(BMJ)—A woman in her 70s had an asymptomatic, slow-growing linear lesion on her left cheek, incidentally noted during a visit to a dermatology clinic for a different reason. Exam: 30×5-mm curvilinear red lesion on left lower orbital rim. What’s the dx?
Mycosis fungoides
Basal cell carcinoma
Squamous cell carcinoma
Fibrous papule of the face
Desmoplastic trichoepithelioma
You are correct. Subsequent bx and clinicopathological correlation showed the lesion to be a mixed superficial/nodulocystic basal cell carcinoma. The patient was referred for Mohs micrographic surgery.

As with all basal cell carcinomas, sun exposure is the main risk factor. Unlike classic basal cell carcinoma, however, linear ones tend to occur in natural skin creases. This rare morphological basal cell carcinoma variant is probably underrecognized and should be suspected if a patient presents with a slow-growing linear lesion in a skin crease.

BMJ 2021;373:n925

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