Prepared by Pinky Jha, MD, Resident, Ankur Segon, MD, Resident, and Harvey Friedman, MD, Attending Physician, Saint Francis Hospital, Evanston, Ill

An 88-year-old woman was referred by the Department of Aging for a progressive necrotic facial lesion that encompassed her upper lip, palate, and nose (Figure 1). She had discovered a growth on her upper lip 3 years earlier. Computed tomography revealed destruction of the anterior aspect of the maxilla and the overlying soft tissues. Abnormal soft tissue extended to the nose, with multiple nodular densities in the inferior turbinates. Histologic examination of the lesion showed basal-cell carcinoma (Figure 2).

Figure 1—Ulcerative facial lesion.

Figure 2—Histopathology of facial lesion showing basal-cell carcinoma.

Points to remember: Basal-cell carcinoma, although rarely metastatic, can be locally invasive, with significant destruction and disfigurement. The causes of ulcerative facial lesions in the geriatric population include basal-cell carcinoma, squamous-cell carcinoma, blastomycosis, and Wegener's granulomatosis.

Diagnosis: Mutilating basal-cell carcinoma of face.