Diagnosis of an atypical presentation of basal cell carcinoma of the nasal pyramid: Case report

TL;DR

A case report describes a rare and complex presentation of basal cell carcinoma on the nose, emphasizing the importance of early diagnosis and surgical treatment.

Contribution

Highlights the challenges of diagnosing and reconstructing large infiltrating basal cell carcinomas on the nasal pyramid.

Findings

Infiltrating basal cell carcinomas have greater sub-clinical extension than other forms.

Surgical resection with a forehead flap is a common treatment for large nasal lesions.

Early diagnosis and treatment are crucial for preventing serious functional and aesthetic damage.

Abstract

Basal cell carcinoma is a common form of skin cancer whose global incidence is rising rapidly, with over 70 % of locations on the face. In contrast to their low mortality, their morbidity is high. Extensive basal cell carcinomas and infiltrative lesions are associated with a high recurrence rate, which can result a serious esthetic and functional damage.

We report the case of a 65-year-old female patient, who consulted our ENT department for a large ulcerating lesion of the nasal pyramid. CT scan revealed a lesion of the nasal pyramid measuring 38 mm in long axis, which appeared to come into contact with the anterior part of the nasal septum. The pathological findings were consistent with an infiltrating basal cell carcinoma. The patient underwent surgical resection with reconstruction using a forehead flap.

Following ANAES guidelines, when the diagnosis of a poor-prognosis BCC is uncertain, or when major reconstruction is required at the time of surgery, biopsy is strongly recommended to confirm the diagnosis. The evolution of BCCs is essentially local, and they rarely metastasize, with a maximum incidence rate of 0.55 %, of which around 85 % appears on the face. Thus, local extension of BCCs mainly involves adjacent tissues, including the perichondrium, in which case imaging is necessary to assess the extent of damage. The most common and effective treatment is surgical excision, with a margin of healthy tissue around the tumor.

Because early diagnosis and carcinological excision are the keys to a good prognosis. We must insist on the role of primary and secondary prevention, and on the importance of early diagnosis.

•The nasal pyramid is a highly affected area by basal cell carcinoma.•Infiltrating basal cell carcinomas have a greater sub-clinical extension than superficial and nodular forms.•Lesions of the nasal pyramid are complex to remove and in reconstruction, especially when the tumor is large.•Frontal flap is the most used flap.•We insist on the role of primary and secondary prevention, and the importance of early diagnosis at a stage when treatment is codified.

The nasal pyramid is a highly affected area by basal cell carcinoma.

Infiltrating basal cell carcinomas have a greater sub-clinical extension than superficial and nodular forms.

Lesions of the nasal pyramid are complex to remove and in reconstruction, especially when the tumor is large.

Frontal flap is the most used flap.

We insist on the role of primary and secondary prevention, and the importance of early diagnosis at a stage when treatment is codified.

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