An 82-year-old woman presents with a persistent “face sore,” which she ascribed to repeatedly and frequently blowing her nose during a recent upper respiratory tract infection. However, the respiratory infection had resolved some 2 months before presentation. The patient felt that all she needed was a prescription for a topical or oral antibiotic.
Key point: The history speaks highly against the lesion actually being related to her prior illness. In fact, close examination reveals a thin but distinct rolled and pearly border surrounding the crusted ulceration. A biopsy demonstrated micronodular basal cell carcinoma.
Treatment: The tumor was removed by Mohs micrographic surgery and the resulting defect closed by using several rotation flaps.
Note: This patient, who was mentally intact, exercised a great deal of denial in attributing her neoplasm to the minimal trauma associated with a respiratory infection. Patient denial can lead to considerable delay in medical attention.