Document Type : Images in clinical practice
Author
Department of Dermatology, Al-Ramadi Teaching Hospital, Anbar Health Directorate, Anbar, Iraq
Abstract
A 39-years-old man was presented to the Dermatology clinic complaining of a crusted ulcer on the nose 5 years ago (Panel A). The lesion was treated many times as a case of cutaneous leishmaniasis. Previously, at the age of 16 years, the patient has recalled that he had the same lesion at that site which has been treated and disappeared. On examination, the crusted ulcer was located on the distal part of the dorsum and tip of the nose, about 3cm by 2cm with an irregular and elevated edge. It was covered by a brownish and honey-colored dry crust that adherent to the ulcer. A biopsy under local anesthesia was done and the histopathological examination was showed a basal cell carcinoma (BCC), mostly infiltrative type (Panel B, H/E stain 4X) and (Panel C, H/E stain 10X). BCC is the most common cancer in humans and the second one that occurs in the scar tissue. Sunlight exposure is the main predisposing factor in addition to genetic disorders, immunosuppression, and scar tissue. The face is the most affected site, particularly the nose. BCC is locally destructive and rarely metastasized. We think that a minimal scar that might be resulted from the previous infection, which was most probably cutaneous leishmaniasis, in addition to sunlight exposure contributes to the appearance of the BCC. The patient was referred to a plastic surgeon for further management.
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