Plastic surgery needed with this BCC
This would partially heal with topical antibiotics only to break down again.
A punch biopsy initially only showed non-specific inflammatory changes. The problem was it was a small punch biopsy. Only later when a 4mm one was taken was the true diagnosis of basal cell carcinoma made.
Cosmetically this was a challenging case: a very skilled plastic surgeon had to reconstruct the man’s philtrum using part of his lower lip.
Even in a young man any persistent ulcerated lesion should be considered a malignancy until proven otherwise. A 2mm punch