Tuesday, February 16, 2016
The patient is a 73-year-old semi-retired carpenter who presents for evaluation of lesions on his back and eyelids. Surprisingly, he did not mention his nose.
O/E: He has two epidermal inclusion cysts on the back some and some small skin tags around the right upper and lower lids (these lesions were snip excised).
More significantly, the skin of the distal nose it grossly thickened and patulous.
Diagnosis: Rhinophyma, Grade 3.
Although he did not initially express concerns regarding his nose, when I mentioned that there are treatments, the patient was very interested.
1. Basal cell carcinoma masked in rhinophyma.
De Seta D1, Russo FY, De Seta E, Filipo R. Case Rep Otolaryngol. 2013;2013:201024. Free Full Text.
2. Basal cell carcinoma and rhinophyma. Leyngold M et. al. Ann Plast Surg. 2008 Oct;61(4):410-2.
Abstract: Rhinophyma, the end stage in the development of acne rosacea, is characterized by sebaceous hyperplasia, fibrosis, follicular plugging, and telangiectasia. Although it is commonly considered a cosmetic problem, it can result in gross distortion of soft tissue and airway obstruction. Basal cell carcinoma (BCC) is a rare finding in patients with rhinophyma. The objective of this study is to review the literature of BCC in rhinophyma and report on a case. A 70-year-old male presented with long-standing rosacea that resulted in a gross nasal deformity. The patient suffered from chronic drainage and recurrent infections that failed conservative treatment with oral and topical antibiotics. The patient decided to proceed with surgical intervention and underwent tangential excision and dermabrasion in the operating room. Since 1955 there have been 11 cases reported in the literature. In our case, the pathology report noted that the specimen had an incidental finding of a completely resected BCC. The patient did well postoperatively and at follow-up remains tumor-free. Despite the uncommon occurrence of BCC in resection specimens for rhinophyma, we recommend that all specimens be reviewed by a pathologist. If BCC is detected, re-excision may be necessary and careful follow-up is mandatory. Larger studies would be needed to determine the correlation between the 2 conditions.