CASE REPORT Superficial Spreading Basal Cell Carcinoma of the Face: A Surgical Challenge

Abstract

Objective: We present the case of a white man with a facial nodule suspicious for basal cell carcinoma.

Methods: Biopsy revealed clusters of basaloid tumor cells with peripheral palisading, consistent with a superficial spreading variant of basal cell carcinoma.

Results: The patient was treated with Mohs micrographic surgery, with clear margins achieved after the second stage of excision. However, since it was a superficial spreading basal cell carcinoma, this was followed by topical imiquimod treatment.

Conclusion: Topical chemotherapy with imiquimod or 5-fluorouracil may be valuable alternatives or adjuncts, given the increased likelihood of recurrence after surgical excision of superficial spreading basal cell carcinoma. Mohs surgery is of limited value in the management of superficial spreading basal cell carcinoma because it characteristically shows areas of uninvolved skin between tumor nests.

Figure 1

Superficial spreading basal cell carcinoma. A “skip region” can be seen between two nests of tumor cells at the dermal-epidermal junction. Solar elastosis is also evident. (H&E, original magnification ×10).

Figure 2

Superficial spreading basal cell carcinoma. A cluster of basaloid tumor cells budding downward from the basal cell layer, limited to the dermal-epidermal junction, is visible here. It is flanked on both sides by tumor-free tissue. (H&E, original magnification ×40).

Figure 3

Superficial spreading basal cell carcinoma. These basaloid tumor cells demonstrate hyperchromatism with uniform nuclei and peripheral palisading, but cleft-like spaces are not seen around the nodule. (H&E, original magnification ×40).