Journal of Cutaneous and Aesthetic Surgery
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CORRESPONDENCE  
Year : 2020  |  Volume : 13  |  Issue : 2  |  Page : 181-182
Basal cell carcinoma camouflaged by rhinophyma


Department of Dermatology and Venereology, Hospital Garcia de Orta, Almada, Portugal

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Date of Web Publication20-Jun-2020
 

How to cite this article:
Costin A, Goulão J. Basal cell carcinoma camouflaged by rhinophyma. J Cutan Aesthet Surg 2020;13:181-2

How to cite this URL:
Costin A, Goulão J. Basal cell carcinoma camouflaged by rhinophyma. J Cutan Aesthet Surg [serial online] 2020 [cited 2020 Jul 3];13:181-2. Available from: http://www.jcasonline.com/text.asp?2020/13/2/181/287314




Dear Editor,

Rhinophyma is a rare and progressively disfiguring condition, characterized by sebaceous hyperplasia and fibrous tissue proliferation.[1] In its extreme form, it may cause nasal airway obstruction and hide malignancies, in addition to the cosmetic and emotional concerns.

An 87-year-old man, with a long-standing history of rosacea, presented with exuberant rhinophyma on the tip of the nose. A closer look disclosed a small crusted papule on the right ala [Figure 1]. The clinical differential diagnosis included phimatous nodule, basal cell carcinoma, or adnexal tumors.
Figure 1: Exuberant rhinophyma with an eroded nodule on the right ala before and after electro-rhinosculpture

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To achieve negative margins and plan the reconstructive approach, we first performed an electro-rhinosculpture. After anesthesia with injection of 2% lidocaine with 1:100,000 epinephrine, the phimatous nodules were excised with a loop tip of electrosurgical device in cutting mode, thus allowing to remove the excess tissue in smooth planes while providing simultaneous hemostasis. Mechanical dermabrasion followed using the cautery tip polisher in order to soften the nasal contours into the desired appearance [Figure 1]. Additional hemostasis was performed with electrocoagulation. We then performed a dressing with metronidazole cream and Surgicel.

In a deferred time, we performed tumor excision and reconstructed the surgical defect using a bilobed flap [Figure 2] and [Figure 3].
Figure 2: Reconstruction with a bilobed flap after excision of basal cell carcinoma

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,
Figure 3: Reconstruction with a bilobed flap after excision of basal cell carcinoma

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At 4-week follow-up, the patient had normal nasal contour, with excellent functional and cosmetic result [Figure 4]. There was no significant scarring on our patient. To avoid scarring, excision should not be below the depth of the pilosebaceous unit, which would result in atrophy rather than porous nasal skin.
Figure 4: Four weeks after treatment

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To the best of our knowledge, there are a few reports of an association between rhinophyma and basal cell carcinoma.[2] It is important to acknowledge this as the surgeon should be alert to the presence of malignancy in atypical or rapidly enlarging rhinophyma in order to guarantee the best treatment approach.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Two AM, Wu W, Gallo RL, Hata TR. Rosacea. Part I: Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol 2015;72:749-58; quiz 759-60.  Back to cited text no. 1
    
2.
Keefe M, Wakeel RA, McBride DI. Basal cell carcinoma mimicking rhinophyma: Case report and literature review. Arch Dermatol 1988;124:1077-9.  Back to cited text no. 2
    

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Correspondence Address:
Adelina Costin
Department of Dermatology and Venereology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada.
Portugal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCAS.JCAS_34_19

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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