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A 66-year-old woman presents with a growth about her left eye. She states that the lesion had been removed by a family physician approximately 6 years ago but has since grown back. A biopsy had not been performed on the lesion. Examination reveals a flesh-colored, somewhat moveable nodule in proximity to the left medial canthus.
Can you diagnose this condition?
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Basal cell carcinoma is the most common form of skin cancer, often developing on sun-exposed areas of light-skinned individuals. Most basal cell carcinomas present as small, dome-shaped papules with a pearly appearance and well-defined borders. Lesions are typically slow growing and rarely metastasize. Treatment options depend on a number of factors including age and location of lesion. Treatment options may include standard surgical excision, Mohs micrographic surgery, curettage and electrodessication, radiotherapy, and topical therapies such as 5-fluorouracil and imiquimod.1
Features of high-risk basal cell carcinoma include tumors of longstanding duration at a diameter of >2 cm. These tumors have perivascular or perineural infiltration located in the mid-face or ears and did not previously respond to treatments.2 Complete excision when anatomically feasible is the preferred treatment modality.3 Mohs micrographic surgery is highly effective for the treatment of recurrent basal cell carcinoma, with a 5-year risk of another recurrence of 5.6% compared with 17.4% with surgical excision and 9.8% with radiotherapy.4
Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.
References
- Wong CS, Strange RC, Lear JT. Basal cell carcinoma. BMJ. 2003;327(7418):794-798.
- Wollina U, Tchernev G. Advanced basal cell carcinoma. Wien Med Wochenschr. 2013;163(15-16):347-353.
- Luz FB, Ferron C, Cardoso GP. Analysis of effectiveness of a surgical treatment algorithm for basal cell carcinoma. An Bras Dermatol. 2016;91(6):726-731.
- Rowe DE, Carroll RJ, Day CL. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol. 1989;15(4):424-431.
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