A spot of bother for James (From Bradford Telegraph and Argus)

A spot of bother for James

9:00am Tuesday 25th November 2008 in Doctor Tom By Dr Tom Smith

James, a 63-year old farmer, has the ruddy complexion of a man who had spent most of his working life outdoors. He had small lumps on his cheeks that were smooth and the same colour as the rest of his skin, causing him no discomfort. They were probably the remains of his teenage acne.

So he didn’t take much notice when a new lump appeared on the side of his nose, in the fold between the fleshy part of his nostril and the side of his cheek.

He started to worry when it grew larger and changed in colour and shape. Now the size of a small pea, it had a dimple in the middle, so that it looked like a tiny doughnut, the outer ring being red, with a pearly sheen on the inner rim that ‘rolled over’ into the centre.

Tiny thread-like blood vessels were scattered over its surface and in the skin surrounding it. His wife persuaded him to see me.

The lump had all the properties of a basal cell cancer, or rodent ulcer. It was also in the right site, the angle between the nose and the cheek, for a classic ‘rodent’. If left, it would erode into his face. It needed to be removed, a job, because of its size and position, that had to be done by a specialist.

The operation involved removing the basal cell cancer and replacing it with a full thickness skin graft. Radiotherapy was considered but rejected as the answer because of the possibility of destroying the cartilage in the centre of the nose (the nasal septum) and the slightly-increased risk of a radiation-induced second cancer developing at the site. If he had been older, say in his seventies, radiation may well have been judged the treatment of choice.

James now has a tiny scar at the angle of his nose and cheek that no-one, apart from a doctor, would notice. He doesn’t notice it himself, but then he isn’t one to pride himself on his beauty.