SURGERY CASE PRESENTATION

Basal cell carcinoma of face

Nasreen Sabana M
• A 66 year old female Mrs. Anthoniyammal ,
coming from agaram , housewife , came to
GVMCH OPD with chief complaints of ulcer in
the Left cheek for past 6 years
 HISTORY OF PRESENTING ILLNESS

• The patient was apparently Normal before 6 years,

then she developed a nodule in left cheek , which
later ulcerated, was gradual in onset , initially small
in size , slowly progressed to attain the current size
• No H/O pain, discharge, bleeding
• No H/O loss of sensation
No H/O trauma
• No H/O radiation exposure
• No H/O contact with arsenic, tar
• No H/O itching
• No H/O suggestive of metastasis
 PAST HISTORY

No H/O similar illness in the past

Not a known case of DM,HTN,CAD,Asthma,
TB, Epilepsy,CKD
No previous surgeries in past
• No H/O drug allergy
 PERSONAL HISTORY

• Patient consumes mixed diet

 MENSTRUAL AND OBSTETRIC
HISTORY

• Age at menarche : 12
• Regular cycle once in 30 days
• Flow for 5 days
• Age at menopause : 46
• Obstetric score : P2L2
 GENERAL EXAMINATION

Patient conscious, oriented,moderately built and moderately

nourished
• Afebrile
• No pallor
• Not icteric
• No cyanosis,no clubbing
• No pedal odema
• No generalised lymphadenopathy
 VITALS

• Bp :110/80mm Hg
• pulse rate :72/min
• Respiratory rate :14/min
 LOCAL EXAMINATION

• Consent was obtained from the patient

• Patient examined in a well lit room
• INSPECTION:
• An ulcer is present in the left naso labial fold of
• Size : 1*1* cm and 0.3 cm in depth
• Shape-Bean shaped,
• Extent – 2 cm away from the tip of the nose , 10 cm
away from the ramus of mandible
Edge – raised and beaded
• Floor of the ulcer is covered with
unhealthy granulation tissue
• Margin – well defined
• Hyperpigmentation In the margin
present
• No other swelling / ulcers
elsewhere
 PALPATION

Inspectory findings are confirmed by palpation

An ulcer of size 1*1 cm over left cheek
• No warmth, No tenderness
• Bleed on touch
• firm in consistency,
• Raised and beaded edges
• well defined margins
• Base indurated – base muscle
present
• Induration present at the margin ,
extending 2mm into the
surrounding areas
• No other ulcers/swelling elsewhere
• No palpable lymph nodes
 PROVISIONAL DIAGNOSIS

A case of basal cell carcinoma over

the left naso labial fold
Staging: T1 N0 M0
STAGE 1
 INVESTIGATION

SPECIFIC INVESTIGATION
Edge wedge biopsy
X ray skull
Metastatic workup
• ROUTINE INVESTIGATION
• Complete hemogram, chest X ray
• ECG , Urine albumin and sugar
 TREATMENT

• WIDE LOCAL EXCISION of

ulcer with 4_6 mm clearance and
Skin flap cover
 DIFFERENTIAL DIAGNOSIS

• SQUAMOUS CELL
CARCINOMA
• KERATOACANTHOMA
• SEBORRHEIC KERATOSIS