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Basal Cell Carcinoma
Presented by
David J. Elpern MD, Williamstown, Massachusetts, USA
on June 23, 2002
History:
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.
Examination:
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.
Impression:
Basal cell carcinoma, left lower lid.
Question
and Discussion:
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.
