On 1/5, Doctor Nguyen Hong Son, Head of the Department of Plastic, Aesthetic, and Rehabilitation Surgery at the National Hospital of Dermatology and Venereology, stated that basal cell carcinoma (BCC) is a common type of skin cancer, accounting for approximately 75% of all skin cancer cases. While the prognosis for BCC is generally much better than other cancers, the disease can recur multiple times and become increasingly complex. This is due to the biological characteristics of certain high-risk BCC subtypes, which possess a subtle, hard-to-control invasive potential.
The patient initially presented with an abnormally thickened area of skin on his upper lip. After examination at a specialized oncology hospital, he was diagnosed with BCC and underwent surgery to remove the tumor for the first time.
Approximately three years later, the old surgical scar began to harden, thicken, and change color. He returned to the hospital, where BCC recurrence was confirmed. He then underwent a second surgery to widely excise the tumor and perform reconstructive surgery. Three months after that, a thickened and hardened area continued to appear next to his right nostril.
A biopsy at Hanoi Medical University Hospital confirmed BCC on the right side of the nose, building on the previously operated BCC on the upper lip. The patient then sought treatment at the National Hospital of Dermatology and Venereology. Doctors observed a skin-colored plaque-like lesion in the right nasolabial fold, measuring 4x3 cm, with a firm surface, indistinct borders, and surrounding telangiectasias (spider veins). The right upper lip showed a fibrous, contracted, and uneven scar, a sequela of the two previous surgeries.
"This case is more complex than usual because three histological subtypes were present simultaneously within the same lesion. Among these, the infiltrative subtype exhibits subtle invasion under the skin that is not clearly visible clinically," Doctor Son explained. Given these biological characteristics, the true extent of the tumor is often much wider than what is visible to the naked eye or through clinical imaging – posing a significant professional challenge even for experienced surgeons.
Furthermore, the lesion's location in the nasolabial fold and upper lip falls within a "high-risk area" (the H-zone of the face). This region features thin skin, complex anatomy, and many vital structures located close together. It is one of the locations that global medical literature classifies as requiring the most specialized approach in BCC treatment.
The patient underwent Mohs surgery combined with defect reconstruction – currently the most advanced method for treating high-risk and recurrent BCC.
Mohs surgery is a technique that involves removing skin cancer in thin layers, with microscopic examination performed immediately in the operating room. This ensures 100% removal of cancerous tissue while preserving as much surrounding healthy tissue as possible. The cure rate for recurrent BCC with Mohs surgery is 90-95%, which is higher than with conventional surgery.
Globally, basal cell carcinoma is the most common cancer among Caucasians, with incidence rates steadily increasing. In Vietnam, BCC is also being recorded with increasing frequency. Lesions are particularly common in exposed skin areas that receive frequent sun exposure, such as the face, ears, and neck. The microscopic borders of BCC are often much wider than what is clinically observed, making control of the excision margin a challenge for doctors.
The disease often begins subtly, without pain or itching, and is easily mistaken for moles, benign tumors, or ordinary scars. Warning signs include: the appearance of a shiny, translucent, pink, or skin-colored nodule or patch of skin, possibly with small surrounding blood vessels; a sore that does not heal, or heals and then recurs multiple times; a thickened, firm skin area with indistinct borders, especially on the face, ears, neck, or areas frequently exposed to sunlight; or an old scar showing signs of hardening, swelling, or color change.
Le Nga
