A 74-year-old Hispanic woman presented with an asymptomatic lesion of one-year duration on the nasal tip. Clinical examination showed a nodular tumor; in addition to being black, there was ulceration (Figures -). There was no palpable neck lymphadenopathy. Morphologically, the clinical differential diagnosis included malignant melanoma.\nA biopsy was performed. Microscopic examination showed nodular aggregates of basaloid tumor cells extending from the epidermis into the dermis. There was pigment not only in the tumor cells but also within the melanophages in the adjacent dermis. Correlation of the clinical presentation and pathology established the diagnosis of pigmented nodular basal cell carcinoma.\nMohs surgery was performed. The tumor was cleared after three stages. A left paramedian forehead flap was performed to treat the surgical wound. Follow-up three months later showed excellent healing without recurrence of the skin cancer. However, there was significant hypertrichosis involving the tissue flap on the nasal tip (Figures -). This was remedied by using electrolysis to eliminate the hair.
A 74-year-old female presented for a complete skin examination in May 2016. She had a history of actinic keratoses and five basal cell carcinomas. There were several new skin lesions since her last visit six months earlier.\nShe also had a previous mantle cell lymphoma. In February 2015, she had achieved a clinical remission after receiving three cycles of Rituxan and Treanda that was followed by an autologous stem cell transplant in April 2015. She also has a past medical history of diabetes mellitus (controlled with diet), obstructive sleep apnea (treated with continuous positive airway pressure therapy) and a recent deep vein thrombosis (that is currently being treated with Coumadin).\nThe cutaneous examination was remarkable for four erythematous scaling plaques on her arms and back, consistent clinically with actinic keratoses. She had three red plaques, each approximately 6 x 4 mm, on her right upper central back, right upper mid back and right hip (Figure ). In addition, she had a 2 x 2 mm red dot within a 7 x 9 mm area of erythema on her left mid back (Figures -); the lesion blanched when pressed with a glass microscope slide (Figure ).\nThe actinic keratoses were treated with liquid nitrogen cryotherapy. The back lesions were each biopsied using a shave technique. The red dot on the left mid back showed superficial buds and nodular aggregates of basaloid tumor cells extending from the epidermis into the dermis; there were also telangiectatic blood vessels in the papillary dermis (Figures -). The other back lesions and right hip lesion also showed similar appearing tumor cells along the basal layer of the epidermis and in the superficial dermis.\nCorrelation of the clinical presentation and pathologic findings of the left mid back lesion was a red dot basal cell carcinoma (with superficial and nodular tumor aggregates). The tumor was excised using the Mohs technique. Only one stage was required for cancer removal; the size of the defect was 15 x 11 mm. A complex layered closure was used to repair the surgical wound.\nThe three superficial and nodular basal cell carcinomas on the right back and right hip were also subsequently excised using the Mohs technique; the surgical wounds were closed with complex layered closures. Follow-up examination six months later showed excellent healing of the four surgical sites and no evidence of recurrence.