A 70-year-old male presented for a complete skin examination in July 2016. He had a history of actinic keratoses (AK) and three basal cell carcinomas. He had new skin lesions on his nose and back.\nHis past medical history is significant for benign paroxysmal positional vertigo (BPPV), hyperlipidemia (treated with atorvastatin), gout (treated with allopurinol), nephrolithiasis and recent stenting of his right coronary artery one month ago and currently receiving (clop nephrolithiasis dogrel).\nThe cutaneous examination was remarkable for 22 erythematous scaling plaques on his scalp, face, and arms, consistent clinically with actinic keratoses. He had yellow longitudinal streaks on his left great and fifth toe, consistent with onychomycosis. On his nasal tip, there was a 3 x 3 mm pearly-colored papule with a red dot of less than 1 mm in the center (Figures -). In addition, there was a 1 x 1 mm black macule with an adjacent 6 x 6 mm white plaque on his upper mid back (Figures -).\nThe actinic keratoses were treated with liquid nitrogen cryotherapy and the patient declined treatment for his toenail fungal infection. The back and nose lesions were each biopsied using a punch and shave technique, respectively. The nasal tip lesion red dot 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 upper mid back lesion showed an atypical proliferation of basaloid cells both emanating from the epidermis as oblong clusters and as discrete nests in the dermis; focally, some of the basaloid cells harbored cytoplasmic melanin pigment.\nCorrelation of the clinical presentation and pathologic findings of the nasal tip lesion was a red dot basal cell carcinoma (with superficial and nodular tumor aggregates). The tumor was excised using the Mohs technique. Two stages were required for cancer removal; the size of the defect was 11 x 10 mm. A full-thickness skin graft was used to repair the surgical wound.\nThe pigmented superficial and nodular basal cell carcinoma on his upper mid back was excised and the surgical wounds were closed with complex layered closure. Follow-up examination five months later showed excellent healing of both surgical sites and no evidence of recurrence.
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.