Basal cell carcinoma. A case of longstanding neglect and a case of early detection.

The early detection and referral of a small basal cell carcinoma of the face will prevent extensive surgical excision and repair necessary for a neglected lesion. Since these tumors occur in the older population, careful examination of the skin should be performed on patients 50 years of age and older. This cancer has been estimated to constitute 90% of all malignant lid tumors and a suspicious lesion on the lid should be considered a basal cell carcinoma until proven otherwise. The lesion has a very characteristic appearance as described in the text; however, they can present with an atypical picture. An important sign in the evaluation of a possible malignant lid tumor is the loss of eyelashes within or adjacent to the lesion, which indicates the destructive nature of the tumor to the hair follicles. Basal cell carcinomas do not metastasize to distant locations in the body but rather extend locally and can produce deep tissue invasion. Differential diagnosis can present problems to the clinician but the definitive diagnosis is dependent upon the pathologist. The treatment usually requires surgical removal with wide excisional margins; however, other forms of treatment have been attempted. Recurrences of basal cell carcinomas are not uncommon, especially following an initial recurrence and it is mandatory that these patients be re-examined at least every six months for a two year follow-up period.