Case discussion: How would you treat this patient? [15 August]
A 69-year-old gentleman presented to Dr Phoebe Chisnall with a ‘hard knobbly thing that has gradually eaten away the right ear lobe’ over the preceding two years.
What is your preliminary diagnosis on review of the macroscopic and dermoscopic images and how will you manage this patient?
Update 1 of 2
A biopsy confirmed infiltrative BCC and the tumour was subsequently excised using a staged procedure, leaving the defect open pending histological confirmation of complete excision. The initial histology report is below. A second excision was required to achieve complete tumour clearance.
The case was referred internally within the practice to Dr Helena Rosengren for closure. See below photo of the ultimate defect.
How would you opt to close the defect? He has a normal looking left ear lobe on the left side.
Final update 2 of 2
To achieve the semblance of an earlobe, the defect was closed with two large banner flaps, one taken from the mastoid process and the other from the lateral jaw area. It is important to face one banner flap superiorly and the other inferiorly for easier closure of the secondary defects.
– Prof David Wilkinson
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