<p>This asymptomatic lesion was picked as an incidental finding in clinic. What surface characteristics can you see and what is your differential?</p>
<p>At first glance, clinically this could be an actinic keratosis, however, dermoscopically we can clearly see a few arborising vessels (upper aspects) in keeping with a BCC, and the ''strawberry features'' of an AK are lacking.</p>
<p><strong>Scale, crust or makeup?</strong></p>
<p>In general, BCCs do not have surface scale, scale is produced by epidermal lesions. However, a number of things need to be considered: </p>
<p>- <strong>Makeup</strong> can appear white, so always remove<br>- <strong>Scale</strong> is usually white, but can be white-yellow <br>- <strong>Crust</strong> tends to be yellow-orange (sometimes with blood), signifying an underlying erosion or ulcer, for example in a BCC <br>- Occasionally an AK and a BCC may <strong>coexist </strong></p>
<p>Copied with kind permission from Dr Chin Whybrew<br></p>
