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 63-year-old Hispanic man presented with an asymptomatic lesion on his left nasal bridge of nine months duration. The tumor appeared as an ulcerated plaque with black pigmentation; there were also red and flesh-colored areas (Figure ). There was no palpable neck lymphadenopathy. The clinical differential diagnosis included ulcerated 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 in two stages. A full thickness graft was used to treat the surgical wound. Follow-up after three months did not reveal any recurrence of the cancer.