Three different consecutive manifestations of morphoeic BCC in the same patient: presenting first as ectropion, then entropion, and finally medial canthal dystopia with epicanthus inversus.
Morpheaform basal cell carcinoma (BCC) can cause diagnostic difficulty due to an atypical clinical presentation. Successful treatment requires a high index of clinical suspicion together with an early confirmatory biopsy. We present the case of an 81-year-old lady with a delayed diagnosis of morphoeic BCC due to an unusual presentation of evolving lid malposition, and we highlight the limitations of a punch biopsy in diagnosing atypical lesions. An appropriate biopsy technique is vital, with consideration for repeat biopsies when necessary, especially if the clinical picture is changing over time.
Eye Department, Dudley Guest Hospital, Dudley, United Kingdom. hannahbaker@doctors.org.uk
H E
HE
Baker
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A
Berry-Brincat
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I
Zaki
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D
Cheung
D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D004483:Ectropion / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D004774:Entropion / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D005142:Eyelid Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D015580:Mohs Surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D018570:Risk Assessment; D013524:Surgical Flaps; D016896:Treatment Outcome