Complex Management of Basal Cell Carcinoma in a Frail Patient

Abstract

Basal cell carcinoma (BCC) is one of the most common cancers diagnosed in older patients and has low mortality. Surgical versus medical management is considered in patients with multiple comorbidities and limited life expectancy (LLE), where the risk-to-benefit ratio must be carefully assessed. Watchful waiting (WW) is a viable option for some patients with severe LLE when follow-up care can be provided vigilantly and frequently. Special consideration should be given to morbidity factors such as tumor growth, bleeding, pain, and social withdrawal that negatively affect the quality of life. We present the case of a 75-year-old male with a past medical history of multiple system atrophy, who presented with a BCC on the ear and face. We discuss the management of this patient and factors that may have led to the inappropriate use of WW.

Keywords: basal cell carcinoma (bcc); dermato-oncology; dermato-surgery; mohs surgery; watchful waiting.

Figure 1. Initial presentation of basal cell carcinoma of the right ear

Figure 2. Healing defect at two weeks post-Mohs

Figure 3. Recurrence of basal cell carcinoma at six-month follow-up