Nodular basal cell carcinoma masquerading as traumatic laceration

A woman in her 80s was referred to us as an emergency for repair of a traumatic laceration. She had a history of hypertension and dementia and lived alone; she had an increasing frequency of falls recently and presented to her local hospital following another fall. The medical team noted a left medial canthus defect with bleeding and unopposed edges. This was suspected to have been secondary to her fall. She was referred to us for emergency repair of the supposed laceration. Ophthalmic review revealed a large ulcerated lesion at the left medial canthus with indurated edges and oozing of blood. Rather than a traumatic aetiology, clinically it appeared more like basal cell carcinoma (BCC), so, instead of repair, punch biopsies were taken: histology later confirmed BCC. This highlights the variable clinical presentation of BCC and the importance of keeping a high index of suspicion for all periocular lesions.