Thursday, May 30, 2019
Infiltrating BCC of the Ala
The patient is a 58 yo man in fair health. He suffers from anxiety and depression as well as diabetes and coronary heart disease and is status past CABG. He was brought in by his female companion who noticed a lesion of the left ala.
O/E There is a nine mm indurated lesion with some surface erosion.
A 3 mm punch biopsy was difficult because of his severe agitation. The pathology showed a deeply infiltrating basal cell.
Given this patient’s pervasive anxieties, should one consider XRT over Mohs surgery? The latter might also cause some deformity and may require a complicated reconstruction. Of course, I will lay out the choices to the patient and his companion; but I thought this was a good question for our members to consider and weigh in on. Some great unknown medical sage said, “Sometimes, it is may be more important to treat the patient who has the lesion, than it is to simply treat the lesion the patient has.”