What is the best course of action for a 65-year-old male patient with a history of basal cell carcinoma (BCC) and a non-healing lesion in the cervical area, pending biopsy results?

From the Guidelines

The best course of action for a 65-year-old male with a history of basal cell carcinoma and a non-healing cervical lesion is to maintain the lesion undisturbed while awaiting biopsy results, as premature treatment could interfere with proper histological evaluation and subsequent treatment planning. The patient should keep the area clean with gentle washing using mild soap and water, and apply petroleum jelly to prevent drying and scabbing. No topical medications, including over-the-counter products, should be applied unless specifically prescribed. The patient should protect the area from sun exposure using clothing or bandages, and avoid trauma to the site. Close monitoring for changes in size, color, bleeding, or pain is essential, with prompt reporting of any concerning changes to the physician.

Given the patient's history of BCC, there's an increased risk that this lesion could be another skin cancer, making accurate diagnosis crucial for determining appropriate treatment, which might include surgical excision, Mohs surgery, radiation therapy, or topical medications depending on the biopsy results, as suggested by the guidelines for the management of basal cell carcinoma 1. A full skin examination is recommended because individuals with a skin cancer often have additional, concurrent precancers or cancers located at other, usually sun-exposed skin sites, as noted in the NCCN clinical practice guidelines in oncology 1.

The patient's history of basal cell carcinoma and the presence of a non-healing lesion in the cervical area warrant a thorough evaluation, including a skin biopsy, to determine the best course of treatment. The biopsy should include deep reticular dermis if the lesion is suspected to be more than a superficial process, as recommended by the guidelines for basal cell skin cancer 1.

Key considerations in the management of this patient include:

• Maintaining the lesion undisturbed while awaiting biopsy results
• Protecting the area from sun exposure and trauma
• Close monitoring for changes in size, color, bleeding, or pain
• Considering the patient's history of BCC and the potential for additional skin cancers
• Following the guidelines for the management of basal cell carcinoma, as outlined in the NCCN clinical practice guidelines in oncology 1 and the guidelines of care for the management of basal cell carcinoma 1.

It is essential to prioritize the patient's overall health and well-being, considering factors such as general fitness, coexisting serious medical conditions, and the use of antiplatelet or anticoagulant medication, as noted in the guidelines for the management of basal cell carcinoma 1.

From the FDA Drug Label

The diagnosis should be established prior to treatment, since this method has not been proven effective in other types of basal cell carcinomas. The best course of action for a 65-year-old male patient with a history of basal cell carcinoma (BCC) and a non-healing lesion in the cervical area, pending biopsy results, is to wait for the biopsy results to establish a diagnosis before determining the appropriate treatment.

• If the biopsy confirms a superficial basal cell carcinoma, treatment options such as imiquimod cream or 5-fluorouracil may be considered.
• If the biopsy results indicate a different condition, such as actinic keratosis, treatment options may include imiquimod cream or 5-fluorouracil.
• It is essential to monitor the patient's skin for any changes or new lesions, especially given the patient's history of basal cell carcinoma and excess sun exposure 2, 3.

From the Research

Patient Management

• The patient's history of basal cell carcinoma (BCC) and the presence of a non-healing lesion in the cervical area warrant a thorough examination and investigation, as supported by 4, 5, 6.
• The biopsy of the lesion is a crucial step in determining the histologic subtype and guiding treatment, as stated in 4.
• The patient's excess sun exposure, as evident from the hyperpigmented skin on his back, is a significant risk factor for nonmelanoma skin cancers (NMSCs), including BCC, as highlighted in 4, 5, 6.

Treatment and Follow-up

• The treatment options for BCC and other NMSCs include surgical techniques such as excision, curettage and electrodessication, and Mohs micrographic surgery, as well as nonsurgical therapies like topical therapy or photodynamic therapy, as mentioned in 4, 5, 6.
• The American Academy of Dermatology recommends skin examinations for all patients with NMSC at least annually, as stated in 4.
• The patient's follow-up schedule, including a review of lab results and regular monitoring of the skin on his back every three months, is reasonable, considering the high risk of subsequent skin cancer, as supported by 5, 6.

Risk Factors and Prevention

• The patient's fair skin type and history of BCC put him at a higher risk for developing NMSCs, as highlighted in 4, 5, 6.
• Counseling on reducing sun exposure, using UV-protective clothing and sunscreen, and discouraging tanning bed use are essential primary interventions for prevention, as recommended in 4, 5.