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Managing a basal cell carcinoma overlying a pacemaker

We report the case of a patient with a nodular basal cell carcinoma (BCC) located on the left chest, directly overlying his pacemaker. This case highlights issues with possible malfunction of pacemakers or implantable cardiac defibrillators (ICDs) when electrocoagulation is used to control bleeding. We also suggest alternative methods of haemostasis to manage such patients. A 65-year-old man presented with a tumour overlying the site of pacemaker implantation (Fig. 1), which clinically appeared to be a nodular BCC, approximately 20 · 15 mm in size. The patient had a history of ischaemic heart disease, cardiac arrhythmia and hypertension, and was taking aspirin. Laboratory investigations were not performed. Various options for treating the patient s BCC such as imiquimod, photodynamic therapy and radiotherapy were considered. In discussion with the patient, and considering the cure rates, the best treatment option was felt to be surgical excision. Preoperative cardiology consultation was undertaken to review the patient s pacemaker. The use of 15 mL of 1% lidocaine and 1 : 200 000 epinephrine for local anaesthesia provided excellent haemostasis during the procedure, and was sufficient to obviate the need for electrocoagulation. It is worth noting that the vasoconstrictive effects of epinephrine can take up to 15 min to take effect. Alternative methods for controlling bleeding would be to use hot tip cautery or to use ligature sutures to tie off bleeding vessels. A pressure dressing with dental rolls and micropore tape was used on completion of surgery,