Mohs Case Before & After - Infiltrative Basal Cell Carcinoma
Dr. David Roy • February 4, 2019
A 77 year-old male patient presented to our clinic complaining of a sore lesion on his left ear (Figure 1). He stated that the spot had been tender and bleeding for several months and that it had been frozen with liquid nitrogen four times in the last two years, with no improvement.
Figure 1. A biopsy of the lesion revealed an infiltrative basal cell carcinoma. While basal cell carcinoma is typically slow growing and not very aggressive, this particular type (infiltrative) is known for demonstrating a more aggressive behavior and a more destructive course. After discussing treatment options including Mohs surgery, radiation therapy, and oral targeted therapy, the patient and his wife felt that surgery would be the best option due to its high cure rate. The patient was also concerned about the cosmetic result, and repair options for the possible resulting defect were discussed.
The surgery and microscopic evaluation of the tissue revealed a very aggressive tumor that had invaded the cartilage of the ear. After three stages of surgery the final defect involved the entire back edge of the ear and a significant portion of the cartilage (Figures 2-3). Luckily, the Mohs procedure allowed for some of the cartilage to be saved, which would later aid in the reconstruction.
The patient stressed the importance of the cosmetic look of his ear and after seeing the defect he was doubtful that his ear would ever look normal again. To solve this problem, we decided upon what is called an interpolation flap. This particular flap closure involves taking skin from the tissue behind the ear (the postauricular area) and attaching it to the ear itself. While doing this we leave a significant portion of the skin attached to the scalp so that the flap of skin has significant blood supply to survive and heal (Figure 4).
The skin was left in this position for 18 days (Figure 5), at which point the flap is separated from its attachment to the scalp and the ear is rebuilt using the freed skin (Figure 6).
Figure 6 – One week after the final repair. If you have been diagnosed with a non-melanoma skin cancer and have been told you need to have Mohs surgery, then come see Dr. David Roy at Pine Belt Dermatology to discuss any and all concerns you may have. Skin cancer diagnoses are never comfortable to receive, and neither is being told you need to have the cancer surgically removed, but at Pine Belt Dermatology we do our best to place your mind at ease and provide you with the highest quality in the Hattiesburg and Laurel area. If you have a history of skin cancer, or a family history of skin cancer, strongly consider seeing Pine Belt Dermatology for the most optimal results!
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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.
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