Description: Dermoscopy - There are quite a few milia-like cysts, features usually associated with seborrhoeic keratosis but this feature is not uncommonly seen in BCC,s (as well as in dermal naevi and melanomas). Fine arborising telangiectasia and brown pigment without network confirm the very strong clinical impression of BCC. Whenever there is a clear-cut criterion of a malignant condition this should "trump" any criteria for a benign condition which might be present.

History: This 55 year old lady presented for a routine skin check. She had a history of one previous melanoma but no previous BCC,s. This lesion was detected during examination of her scalp. I find it is unusual to find BCC,s on the scalps of females where the hair cover is good but this is an exception to that rule. She had in fact shown this lesion to another GP twice over the preceding 2 years and he had reassured her that it was benign. The the hair was so thick it was only after snipping some of it away for a better view that I was able to make the diagnosis. Until I did that and got a clear view of it clinically and was able to effectively apply the dermatoscope I thought it was a dermal naevus. It was in fact a BCC of mixed solid and micronodular types.