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Hidradenitis suppurativa — SCE Dermatology MCQ

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HardGeneral dermatology & dermatology in primary health careHidradenitis suppurativaSCE Dermatology

A recurrent, ill-defined micronodular BCC on the nasal ala measures 9 mm. The patient asks for topical imiquimod to avoid surgery. Which management principle is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Use surgery with margin control because recurrent micronodular nasal BCC is high risk

Explanation lettering: E = shown as A · A = shown as E

D is correct. Topical or destructive therapy is reserved for carefully selected low-risk superficial BCC. This lesion has three independent high-risk features: recurrence, an aggressive micronodular subtype and a nasal H-zone site. Surgery—often Mohs micrographic surgery depending on margins and local expertise—offers histological margin control and tissue conservation. Small diameter does not cancel other risk factors. Curettage and photodynamic therapy provide less reliable control for this pattern, and observation risks deeper local invasion and more complex reconstruction.

Reference: BAD guideline for basal-cell carcinoma: https://doi.org/10.1111/bjd.20524