No significant pathologies in the patient’s medical history.

The patient has always had regular blood chemistry tests, as she donates blood to AVIS.

On March 5, 2008 the patient underwent surgery as an outpatient for the removal of a suspected basocellular epithelioma at the base of her nose on the right hand side. She had had this lesion for two years and it was rapidly growing. Following surgery, only Colbiocin ophthalmic cream was prescribed for the eyelid region.

The histology diagnosis was as follows:

“Basocellular carcinoma.

Depth of maximum tumor infiltration: 2 mm.

Expanding type of invading tumor front.

There is no direct cancer proliferation involvement of the surgical resection margins.”

The patient had her sutures removed from her face on March 13, 2008 and at that session, the lesion did not display any signs of phlogosis.

The patient’s husband reports not having received appropriate information about postsurgical care and any follow-up or therapy requirements.

A follow-up appointment has been made for July 24, 2008.

Questions:

1) Is a follow-up required in this case? If so, what does this involve and how long will it last?

2) What is the risk of local or remote relapses? What is the expected prognosis?

3) Are there any further treatments that can be carried out in addition to surgery to reduce the risk of such relapse?

Second medical opinion report 

This 62-year-old female has had a basal cell carcinoma excised from the right side of her nose. The summary indicates that on pathology examination, the tissue edges were not involved with tumor.

Basal cell carcinoma is the most common form of cancer occurring in the United States and the nose is a typical location. This type of tumor very rarely metastasizes so local invasion is the main problem (by direct extension). Recurrence after excisional surgery with narrow margins (typically 3 mm) is approximately 5%. Local recurrences can usually be successfully treated with microscopically controlled surgery (Mohs). Once one has had 1 skin cancer, one is at elevated risk for a totally new skin cancer at some other (usually sun exposed) site.

Questions:

1) Patient should receive follow-up with total body skin exams at 6-12 month intervals looking clinically for local recurrence and new primary tumors. This usually takes about 10-minutes/office visit and should be done for life.

2) Risk of local recurrence (at the scar site) is 5%. Risk of remote relapses (metastasis) is near zero. Her prognosis is excellent. There should be no reduction in her life expectancy from this tumor.

3) There are no additional treatments needed at this time as long as the surgical removal margins are adequate.

Reference: Neel VA, SoberAJ. Other Skin Cancers. Holland.Frei. Cancer Medicine, 6th ed. BC Decker. Hamilton. 1997-2013, 2003