Basal Cell Carcinoma on Forehead of a 78-Year-Old Man

A 78-year-old man sought medical attention after noting a non-tender, subtle “hole” in his forehead. The firm lesion was asymptomatic. Personal past history was positive for non-melanoma skin cancer.

Key point: While uncommon, basal cell carcinoma (BCC) can be embedded in a heavily fibrotic stroma; this is called morphea-like BCC. Such tumors may present with a greater degree of firmness and some degree of atrophy. In this case, the fibrous stroma was pulling down the overlying epidermis, making a “dent” in the skin. A biopsy confirmed the diagnosis.

Treatment: The BCC was removed by Moh’s micrographic surgery.

Note: This BCC lacks the pearly, telangiectatic morphology of a typical nodular BCC.