Basal cell carcinoma (BCC) is the most common type of malignancy worldwide. The incidence of BCC is positively associated with increasing age; thus, centenarians, defined as those aged 100 years and above, become a vulnerable population to developing malignancy. As a person ages, risk factors such as chronic sun exposure, ionizing radiation, and immunosuppression induce mutations that contribute to tumor formation. Impaired DNA repair capacity in response to carcinogens and immune function dysfunction also increases BCC risk in the elderly. Currently, studies among centenarians with high-risk basal cell carcinoma
treated with surgical interventions are limited.
Presented herewith is a case of a 101-year-old female with a 15-year history of hyperpigmented, hyperkeratotic plaque over the right malar area and a one-year history of progressive pain (PS 10/10) and enlargement of the lesion, forming an ulcerated, hyperpigmented tumor. Laboratory workup showed normal findings. Histopathology was signed out as a pigmented nodulocystic basal cell carcinoma. Moh’s micrographic surgery (MMS) and cheek advancement flap were performed with good wound healing and no perioperative complications.
Despite the limited options of medical and physical management due to decreased life expectancy of centenarians, MMS remains the standard of therapy in high-risk BCC. MMS with reconstructive surgery is generally a safe and effective modality with no increased risk of peri- and post-operative complications.