Mohs' Surgery as an Approach to Treatment of Multiple Skin Cancer in Rhinophyma

Abstract

Skin cancer, especially basal and squamous cell carcinoma, diagnosed simultaneously in a rhinophyma creates a challenge; the enlarged, inflamed, and hypertrophied tissue masks their margins. In our opinion, Mohs' micrographic surgery is the treatment of choice and should be primarily considered in view of the malignant potential of these tumours, as is shown by the substantial tumour extension in the case described.

Malignancies Within Rhinophyma: Report of Three New Cases and Review of the Literature

“…A case of sebaceous gland carcinoma (SGC) [24] and a case of angiosarcoma within rhinophyma were also noted [18]. In four patients an association with malignant basal and squamous type cells was observed within the tumor [8,17,22,29], and in one case no histological data were reported [10]. All patients [15-19, 21-24, 26-33] but one [27] were male.…”

“…The presenting symptoms in virtually all patients who were developing malignancy within rhinophyma were sudden progressive enlargement [21-24, 27, 28, 30] of a long-standing silent disease in BCC and SGC cases, and the onset of ulceration [16,19,26,29] and rapid growth [16] that may be associated with malodorous drainage [16,17] and serous discharge [30] as well as chronic irritation [15] in SCC cases (Table 1). Seldom do BCCs associated with rhinophyma present with ulceration [21,28,31,33], bleeding [22], or serous discharge [28,32].…”

“…In 19 cases information about sex was not available [8-14, 20, 25]. Interestingly, there was little prevalence of rhinophyma-associated malignancies that were diagnosed during preoperative clinical examination (n = 22) [12,14,16,19,21,23,25,26,28,29,31] over those detected incidentally during histological evaluation (n = 19) [11-15, 17, 18, 21, 22, 24, 27, 28, 30, 32, 33]; in five cases information was not available from the article [8][9][10][11]20].…”

“…Including our series, the mean interval time between diagnosis of rhinophyma and the development of the malignancy was 18.47 years [11,16,21,23,24,26,[28][29][30] (SD ± 7.73; ranging from 5 [21] to 30 [28]), although this information was not available in several articles. The vast majority of cases presented with a localized stage of the skin tumor, whereas in a few cases the cancer was locally advanced and required surgical debulking (Table 1).…”

“…Tangential shaving [28][29][30]32] with or without Mohs' micrographic surgery was usually followed by either skin graft [11,18,21,29,30] or compressive garments, whereas in those cases in which more aggressive surgery [15] was required, either local flaps [19,21,23,29] or nasal prostheses [16,26] were chosen depending on the health condition of the patient. Seldom was the surgical approach combined with radiation therapy (RT) [22,26]; in three cases RT was administered alone [27,33].…”