.

I am checked every 2-3 months, but I still find the spots myself. How can I tell the difference between Rosacea and BCC? I use doxycycline and Metrogel. I have not used laser for fear of camouflaging BCC.

Doctor Answers 2

Finding BCC's in rosacea can be difficult

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Finding and evaluating skin lesions in a background of skin can disease can be very difficult. Rosacea on the skin comes in many forms (erythematotelangiectatic, papulo-pustular, glandular) and many people have features of all three forms. Basal cell carcinomas also come in many forms (nodular, superficial, morpheaform, etc). As you can imagine, there can are many features common to both conditions (bumps, blood vessels, location of the conditions, location)

Regular self-exams and regular exams by your dermatologist would be the best way to detect basal cells early. One or two exams are almost never sufficient to scrutinize every lesion. Nor do you want to biopsy every bump and skin thickening that you find, since this can lead to disfigurement. Regular exams will allow you and your doctor to address new lesions and biopsy or re-evalate lesions based on the level of suspicion for cancer. If you find lesions that you are concerned about, bring them to your dermatologist's attention. This will likely be an on-going project for you and your doctor, but a strong collaborative effort will minimize your morbidity. Best of luck.

Summit Dermatologic Surgeon

Occasionally Hard

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It actually sounds like you were right and not wrong to insist on a biopsy.

Usually it is quite easy to tell the difference with the erythematotelangiectatic type of Rosacea. This is the type in which there is a sheet of redness spread across the center of the face, often times with small blood vessels called telangiectasias.A basal cell carcinoma will appear as a pearly, shiny papule or nodule oftentimes with a telangiectasia ( wiry thin blood vessel) perched on its top or emanating from the side. Since this is the type of Rosacea usually found in females, there is not much of a diagnostic challenge.

However, if you have the papulopustular variant, in which there are large pores, knobby bumps, and intermittent pustules, this can be more difficult than it would first appear. The granulomatous type of Rosacea ( roughly a bump from a cluster of lymphocytes, a type of white cell) can be even more of a diagnostic dilemma. Usually a basal cell is a bit more shiny. Growth in a bump would also be indicative of a basal cell. Any sort of ulceration ( hole formation) is an ominous sign.

However, even the most experienced dermatologist may be forced to biopsy one of these lesions to rule out a basal cell.

The fact that you have had two of these lesions, requiring Moh's chemosurgery, will emphasize to all of your physicians, not only your dermatologist, to be en garde.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.