Question: 85 y old white male developed a small papula on his cheek.The dermatologist

performed biopsy by excision.The dermatopathologist reported that

a Ber-EP4 immuno stain was positive in a small cluster of cells.She stated that a differential diagnosis include a hair germ and recommended another biopsy.

Because of a grave illness in the family patient had to leave New York City to

spend several weeks with his dying brother in Chicago.The lesion on his cheek

healed completely .Upon return to New York he consulted his dermatologist

who suggested 4 weeks treatment with flurouracil cream applied twice a day.

Patient is extremely reluctant to follow this recommendation because of his fear of very unpleasant side effects which he read about and heard from several patients who had this treatment ,for “a condition which I may not have”.

He would like to wait and see if the lesion recurs,have a second biopsy if it does , and if the BCC is confirmed choose one of the surgical treatments or a non surgical alternative.

I would appreciate your opinion concerning the best management of this case