CASE REPORTS: A 59-year-old man noted a sore on his right upper lip in June, 2014. The sore persisted for a few weeks and then disappeared. In February, 2015 the patient saw the sore reappear and it was present during his dental hygiene appointment in April, 2015. His dentist was concerned when he confirmed that this lesion was a new finding and not present during his last hygiene appointment several months ago. He was referred for a consultation and possible treatment.
The patient appeared with a moustache that made the clinical appearance hard to observe. However, the clinical history, ulceration of the skin surface, irregular borders and firmness to palpation made it highly probable that a malignant process was present. This man is healthy and does not smoke or take any medications. He does not spend much time outdoors in the natural sunlight. The patient was asked to shave his moustache prior to his appointment. A complete excision of this lesion down to the fascia and vermillion border was performed in the office with a local anesthetic. The size of the lesion was about 5 mm x 4 mm on the surface of his skin. However, the surgical specimen was much larger. The tumor was in one piece and sent for a diagnostic biopsy. The report revealed this to be a basal cell carcinoma with some microscopic tumor tissue left in one of the margins. As a result of this, a MOH’s procedure will be done on his lip to confirm during his revision surgery, that all of his skin and lip margins are free of any tumor tissue. This should be done while the wound is still fresh to minimize scarring and infection.