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Basal Cell Carcinoma (Skin Cancer) & Rhinophyma [April 2007]

Basal or squamous cell carcinomas have rarely been reported occurring in rhinophyma.

Clinical diagnosis can be difficult as the characteristics of carcinomatous lesions may be overlooked given the background of soft tissue hypertrophy and distortion seen in gross rhinophyma.

A 77-year-old man with long standing gross rhinophyma developed a 6 x 8-mm ulcerated nodular lesion on the right side of his nose.

Such a lesion would normally have been clinically obvious when occurring on normal skin; however. given the soft tissue hypertrophy and general nodularity of the nose due to rhinophyma, it had not been initially apparent.

The patient had been attending the Clinic for treatment of his acne rosacea.

He had also recently been assessed in the plastic surgery department for shave removal of the larger protuberant parts of the rhinophyma to improve the appearance of his nose.

There was a history of severe ischaemic heart disease; surgery had therefore been cancelled because of concerns about unduly high anaesthetic and surgical risks for this cosmetic procedure.

The ulcerated nodule was only considered subsequently on close inspection to be suspicious of neoplasm.

Diagnostic punch biopsy confirmed the presence of a nodular microcystic basal cell carcinoma (BCC). The patient had no previous history of skin cancers and no other clinically suspicious lesions.

Despite developing quite a large BCC in a prominent location, the gross appearance of the nose had caused it to be overlooked.

Even the patient himself had not been concerned.

In 1967 Acker and Helwig reviewed 47 cases of rhinophyma and found that five had developed a BCC on the nose.

Using epidemiological data, they concluded that BCC occurred on the nose in a significantly greater proportion of patients with rhinophyma than in those without.

However, Keefe et al. later showed that the statistical technique used had been incorrect, and biases in the study prevented generalization.

Using the correct technique, the results of Acker and Helwig just failed to reach statistical significance at the 5% level.

There have been sporadic published reports in the literature of carcinoma developing within rhinophyma.

In 1990, Silvis and Zachary summarized the previously reported cases.

They added a case of basal cell carcinoma to the previous 10 cases of BCC of squamous cell carcinoma and 2 of unspecified carcinoma.

Since then there have been very few published reports of carcinoma developing within rhinophyma.

Recently, a retrospective epidemiological audit of 45 cases of rhinophyma treated surgically found no coincidental malignancies on histology.

In theory, a causal association between rhinophyma and BCC might be explained by the chronic inflammation, hypertrophy, hyperplasia and scarring that occurs in rhinophyma.

Our case has prompted us to look for evidence of a causal association, but opinion in the literature has been divided.

There does not appear to be definite proof that the two conditions do not occur together by chance.

Further larger studies would be required to clarify this question.

However. the importance of careful examination of the skin in rhinophyma for coincidental carcinoma, and diagnostic biopsy of suspicious areas is emphasized by our case.

The distortion and soft tissue hypertrophy of gross rhinophyma may make carcinomatous lesions more difficult to recognize clinically and early lesions may go unnoticed.

The surgical margins could also be more difficult to define.

Mohs' micrographic surgery could be considered, and is felt by some to be the treatment of choice for carcinoma arising within rhinophyma.

Alternatively, radiotherapy is an accepted treatment option for rhinophyma and for BCC, and has successfully been used to treat both conditions when they occur together.

Skin Cancer Prevention:

• Antioxidants;
• Rosacea Sunscreens.

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Related Rosacea Treatment Information and Notes:

• Rosacea: A Potential Complication of Skin Cancer Removal [April 2007]
• (Non)Comedogenicity of Skin Care Ingredients in Rosacea Skin Care Products
• Order of Application Including Metrogel (Metronidazole)
• Glycolic Acid in Rosacea Treatment
• Invisible Daylight Exposure Produces Dry Skin in Rosacea
• Hypoallergenicity

Additional Resources:

About Basal Cell Carcinomas — DERM NET NZ.

Skin Cancer Information, including treatment and prevention — frequently updated, at the general dermatological skin care site from Melbourne Dermatology.

Commonly Held Misconceptions about Sun Exposure.

Australian Skin Cancer Campaign (Quicktime Video and links to more information on treatment and prevention) [AU] [UK]

References

• Acker OW. Helwig EB. Rhinophyma with carcinoma. Arch. Dermatol. 1967; 95: 250-4.
• Keefe M. Wakeel RA. McBride Dr. Basal cell carcinoma mimicking rhinophyma. Case report and literature review. Arch. Dermatol. 1988; 124: 1077-9.
• Silvis NG. Zachary CB. Occult basal cell carcinoma within rhinophyma. Clin. Exp. Dermatol. 1990; 15: 282-4.
• Curnier A. Choudhary S. Rhinophyma: dispelling the myths. Plast. Reconst. Surg. 2004; 114: 351--4.
• Tamir G. Murakami C. Berg O. Moh's surgery as an approach to treatment of multiple skin cancer in rhinophyma. J. Cutan. Med. Surg. 1999; 3: 169-71.
• Plenk HP. Rhinophyma associated with carcinoma, treated successfully with radiation. Plast. Reconst. Surg. 1995; 95.

Author: .

Reviewed: Thursday, 5 April 2007.

Further Information: Faultless Hydration [April 2007] : Bakel Skin Care : Basal Cell Carcinoma (Skin Cancer) & Rhinophyma [April 2007] : Rosacea: A Potential Complication of Skin Cancer Removal [April 2007] : Cycling Hormones and Female Skin Behaviour [April 2007] : Variable-Pulse Nd:YAG Laser in the Treatment of Facial Telangiectasias (Broken Capillaries) [April 2007] : Senetek Initiates Clinical Trials of Pyratine 6 for Acne Rosacea [April 2007] : New RosaTox Forté Firming Soothing Mask [March 2007] : More on Metronidazole (Metro Gel/Lotion/Cream) :

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