Basosquamous Carcinoma

A 72 year-old female patient was referred to our office for treatment of a basosquamous carcinoma of the left side of her nose (Figure 1). According to the patient, the lesion had been growing for several months and had bled. This type of skin cancer is somewhat of a mix of basal cell carcinoma and squamous cell carcinoma and is typically more aggressive than a standard basal cell carcinoma. Basosquamous carcinomas commonly behave in a manner similar to that of squamous cell carcinomas and can be very aggressive and even metastasize in some cases. Of note is a smaller secondary lesion a short distance away on the cheek of the patient. A biopsy of this lesion on the day of the surgery revealed a nodular basal cell carcinoma. (Figure 1.)

Three stages of Mohs micrographic surgery were required to clear the primary tumor and two stages were required to clear the smaller secondary tumor. The final defects involved a significant portion of the patient’s nose and cheek (Figure 2).  

Several closure options were reviewed with the patient.  Grafting was discussed, but she and her husband had significant concerns regarding the look of a graft, especially at this location. Ultimately, the patient opted for a rotation flap originating from her left cheek (Mustarde Flap). As we have discussed in a previous blog post, this flap has the advantage of being performed in a single stage while yielding a cosmetically pleasing result. Tissue from the lateral aspect of the left cheek was elevated and moved (rotated) centrally (Figures 3 and 4).   This allowed for complete closure of both wounds while keeping the nose level and even and prevented the eyelid from being pulled down. The patient did develop bruising from the procedure due to the use of Plavix and aspirin. These medications were not held for our procedure as it is safer for the patient. At Pine Belt Dermatology, we almost never hold blood thinners prior to procedures. (Figure 3., Figure 4.)

The sutures were removed after one week of healing (Figure 5). The patient was extremely happy with the results and had no complications during the course of her healing.

At a 6 month follow up visit, the surgery has healed completely, there is no evidence of recurrence of either tumor, and the scar is acceptable (Figure 6.). The patient and her husband were very happy with the results.