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Basal Cell Carcinoma — SCE Dermatology MCQ

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ModerateSkin CancerBasal Cell CarcinomaSCE Dermatology

A 68-year-old man presents with a firm, flesh-coloured nodule on his right ear that has been present for 8 months. Dermoscopy shows arborising vessels but no pigment network. Biopsy shows nests of basaloid cells with peripheral palisading and retraction artefact. The tumour extends to the deep margin. What is the most appropriate next step?

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Correct answer: B — Mohs micrographic surgery

The ear is a high-risk site (H-zone equivalent) and the tumour has incompletely excised deep margins. Mohs micrographic surgery is the treatment of choice for BCCs in high-risk sites with incomplete excision, providing complete margin assessment with maximal tissue conservation. Re-excision with standard margins on the ear may sacrifice excessive tissue and still risk incomplete clearance. Radiotherapy is a second-line option. Imiquimod is only appropriate for superficial BCC. Observation of an incompletely excised BCC is not appropriate.

Reference: BAD 2021 Guidelines for management of BCC