Basal Cell Carcinoma

Review Case: Basal Cell Carcinoma
Answer the questions in paragraph form in a discussion paper, 350 word minimum, APA format.
Be sure to include a title page. One reference is required

PATIENT CASE: Basal Cell Carcinoma
Patients Chief Complaints This lump on my face is getting bigger . . . and sometimes it bleeds.
History of Present Illness: Mr. N.S. is a 49 yo white male, who was referred to the dermatology clinic by his PCP
after complaining of a slowly growing lesion overlying his right cheekbone. He first noticed the abnormal growth
approximately five months ago, but just recently became aware that it was increasing in size. He states that the
growth bleeds occasionally after he has showered and dried his face with a towel.
Past Medical History Tonsillectomy, age 6 years Appendectomy complicated with infection, age 10
Duodenal ulcer, age 44, resolved with pharmacotherapy, no recurrence Hernia repair, age 45 HTN diagnosed
2 years ago
Family History Mother alive and healthy at age 71 Father died from cardiac arrest at age 56 Brother alive
and well at age 46 Maternal grandparents may have had CAD Two daughters, ages 23 and 26, are in good
health No known history of cancer or chronic skin conditions
Social History Has worked full-time as a roofer for 19 years Hobbies include gardening, fishing, and working
out with weights at the gym History of several blistering sunburns as a child and chronic exposure to the sun
with daily sunbathing as a young man Lives with wife of 29 years Smoked 1 23 4 pack of cigarettes/day for
25 years but quit 8 years ago Drinks several beers on Friday-Saturday evenings Denies current IV drug use
although he has snorted heroin in the past
Review of Systems No changes in vision or hearing No headaches, cough, fevers, chills, night sweats, nausea,
or vomiting No changes in bowel or bladder habits Denies weakness, tiredness, shortness of breath, bruising
tendencies, and chest pain
Allergies Aspirin (diarrhea) Penicillin (skin rash as a child)
Medications Nifedipine XL 60 mg po QD
Patient Case Question 1. Why is this patient taking nifedipine? Patient Case Question 2. Explain why
nifedipine is effective for the condition that you cited for Question 1?
Physical Examination and Laboratory Tests General
The patient is a well-developed, well-nourished, muscular, middle-aged white male with blue eyes and blond
hair. He is of Scandinavian heritage. He is both alert and interactive. Vital Signs See Patient Case Table 82.1
Patient Case Table 82.1 Vital Signs BP 125/80 RR 15 and unlabored HT 510 P 65 and regular T 98.8F WT 180 lbs
Patient Case Question 3. Including body mass index, should any of this patients vital signs be a cause for
concern?
Patient Case Question 4. Identify a minimum of four significant risk factors for basal cell carcinoma for this
patient.

Skin Warm and dry, but aged and poorly resilient from years of sun exposure Dark summer tan No signs of
nevi, rash, ecchymoses, or petechiae 1.5-cm waxy, flesh-colored papule on the right cheek with some erosion
centrally; telangiectases obvious upon close inspection; no pigmentation, erythema, or scar-like properties

Patient Case Question 5. Based on the gross appearance of the neoplasm, which type of basal cell carcinoma
does this patient probably have?
Head, Eyes, Ears, Nose, and Throat Male pattern baldness Pupils equal at 3 mm, round, reactive to
light/accommodation EOMI Sclera anicteric TMs clear No sinus drainage or tenderness Throat without
lesions or erythema Oral mucosa moist and intact
Neck and Lymph Nodes Supple and non-tender No lymphadenopathy Thyroid without masses No carotid
bruits auscultated
Lungs CTA bilaterally without wheezes or crackles
Cardiovascular RRR Normal S1 and S2 No m/r/g No JVD
Abdomen Soft and non-tender (+) BS No rebound, guarding, or distension No HSM
Rectum Normal sphincter tone (-) heme Prostate normal size without nodules
Musculoskeletal and Extremities No CCE Femoral pulses 2 bilaterally No joint deformities ROM and
muscle strength symmetric throughout No pain elicited with palpation
Neurologic A & O x 3 CNs IIXII intact Fixes and follows well with conjugate eye movements Hearing
appears normal DTRs 2 and symmetric throughout Cerebellar function intact (gait steady) Sensory levels
grossly intact 5/5 motor strength throughout Facial strength appears symmetric and normal Babinski
downgoing bilaterally
Patient Case Question 6. Other than the solitary neoplasm on the face, are there any other clinical findings in
the physical examination that should raise concern?
Biopsy Results Cells have large, uniform, oval, hyperchromatic, relatively non-anaplastic nuclei with little
cytoplasm. Nuclear-to-cytoplasmic ratio appears greater than that of normal basal cells. Tumor appears well
differentiated. Mitotic figures are rare. Tumor cells are aligned in a palisade pattern at the periphery of cell
aggregates. Consistent with basal cell carcinoma nodular subtype.
Patient Case Question 7. Which type of treatment is preferred for this type of basal cell carcinoma?
Patient Case Question 8. Would it be appropriate for the primary care provider to order a chest x-ray or a CT
scan for this patient?
Patient Case Question 9. Would it be appropriate for the primary care provider to order a complete blood
count, chemistry panel, and urinalysis?
Patient Case Question 10. What is the probability that this patient will develop a basal cell carcinoma at
another site within 5 years?
Patient Case Question 11. What is the single best piece of advice that can be provided by the patients primary
caregiver?

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