Case 1

CASE:
A 50-year-old man presents for evaluation of a lesion on the lateral canthus of his left eye. Recently, the lesion has started to bleed. The patient insists that the growth has been present since birth or early childhood and that it began to slowly increase in size throughout the past year. Family history is negative for skin cancer. Examination reveals a 1.2-cm reddish nodule with telangiectasias and central denudation. A biopsy is performed, and the patient is urged to check photographs from his youth to verify that the lesion was present during his childhood.

WHAT IS YOUR DIAGNOSIS?

Biopsy confirmed clinical suspicion of a nodular basal cell carcinoma. The patient returned for follow-up and admitted that a review of childhood photographs revealed no sign of the lesion. Basal cell carcinoma is the most common form of skin cancer; the majority of these tumors occur on the head and neck. Although the malignancy can arise during teenage years, such timing would be most unlikely. This case illustrates that at times, patients are inaccurate historians. The patient was referred to a plastic surgeon for definitive surgical removal.