Basal Cell Carcinoma Masked in Rhinophyma

Rhinophyma, the advanced stage of rosacea, is a lesion characterized by progressive hypertrophy and hyperplasia of sebaceous glandular tissue, connective tissue, and blood vessels. Rhinophyma can lead to a significant facial disfigurement and severe emotional distress, but it is not only an aesthetic problem, since rare cases of simultaneous presence of malignant tissue are described in the literature. The case of an 84-year-old farmer affected by basal cell carcinoma (BCC) and diagnosed in the context of rhinophyma is presented. The anatomical distortion produced by the chronic inflammation and fibrous scarring makes the BCC diagnosis difficult and uncertain. The histological examination of the entire mass and its margins is fundamental. A partial biopsy can lead to a false negative result, and the histological examination must be repeated intra- or postoperatively. 1. Introduction Basal cell carcinoma (BCC) represents about 75–90% of skin cancers [1, 2]. 85% of these tumors are located in the head and neck area, the majority of these affecting the nose [3]. Fair skin phenotype and sun exposure are important risk factors for this kind of tumor unlike other skin lesions. Although slow growing and unlikely to metastasize, these tumors may have an indolent course and are prone to recur if inadequately treated [1, 2]. If neglected, tumor-related destruction of anatomic features may create difficult reconstructive challenges. In aggressive forms of BCC, associated with extensive dermal invasion and destruction of collagen, the identification of tumor borders can be difficult [4]. Clinical diagnosis can be difficult as the characteristics of the carcinomatous lesions may be masked by the background of soft tissue hypertrophy and distortion seen in gross rhinophyma. Rhinophyma is a rare condition caused by a progressive hypertrophy of sebaceous glandular tissue, connective tissue, and blood vessels. It is considered to represent the final stage of severe rosacea, although it may occur in patients with few or no features of rosacea [5]. Caucasian people between 45 and 60 years old, with a male-female ratio of 5/1–30/1, are more frequently affected by rhinophyma, while it is slightly present in the black people [6]. Its etiology remains unknown, even though several causes have been proposed, including vitamin deficiencies, stress, androgenic hormone influences, and chronic infections by the Demodex folliculorum mite [7]. Convincing evidence for a causal relationship between malignancy and rhinophyma is currently lacking [8]; nevertheless, some cases of BCC are