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Prompt and safe skin cancer treatment should remain a priority during the pandemic: a rapidly growing basosquamous carcinoma to the tip of the nose in an immunocompromised patient

© BMJ Publishing Group Limited 2021. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A 78yearold patient was referred to us by dermatology with a suspected squamous cell carcinoma (SCC) of the nose. His risk factors for skin cancer include a myeloproliferative disorder as well as previous SCCs to the right cheek and both ears. His medications include hydroxycarbamide, anagrelide and aspirin. The patient has a background of learning difficulties and lives at home with his nephew, who acted as his carer, as well as his mother. He is able to look after himself with minimal support. The consultation was remote and the photographs of the lesion to the nose were reviewed by the plastic surgery team. The patient was listed for an urgent excision under the SCC pathway. The lesion was rapidly progressing and transformed from a flat lesion to a 5 cm raised tumour within a few weeks (figure 1). During the time of COVID-19related restrictions, the patient underwent excision of the lesion (figure 2) under local anaesthesia within 6 weeks of the consultation in a private hospital used by the National Health Service (NHS) during the time of the pandemic. The measures undertaken to combat the contraction of COVID-19 included preoperative and postoperative patient isolation, preoperative COVID-19 swabs, temperature checks on the day and full personal protective equipment (PPE) for all healthcare professionals. The histopathology demonstrated basosquamous carcinoma (BSC) of the tip of the nose (figure 3). It was 4 mm thick with areas of poor differentiation. The plane of excision was down to periosteum. The peripheral margin was 7 mm and deep margin was <1 mm. There was no perineural or lymphovascular infiltration. The patient was subsequently referred for postoperative radiotherapy due to a narrow deep margin. There was no evidence of lymph node involvement or metastases. The patient did not contract COVID-19 due to his skin cancer treatment. BSC is a rare cutaneous neoplasm with both basaloid and squamous morphology. Its incidence is less than 2% of all nonmelanoma skin cancers. While