Basal Cell Carcinoma
David J. Elpern MD, Williamstown, Massachusetts, USA
on June 23, 2002
Mr. O.A. is a 78-year-old man who presents for evaluation of a lesion on the left lower lid. He has a long history of actinic disease. He has had many nonmelanoma skin cancers. Significantly, he had a basal cell carcinoma of the right preauricular area which was excised twice by a plastic surgeon and recurred twice. The tumor then invaded the bony process of the temporal bone and was visible in the ear canal through an otoscope. About six months ago, the patient underwent exenteration of his right ear and portions of the temporal bone at a university center (see pre and post-op pictures). We hope this procedure was curative.
On June 19th, 2002, there is a 1.2 cm in diameter, pearly papule with a rolled border on the left lower lid, about 2 mm from the lid margin (see photograph). He has numerous hypertrophic actinic keratoses on the face and arms. A few superficial basal cells on the back.
Basal cell carcinoma, left lower lid.
Would Mr. O.A. be best referred for micrographic surgery? Or to an ophthalmic plastic surgeon, or to a micrographic surgeon who is working closely with an ophthalmic surgeon? The patient asked whether Aldara would be effective and my feeling is that the cure rate is not high enough to recommend it. Given his history of atypical and aggressive basal cell carcinoma, I feel the need for curative surgery at this point. Opinions will be sought from VGRD. My preference would be to have him seen by a Moh's surgeon who could do the plastic repair or who had close association with a plastic surgeon or ophthalmic plastic surgeon. He is also being presented to highlight the occasional bad results when the nonmelanoma skin cancer in certain sites is not treated appropriately and aggressively. Your comments will be appreciated.