Unusual Presentation of Pigmented Basal Cell Carcinoma of Face: Surgical Challenge.

Abstract

A 55-year-old man reported with the chief complaint of black pigmented mass on right side of the face. The patient initially noticed the lesion two years back, gradually increasing in size. Patient’s family and medical history was non-contributory. Personal history revealed that he smoked one packet of bidi per day since 20 years. Patient was a farmer by occupation. On extra oral examination, irregular rectangular dark brown mass was present on right side of the face extending medially up to the lateral wall of nose and superiorly up to the infra-orbital region 5mm below the lower eyelid, and medially the mass was extending up to the medial canthus of right eye measuring around 5 X 4cm in size with well defined borders [Table/Fig-1]. On palpation, it was non-tender, non-fixed, non indurated and firm in consistency. Adjacent skin was normal with no lymphadenopathy. Based on history and clinical examination, provisional diagnosis of Basal Cell Carcinoma (BCC) was given. An incisional biopsy was done, and specimen was sent for Histopathological Examination (HPE) [Table/Fig-2]. The lesion was excised with wide local resection with 4-5 mm lateral and deep margins under general anesthesia and the raw area created was covered by Limberg Flap [Table/Fig-3,​,4].4]. Patient was followed up after 10 days and the flap was found healthy [Table/Fig-5]. Specimen was sent for HPE which revealed Pigmented BCC (PBCC) [Table/Fig-6].