askaderm.net

1. A case of BCC
Presented By:
Dr Hasan Khalaf

2.  87 year old male
 DM
 HTN
 IHD
 Mild renal impairment
 Hypertension
Presented with a 15 years history of a neglected facial ulcer.
He was referred several times to dermatology but missed his
appointments.

5.  A 4 mm punch biopsy biopsy was taken from the ulcer
under local anesthesia

9.  Immunohistochemistry was positive for
 BCL2
 BerEP4
 CK 5 and 6
 P63

10.  Histopathologic diagnosis:
Basosquamous BCC (high risk subtype)

11.  CT scan for neck, chest, abdomen and pelvis
showed no lymphedenopathy

12. Case was referred to Plastic Surgery.
The defect was reconstructed with a cheek rotation flap for the
lower eyelid area and a nasolabial VY advancement flap for the
medial canthal area.

14.  Histopathology report
• Histopatholigical subtype: Basosquamous BCC
• Level of invasion: Extradermal, muscle
• Margins: Lateral and superior margins are
• involved, medial and inferior margins are more
• Than 5 mm away from the tumor.
• TNM: T2

16.  Tumor was removed but still has positive margins.
 Patient is a poor candidate for surgery.

17. Case was discussed with oncology depatment and the most
appropriate next step was to order Vismodegib for the
patient.

19. Could it have been possible to minimize size of tumor before
surgery?

20. Thank You!
Dr Hasan Khalaf