This paper documents a case report where a patient who was suffering from rhinphyma also had a basal cell carcinoma – a type of skin cancer. The skin cancer growth would normally have been obvious, but the rhinophyma growths made it difficult to diagnose. The paper warns that in the case of severe rhinophyma, biopsies may be required to confirm that skin cancer is not also present.
Basal cell carcinoma lurking within gross rhinophyma, Dennis John Mckenna, MBChB, Kevin Mckenna, MD, MBChB, Belfast City Hospital, Belfast, United Kingdom
A 77-year-old man with long-standing gross rhinophyma developed a 6- by 8-mm ulcerated nodular lesion on the right side of his nose. Such a lesion would normally have been clinically obvious when occurring on normal skin. However, given the soft tissue hypertrophy and general nodularity of the nose due to rhinophyma, it had not been initially apparent. He had been attending the dermatology clinic for treatment of his acne rosacea. He had also recently been assessed in plastic surgery for shave removal of the larger protuberant parts of the rhinophyma in an effort to improve the appearance of his nose. There was a history of severe ischemic heart disease. Surgery had therefore been cancelled because of concerns about unduly high anesthetic and surgical risks for this cosmetic procedure. The ulcerated nodule was only considered subsequently on close inspection as suspicious of being neoplastic. Diagnostic punch biopsy confirmed the presence of a nodular microcystic basal cell carcinoma. Despite development of quite a large basal cell carcinoma in a prominent location, the gross appearance of the nose had caused it to be initially overlooked.
Conclusion: The clinical photographs in this poster demonstrate the difficulty in diagnosing carcinoma in patients with gross rhinophyma. The distortion and soft tissue hypertrophy of gross rhinophyma make carcinomatous lesions more difficult to recognize clinically and early lesions may go unnoticed. We review the literature and show that opinion has been divided as to whether there is a causal association between rhinophyma and carcinoma. In theory a causal association might be explained by the chronic inflammation, hypertrophy, hyperplasia, and scarring which occurs in rhinophyma. There does not appear, however, to be definite proof that the two conditions do not occur together by chance.We are reminded that dual pathology can occur, and the importance of careful examination of the skin in rhinophyma for coincidental carcinoma and diagnostic biopsy of suspicious areas are emphasized by our case. We also discuss the best treatment options. Mohs micrographic surgery has been used in cases such as this when the surgical margins are difficult to define clinically. Alternatively, radiotherapy is an accepted treatment option for rhinophyma and for basal cell carcinoma and has successfully been used to treat both conditions when they occur together.
Author disclosure: Nothing disclosed at press time. Commercial support: None.
Poster Discussion Session P27, American Academy of Dermatology, 64th Annual Meeting, March 3-7 2006, San Francisco.
Supplement to Journal of The American Academy of Dermatology, March 2006, Volume 54, Number 3.
this is very interesting.