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Teachable Moment
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November 2017

Basal Cell Carcinoma in an Elderly Man

Author Affiliations
  • 1Internal Medicine Residency Training Program, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri
JAMA Intern Med. 2017;177(11):1672. doi:10.1001/jamainternmed.2017.4006

A robust man in his 90s, who was active and living independently, presented to a dermatologist’s office after a punch biopsy specimen of an asymptomatic mass he noticed on his left cheek revealed basal cell carcinoma (BCC). Examination of the mass showed a 1.5 × 2.0-cm crusted plaque on the left marionette line. Without a discussion with his physician regarding alternative treatment options, he underwent Mohs micrographic surgery 7 weeks later, which confirmed a micronodular BCC. After a 3-stage surgery, the patient was left with a 4.5 × 5.7-cm defect with resection of most of the buccinator muscle and a partial laceration of the parotid gland. After each stage, the patient was given the option to stop the procedure. Each time, he opted to continue in hopes for a cure. He was sent home with an otolaryngology follow-up. Given the large facial defect and complications from Mohs surgery, he subsequently had another operation for further removal of positive tissue margins, parotid duct laceration repair, and cervicofacial flap reconstruction.

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