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Basal Cell Carcinoma — SCE Dermatology MCQ

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ModerateSkin CancerBasal Cell CarcinomaSCE Dermatology

A 70-year-old woman presents with a 2 cm pearly papule with rolled edges and telangiectasia on the nasal ala. Biopsy confirms nodular basal cell carcinoma. What is the most appropriate surgical treatment?

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Correct answer: C — Mohs micrographic surgery

For BCC on the nose (H-zone/high-risk site), particularly the nasal ala, Mohs micrographic surgery (MMS) is recommended as it provides the highest cure rate (99%) while preserving maximal tissue. BAD guidelines recommend MMS for BCCs in cosmetically sensitive or high-risk sites, recurrent BCCs, and aggressive histological subtypes. Standard excision with 3-4 mm margins is appropriate for low-risk nodular BCCs on the trunk/limbs, but in this high-risk facial site, MMS is preferred.

Reference: BAD 2021 Guidelines for the management of BCC