Basal Cell Carcinoma

This 40-year-old man presented for evaluation of a “scar” on his nose. He could not remember sustaining any trauma to the area.

Examination revealed a morpheiform, or sclerosing, basal cell carcinoma in the left upper lateral nasal sidewall. Because of their scar-like appearance, with surface atrophy and sparse surface telangiectases, morpheiform basal cell carcinomas can easily escape detection. In addition to cicatrix, the differential diagnosis for this lesion included morphea.

After a confirmatory punch biopsy was performed, this patient was referred for Mohs surgery, and clear margins were obtained, with primary closure. The extensive solar damage observed on this patient’s skin was a strong clue as to the nature of this sun-related malignancy.