Title : Recurrence of basal cell carcinoma (bcc) with narrow margin in nasal tip: A case report
Abstract:
Basal cell carcinoma (BCC) is considered the most prevalent malignant neoplasm worldwide. Despite its high prevalence, CBC has favorable characteristics for its treatment and can be treated with surgical excision of lesions. Surgical excision has been shown to be effective in the treatment of most basal cell carcinomas, being one of the most used therapeutic forms currently. However, even when tumor lesions are excised properly, compromised histological margins may occur. The management of basal cell carcinomas with positive margins is still a discussion in the literature, where there is the dilemma between performing a surgical enlargement of the lesion immediately or opting for the observation of these patients, reserving treatment in case of clinical recurrence. In this report, we observed an elderly patient of 72 years in a Brazil public hospital with the diagnosis of recurrent CBC after surgical excision with a narrow margin, in which it was chosen to follow the lesion ambulatory until the moment of clinical recurrence. At first, the patient reported a nose lesion for approximately 05 years that presented frequent bleeding, already performed local cryotherapy procedures previously, without success. On physical examination, exulcerated papule was observed in the region of the nasal dorsum to the left of 01cm of pearlescent border, with a diagnostic hypothesis of pigmented CBC. Surgery was scheduled for excision of the lesion. After three months of surgery, the patient returned with anatomopathological results, which showed ulcerated CBC (nasal tip), with narrow margins and physical examination of the scar of the lesion showed, by dermatoscopy, arboriform vascular patterns. The diagnostic hypothesis was recurrent CBC and the chosen procedure was conservative, asking the patient to return in 03 months to reevaluate the lesion. After 03 months, the patient returned with the complaint of pruritus in right temporal scar injury and the appearance of gallbladder in nasal tip. On physical examination: CBC recurrence in nasal tip - discrete atrophic plaque erythematosus with telangiectasias on the surface. After the physical examination, surgery was scheduled and the lesion excised. With this case, the need for oncological follow-up of all patients after surgical excision of the lesions was evidenced, besides making explicit the importance of carefully monitoring and observing lesions of CBCs of compromised margins, since they tend to have a higher chance of recurrence. The individualized evaluation of each patient in choosing the best management against basal cell carcinoma with positive margins is the way to further reduce the rates of recurrence of these tumors, reserving surgical reintervention for the most aggressive cases.
