This 76 year old man presented with a right lower lid/upper cheek lesion that had been present for a few months. Initially it was a firm lump that did not cause him any concern. It started to bleed intermittently and then scab over, although he attributed this to minor trauma to the lesion. He had had previous benign cystic lesions of the temple and occipital area. On examination there is a large (23mm x 17mm) nodular lesion with an area of ulceration and telangiectasis (small irregular, ‘spidery’, surface blood vessels) on one part of it. Although the edges of the lesion are relatively clear, it does not look to be entirely distinct from the surrounding skin and gives an impression of merging with the healthy skin around it.
A biopsy of the lesion found it be a basal cell carcinoma (BCC). BCCs are skin cancers. They are malignant (invasive). They almost never metastasise (spread to other areas of the body, but if left untreated will steadily enlarge and can be invasive and destructive and cause significant morbidity and very occasionally even death.
The BCC was excised with a 4mm margin of normal of skin to ensure complete excision. This entails removal of much of the lower lid and cheek and therefore the defect requires reconstruction with a cheek rotation flap (rotating skin from the cheek into the defect) in order to avoid lower lid retraction or ectropion.