Problem:
Possible recurrence of basal cell carcinoma, left cheek. Hx of Present Illness: Patient is a 74 y/o male first seen by his regular physician 5 years ago for persistent facial lesions. Biopsies revealed basal cell carcinoma in two lesions, one on the nasal tip and the other on the left cheek. These were successfully excised. The patient noted that the left cheek lesion returned approximately one year ago. Patient reports pruritus and states the lesion is growing larger. Results of Physical Exam: Examination revealed a 10x14 mm lesion on left cheek 20 mm anterior to the ear. The lesion displays marked erythema and poorly defined borders. The area immediately around the lesion shows depigmentation with vesicles. Assessment: Recurrence of basal cell carcinoma. Recommendations: Due to the lesion's size, shape, and reoccurrence, deep excision of the carcinoma through the epidermis and dermis layers followed by dermatoplasty is recommended.