March Mohs Case Presentation - Infiltrative Basal Cell On The Nose
Dr. David Roy • February 27, 2019
A 75 year-old male patient, on warfarin (blood thinner) therapy, presented to our office for a non-healing sore on his nose (Figure 1). According to the patient, the lesion had been treated with liquid nitrogen at least twice in the past 12 months. A biopsy demonstrated an infiltrative basal cell carcinoma. This type of basal cell carcinoma is typically more aggressive than a standard nodular basal cell carcinoma and is frequently larger than it appears to be. These cancers can cause severe disfigurement if left untreated. This cancer can grow both extremely wide and deep, causing it to destroy skin, deeper tissue, and can even damage bone. The most common place that a Basal Cell Carcinoma will present itself is on the nose.
Three stages of Mohs micrographic surgery were required to clear the tumor. The final defect involved the majority of the nasal dorsum, nasal tip and a small amount of the bilateral nasal sidewall (Figure 2). Minor involvement of the nasal cartilage was noted.
Several closure options were discussed with the patient including but not limited to a paramedian forehead flap. This closure involves identifying the supratrochlear artery that supplies some of the skin on the forehead and dissecting the surrounding tissue to utilize for the repair. This is typically a two-stage process and can be difficult for some patients to tolerate, especially those on life saving blood thinners. Due to the complexity of this procedure, the patient wished to pursue other options.
Grafting was discussed, but he and his wife had significant concerns regarding the cosmetic results of a graft. Skin grafts can be very cosmetically pleasing when executed correctly. Unfortunately, in this case, the large defect size and exposure of cartilage would make the likelihood of a cosmetically pleasing graft very low.
In the end we opted for a bilateral transposition flap. This flap had the advantage of being performed in a single stage while yielding a cosmetically pleasing result. Tissue from the middle part of each cheek was elevated and moved over to the intact tissue of the sides of the nose (transposed) and sewed into place over the defect (Figure 3).
The sutures were removed after one week of healing. At two weeks a small amount of scabbing is noted at the tip of the nose (Figure 4), but the patient and his wife were extremely happy with the result.
When a ‘Rash’ Might Be Something More Serious At Pine Belt Dermatology & Skin Cancer Center, we recognize that rashes are common and frequently resolve quickly with minimal treatment. However, some rashes may signify underlying conditions that require prompt medical attention. Identifying when a rash is more than a minor irritation is key to protecting your health. Comprehending Common vs. Concerning Rashes Most everyday rashes result from irritants, allergies, heat, or minor infections and typically improve within a few days with over-the-counter treatments. However, if a rash lasts longer, worsens, or appears with other symptoms, it may signal a more serious issue. Identifying the difference between a routine rash and one that requires medical evaluation helps avoid complications and ensure appropriate care. Warning Signs to Watch For Certain features may indicate a rash requires clinical assessment, including: Rapidly spreading or worsening rash Severe pain, swelling, or blistering Signs of infection such as pus, warmth, or red streaks Fever or flu-like symptoms accompanying the rash A rash that does not improve after several days of treatment Dark, purple, or bruised-looking areas on the skin For example, a rash with fever may indicate a viral or bacterial infection, whereas painful blistering can suggest conditions such as shingles. In rare cases, rashes may signal autoimmune disorders or severe allergic reactions. Rashes That May Point to Underlying Conditions Some rashes may be linked to broader health concerns, including conditions that cause inflammation in the skin and other organs: Allergic reactions that may escalate into further severe responses Infections that spread beyond the skin if untreated Medication reactions that require immediate adjustment Persistent or unusual skin changes may be early signs of skin cancer or precancerous conditions, especially if they do not heal or continue to change over time. Why Early Evaluation Matters Delaying care for a worrisome rash may allow the underlying condition to progress. Early diagnosis improves treatment outcomes and helps prevent discomfort and complications. A dermatology specialist can assess the rash’s appearance, location, and progression, and may recommend diagnostic tests if needed. This approach assures treatment addresses the underlying cause, not just the visible symptoms. When to See a Dermatology Specialist If you are unsure about your rash, it is best to err on the side of caution. Consider seeking care if: The rash is persistent, painful, or unusual in appearance Over-the-counter treatments are not effective You experience additional symptoms such as fever or fatigue The rash interferes with your daily comfort or quality of life At Pine Belt Dermatology & Skin Cancer Center, our experienced providers supply comprehensive skin evaluations and customized treatment plans. We take time to understand your symptoms and deliver clear, effective solutions tailored to your needs. Protecting Your Skin and Your Health While many rashes are minor, some may be early warning signs of more serious health concerns. Monitoring skin changes and pursuing prompt medical advice can produce a notable effect. If you notice a rash that does not seem right, do not ignore it. Schedule a consultation with Pine Belt Dermatology & Skin Cancer Center for expert evaluation and peace of mind. Your skin is an important indicator of your overall health, and taking it seriously supports ongoing well-being.
At Pine Belt Dermatology & Skin Cancer Center, we know that healthy skin is affected by more than just external care—it’s related to your overall health...
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