Kas 7-1E: A patient with a tumour of the nose

Kas 7-1E: A patient with a tumour of the nose
73 years old pensioner, widower, lives alone, coming from plastic surgery department
Family history: mother died at 83 years of stomach cancer, father unknown, two brothers
alive and well
Past medical history: TUR prostate for carcinoma, at present in good remission, the patient
underwent excision at the department of urology. Drug history: no medication. No-smoker,
History of the present complaint: surgery of ulcer on the left side of the nose two years ago,
not pathologically verified. Now, a red crusty lesion in scar appeared with occasional bleeding
due to which a re-excision with pathology verification and reconstruction was performed at
the plastic surgery department.
Physical examination: skin transplant on the nose with no signs of recurrence, the scar
healed well. No hyperkeratosis, no inflammatory component. No other suspicious lesions on
the skin in the sense of malignant tumour. Several pigmented nevi on the back and keratosis.
Physical status of the patient is adequate to his age. Per rectum: soft elastic prostate bed,
normal rectal mucosa.
Examinations: CX-Ray: no lesions, Liver U/S: no signs of metastatic involvement,
Bone scan: no pathological deposits, PSA: 3.1 mmol/l;
Questions and tasks:
1. What is the most likely diagnosis?
2. Is pathological verification necessary?
3. Why a re-operation with a consequent reconstruction was performed?
Do you know some other treatment modalities?
4. What are typical symptoms of malignant skin tumours?
5. Is presence of distant metastases probable?
6. Why rectum is examined in patient with skin tumour?
7. Histological types of malignant skin tumours and their possible precursor lesions.
8. Damage of the organism by physical factors of external sourounding