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Case Reports
. 2025 Jun:131:111333.
doi: 10.1016/j.ijscr.2025.111333. Epub 2025 Apr 21.

Diagnosis of a locally aggressive basal cell carcinoma in an uncommon location: The nasal vestibule - A case report

Reza Kaboodkhani  1 , Sajjad Soltani  2 , Shayan Yousufzai  3 , Negar Fatehi  2 , Mahsan Nadgaran  2 , Alireza Yousefi  4
Affiliations
Case Reports

Diagnosis of a locally aggressive basal cell carcinoma in an uncommon location: The nasal vestibule - A case report

Reza Kaboodkhani et al. Int J Surg Case Rep. 2025 Jun.

Abstract

Background: BCC (BCC) is the most common form of nonmelanocytic skin cancer, particularly prevalent in sun-exposed areas like the head and neck. BCC in the nasal vestibule is rare, with an incidence of only 0.01 %. This case report examines the clinical presentation and management of BCC in this unusual location.

Case presentation: A 65-year-old male with no significant medical history presented with a two-year history of a mass sensation in the left nasal vestibule, accompanied by recurrent epistaxis. Examination revealed a firm, rubbery, and ulcerated 1 cm mass. Histopathologic findings confirmed Micronodular BCC, leading to surgical excision and reconstruction using posterior auricular skin. Despite successful removal, pathological analysis showed positive margins, necessitating careful follow-up.

Discussion: The report discusses the rising global incidence of BCC due to increased solar exposure and an aging population, with 80 % of cases occurring in the head and neck. While the nasal tip and upper lateral surface are common sites, BCC in the nasal vestibule is exceedingly rare. Differential diagnoses include various premalignant and malignant conditions. Surgical excision with adequate margins is the preferred treatment, alongside options like topical agents and Mohs micrographic surgery for less advanced cases. The challenges of tissue reconstruction post-excision are addressed, recommending total skin grafts or specific flaps depending on tissue loss.

Conclusion: This report highlights the rarity and clinical significance of BCC in the nasal vestibule, advocating for increased awareness among healthcare professionals regarding atypical skin cancer presentations and emphasizing the importance of early detection and management.

Keywords: BCC; ENT; Nasal vestibule; Surgical oncology.

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Conflict of interest statement

Declaration of competing interest The authors declare no competing interest.

Figures

Fig. 1
Fig. 1
a and b. Illustrates The neoplastic infiltrate observed in basaloid squamous cell carcinoma (BSCC) is primarily characterized by the presence of basaloid cells, which exhibit pleomorphic and hyperchromatic nuclei, an elevated nuclear-to-cytoplasmic ratio, and heightened mitotic activity. This includes atypical mitoses and nuclear palisading at the periphery of the neoplastic lobule, notably without accompanying stromal retraction. Furthermore, a distinctive feature of BSCC is the occurrence of comedonecrosis within the central regions of the neoplastic lobules. Additionally, this area demonstrates pronounced cytoplasmic alterations.
Fig. 2
Fig. 2
Demonstrates the successful resection of the tumor with the absence of recurrence within a follow-up period of three months.
See this image and copyright information in PMC

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