Combined Mohs micrographic surgery and 5-aminolevulinic acid photodynamic therapy for nasal ala basal cell carcinoma: A case report.

Basal cell carcinoma (BCC) is a common skin malignancy, often occurring in cosmetically sensitive facial areas. We report a case of a 46-year-old woman with BCC of the right nasal ala. The lesion had persisted for nine years, gradually enlarging, with recent ulceration and crusting. Skin biopsy confirmed BCC. The patient underwent Mohs micrographic surgery (MMS), with the wound left to heal by secondary intention for 48 h, followed by sequential 5-aminolevulinic acid photodynamic therapy (ALA-PDT) once weekly for five consecutive weeks. A freshly prepared 20 % 5-aminolevulinic acid (ALA) solution (118 mg, Shanghai Fudan-Zhangjiang Bio-Pharmaceutical Co., Ltd) was topically applied to the entire open defect of the right nasal ala and its 0.5 cm peripheral marginal area, occluded with aluminum foil to block light, and incubated for 3 h. After removal of the covering, the area was irradiated with 635-nm red light at 80 mW/cm²and 120 J/cm² for 20 min (Wuhan Yage Optic and Electronic Technique Co., Ltd). Approximately 5 months and 12 days after the final PDT session, repeat histopathology showed no residual tumor, and hypertrophic scar formation was observed. No recurrence or further BCC was noted during the 5-year follow-up. This case demonstrates that MMS combined with ALA-PDT can achieve effective local tumor control while preserving function and optimizing cosmetic outcome for BCCs larger than 1 cm in aesthetically sensitive facial areas.