Dr. Nguyen Hong Son, Head of the Department of Plastic Surgery, Aesthetics and Rehabilitation, Central Dermatology Hospital, said: Basel Cell Carcinoma (BCC) is the most common type of skin cancer, accounting for about 75% of the total number of skin cancer cases.
Although it has a much better prognosis than other forms of cancer, the disease can still recur many times and become more and more complex – even when treated methodically. This stems from the biological properties of some high-risk BCCs, with an uncontrollable silent invasive ability.
Typically, a male patient nearly 60 years old, began to notice abnormally thickening signs in the skin area of his upper right lip. After examination at the Oncology Hospital, he was diagnosed with basal cell carcinoma (BCC) and underwent the first tumor removal surgery.
About 3 years later - the old surgical scar area began to become hard, thick and change color. He returned to the Hospital and was diagnosed with recurrent BCC, indicated for a second surgery: widening the tumor and combining plastic surgery.
Only 3 months after the second surgery, the area next to the right nose continued to show thickness and stiffness. The patient came to Hanoi Medical University Hospital, underwent biopsy and was diagnosed with right wing rhinoplasty on the background of surgically removed upper lip rhinoplasty. Although he was indicated to continue surgery, his family did not agree to hospitalization at that time. After that, he went to the Central Dermatology Hospital for advice and in-depth treatment.
At the time of examination, the doctor recorded a patch-like skin lesion in the right nasolabial groove, size 4 × 3 cm, solid surface, unclear boundaries, with vasodilation around. The upper right lip area left fibrous scars, contraction, uneven surface – sequelae of previous two surgeries.
Skin analysis reveals an atypical recurrence of BCC on a scar background – a sign that is easily overlooked when only observed with the naked eye.
The biopsy results confirmed basal cell carcinoma of the nasolabial fossa with particularly dangerous characteristics: simultaneously carrying three forms - small, superficial and infiltrated tumors.
CT scan and MRI of the head – face – neck area also recorded localized, non-invasive deep structural lesions.
The point that makes this case more complicated than usual is that: The patient is carrying three pathological tissue forms simultaneously in the same lesion - in which the infiltrated form is silently invasive under the skin, not clearly manifested clinically.
With this biological characteristic, the real boundaries of the tumor are often much wider than what can be seen with the naked eye or on clinical images – this is a major professional challenge even for experienced surgeons.
In addition, the lesion site in the nasolabial groove and upper lip belongs to the "high-risk area" (H area of the face) – where the skin is thin, the anatomical structure is complex, and there are many important structures located close together. This is one of the positions that is classified by world medical literature as the group that needs the most in-depth access in BCC treatment.
After a professional consultation, the patient was indicated for treatment with Mohs surgery combined with defect reconstruction - the most advanced method currently in the treatment of high-risk and recurrent BCC.
The patient underwent Mohs surgery at the Department of Cosmetic and Rehabilitation Plastic Surgery - Central Dermatology Hospital. The surgery and plastic surgery were performed by a team of experienced doctors. The patient is still being monitored and cared for, changing bandages daily after treatment.
Mohs surgery is a technique for removing skin cancer in thin layers, checking microscopy right in the operating room to ensure 100% removal of cancerous tissue while preserving maximum healthy tissue around it. This method provides a cure rate of up to 90-95% for recurrent BCC – significantly superior to conventional surgery.
