Pigmented basal cell carcinoma in an old man treated with surgical excision and flap reconstruction: a case report

Abstract

Background: Basal cell carcinoma (BCC) stands as the prevailing form of malignancy, and its prevalence is on the rise. While BCC carries a minimal risk of mortality, it can induce notable morbidity, chiefly due to localized damage. The incidence of BCC increases significantly after the age of 40 years, especially in women who are caused by exposure to ultraviolet (UV) rays. There are a variety of surgical and non-surgical treatments for BCC. In general, surgical methods are used more frequently because of their higher cure rates. We are reporting a case of pigmented basal cell carcinoma in an old Asian man who was treated with surgical excision with wound reconstruction using flap surgery.  Case Report: A 70-year-old man sought consultation at the Dermatology and Venereology outpatient clinic of Dr. Soetomo Regional Public Hospital. His main complaint was a wound on his forehead from two years ago. Initially, it appeared as a small lump with skin color. Over time, the lump got bigger and then turned into a wound that got wider. He also felt pain and itchy on the wound. For the past year, the wound had become easily bleeding. Dermatological examination revealed an ulcer with a clean base, not sharply marginated, asymmetry, and a size of 1,8 x 1,6 cm, with a rolled-up margin and an elevated edge. There was a translucent hyperpigmented nodule on the edges and a sign of bleeding in the center of the ulcer. A dermoscopy examination showed a blue-gray ovoid nest, shiny white structureless area, arborizing vessels, and ulceration. Histopathological results from both biopsies showed the proliferation of anaplastic basal cells was a monotonous rounded nucleus, coarse chromatin, several prominent nuclei, and narrow cytoplasm to moderately that partially contained melanin. The patient was diagnosed with Pigmented BCC. The treatment plan was to use surgical excision with advancement flap reconstruction. Postoperative lesions showed improvement and healed after three weeks post-surgery. Conclusion: The management of BCC is determined based on the anatomical location and histological features. Widely used therapeutic approaches such as standard excision surgery or other invasive methods are significant therapeutic options.