Photo Quiz

Persistent Infraorbital Plaque


Am Fam Physician. 2020 Apr 1;101(7):429-430.

A 46-year-old woman presented with a mass under her eye that had been growing slowly for approximately three years. It was pruritic but not associated with pain or bleeding. She had no significant medical history aside from hyperlipidemia.

Physical examination revealed a pink papule on her left lower eyelid, which had a central punctation with rolled borders (Figure 1).




Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Hidrocystoma.

B. Lipoid proteinosis.

C. Nodular basal cell carcinoma.

D. Syringoma.

E. Xanthelasma.


Answer is C: nodular basal cell carcinoma. Basal cell carcinoma is the most common cancer worldwide.1 Lifetime risk in the United States is approximately 20%, and the annual incidence is estimated at 8%.1 Risk factors include Fitzpatrick skin types I and II. The predominant environmental risk factor is exposure to ultraviolet radiation.2 Subtypes include nodular, superficial, infundibulocystic, fibroepithelial, morpheaform, and infiltrative.2 Nodular basal cell carcinoma is the most common subtype, accounting for 50% to 80% of basal cell carcinoma lesions.1

Nodular basal cell carcinoma presents as a translucent, pink, or pearly well-circumscribed papule or nodule with rolled borders. Lesions are often associated with telangiectasias. Lesions may be asymptomatic, or they may ulcerate, bleed, or be pruritic. The face (i.e., cheeks, nasolabial folds, forehead, and eyelids) is the

Address correspondence to Amanda M. Lau, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Cameron MC, Lee E, Hibler BP, et al. Basal cell carcinoma. J Am Acad Dermatol. 2019;80(2):303–317....

2. Heymann WR. Coming into focus: dermoscopy for basal cell carcinomas. J Am Acad Dermatol. 2019;80(5):1254–1255.

3. Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Elsevier/Saunders; 2012.

4. Connolly SM, Baker DR, Coldiron BM, et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery. Dermatol Surg. 2012;38(10):1582–1603.

5. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Basal cell skin cancer. Version 1.2020. October 24, 2019. Accessed February 6, 2020.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

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