A 71-year-old male presented for a complete skin examination in November 2016. He had a history of actinic keratoses, a basal cell carcinoma, and a squamous cell carcinoma. He had new skin lesions on his nose.\nHis past medical history was significant for hyperlipidemia (treated with simvastatin) and coronary artery disease (and currently receiving clopidogrel).\nThe cutaneous examination was remarkable for 11 erythematous scaling plaques on his face and arms, consistent clinically with actinic keratoses. There is a 1 x 1 mm red dot surrounded by a 2 x 2 mm flesh-colored papule on his left nostril (Figures -). The lesion did not blanch when pressed with a glass microscope slide (Figure ).\nThe actinic keratoses were treated with liquid nitrogen cryotherapy. The lesion on his left nostril was biopsied using the shave technique. Microscopic examination of the lesion showed nodular aggregates of basaloid tumor cells extended from the adjacent epidermis into the dermis. There were also telangiectatic blood vessels in the papillary dermis (Figures -).\nCorrelation of the clinical presentation and pathologic findings of the nasal tip lesion was a red dot basal cell carcinoma (with nodular tumor aggregates). Excision of the tumor using the Mohs technique is planned.
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.