Infiltrative Basal Cell Carcinoma

An 82 year-old male patient was referred to our office for evaluation of a biopsy proven infiltrative basal cell carcinoma of the nose (Figure 1). The patient stated that the spot had been preset for several months and that it had been enlarging. 

After discussing treatment options including Mohs surgery, radiation therapy, and oral targeted therapy, the patient decided that Mohs surgery would be the best option, as he was very active and preferred an effective but fast definitive treatment.

The surgery and microscopic evaluation of the tissue revealed a very large and aggressive tumor that had invaded widely into the nose. The tumor was much larger than it looked and involved a significant portion of the nose (Figure 2). Three stages of tissue were taken in order to clear the tumor.

After discussing several closure options, the patient and I decided upon a full thickness skin graft. This would allow for a single stage procedure, excellent tissue match in terms of skin texture and color, and simplicity for the patient (Figure 3).

At a 3-year follow-up visit, there is no evidence of recurrence, the nose is level and centered and the patient and referring physician are very pleased with the results (Figure 4).