A 74-year-old man had neglected multiple skin lesions. These gradually enlarged, became ulcerated, and started to bleed spontaneously.
Key point: Denial is a strong defense mechanism, which can lead to an amazing delay in seeking medical attention. When biopsied, all lesions proved to be infiltrative basal cell carcinoma.
Treatment: A metastatic workup was negative. Because of the locally aggressive nature of the tumors, each was subjected to Moh’s micrographic surgery. The patient was admonished to undergo periodic total body skin examinations at least every 6 months.
Note: Larger facial basal cell carcinoma, especially those located on or near an orifice (nose, eyes, ears, mouth), are considered inherently risky. Conservative intervention is less appropriate in such cases. Vismodegib, a Sonic Hedgehog pathway inhibitor, could be legitimately considered in this instance as adjunctive or preoperative therapy.
