To see views enlarged, click on the individual pictures...

Photos courtesy of: Bita Esmaeli, M.D. / M.D. Anderson Cancer Center
Used with permission. Not to be reproduced.

This 35-year-old man presented with a slow growing left medial canthal lesion.

1.	The most likely diagnosis is:
	b -- basal cell carcinoma The lesion has the classic appearance of a basal cell carcinoma including pearly gray color, rolled up borders, central ulcer, and telangiectasias.  While a keratoacanthoma may have a somewhat similar appearance, it is typically fast growing.
2.	The most common periocular site involved with this lesion is:
	c -- lower lid > medial canthus > upper lid > lateral canthus Basal cell carcinomas (and squamous cell carcinomas) most commonly involve the lower eyelid.  This is thought to be due to more direct sun exposure.
3.	Histopathologic examination would show:
	c -- proliferation of basaloid cells with peripheral palisading, and retraction artifact These are the classic histologic features of nodular basal cell carcinoma (the most common histologic type, photo).