Diagnosis of a locally aggressive basal cell carcinoma in an uncommon location: The nasal vestibule - A case report.

BACKGROUND

BCC (BCC) is the most common form of nonmelanocytic skin cancer, particularly prevalent in sun-exposed areas like the head and neck. BCC in the nasal vestibule is rare, with an incidence of only 0.01 %. This case report examines the clinical presentation and management of BCC in this unusual location.

CASE PRESENTATION

A 65-year-old male with no significant medical history presented with a two-year history of a mass sensation in the left nasal vestibule, accompanied by recurrent epistaxis. Examination revealed a firm, rubbery, and ulcerated 1 cm mass. Histopathologic findings confirmed Micronodular BCC, leading to surgical excision and reconstruction using posterior auricular skin. Despite successful removal, pathological analysis showed positive margins, necessitating careful follow-up.

DISCUSSION

The report discusses the rising global incidence of BCC due to increased solar exposure and an aging population, with 80 % of cases occurring in the head and neck. While the nasal tip and upper lateral surface are common sites, BCC in the nasal vestibule is exceedingly rare. Differential diagnoses include various premalignant and malignant conditions. Surgical excision with adequate margins is the preferred treatment, alongside options like topical agents and Mohs micrographic surgery for less advanced cases. The challenges of tissue reconstruction post-excision are addressed, recommending total skin grafts or specific flaps depending on tissue loss.

CONCLUSION

This report highlights the rarity and clinical significance of BCC in the nasal vestibule, advocating for increased awareness among healthcare professionals regarding atypical skin cancer presentations and emphasizing the importance of early detection and management.