LAUSR

CASE REPORT A 94-year-old white woman presented to our clinic with a slow-growing, well-demarcated 3-3 2-mm ulcerated pigmented papule on the nasal tip that had been present for 6 months. Clinically, the lesion resembled a pigmented basal cell carcinoma (BCC). Given patient’s age, the family wanted the least invasive treatment option; thus, a 6-mm punch excision was performed. Histology found an acanthotic epidermis with full-thickness dysmaturation of keratinocytes, with multiple cords and strands of atypical keratinocytes dissecting through the dermis. Additionally, large lobulated areas of epithelial hyperplasia of keratinocytes with clear cytoplasm reminiscent of the outer root sheath of the hair follicle were identified (Figs 1-3). These findings were consistent with invasive TC but had involved margins. The patient was subsequently treated with Mohs micrographic surgery (MMS). Clear surgical margins were obtained after 2 stages of MMS resulting in the 203 17-mm defect. A full-thickness skin graft using a Burow triangle was used to close the defect.