Keratinizing Squamous Cell Carcinoma Masquerading as Basal Cell Carcinoma Constituting a Diagnostic Pitfall: A Case Report With Etiopathogenetic Discourse and Mohs Micrographic Surgical Management

TL;DR

A case of squamous cell carcinoma misdiagnosed as basal cell carcinoma highlights the importance of accurate diagnosis and effective surgical treatment for facial skin cancers.

Contribution

This case report highlights a diagnostic challenge and demonstrates the utility of Mohs surgery in facial skin cancer management.

Findings

A squamous cell carcinoma was initially misdiagnosed as a basal cell carcinoma.

Mohs micrographic surgery ensured complete tumor removal with minimal tissue damage.

Environmental and demographic factors influence the development of facial skin cancers.

Abstract

Among non-melanoma skin cancers of the face, basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) are the most common. They are close differentials of each other and often constitute diagnostic pitfalls during assessment. This is a case report of the diagnosis and Mohs surgical management of an SCC that was initially clinically diagnosed as BCC. Mohs micrographic surgery (MMS) for cancers of cosmetically sensitive areas such as the face has proved to be a very useful procedure for ensuring 100% tumor removal with maximum normal tissue-sparing. This case report also analyzes the etiological, environmental, and demographic factors that lead to skin cancers of the face, with emphasis on the relationship of Fitzpatrick skin types and ultraviolet (UV) solar radiation vis-à-vis their propensity to cause skin cancers. High index of suspicion followed by early intervention still remains the hallmark of early, accurate diagnosis of skin cancers of the face, with the aim of ensuring high cure rates and minimum facial disfigurements. A case series of this type with longer follow-ups will alleviate the limitations of this case report.

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