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Indian J Dermatol
Indian J Dermatol
IJD
Indian J Dermatol
Indian Journal of Dermatology
0019-5154
1998-3611
Wolters Kluwer - Medknow India

IJD-69-366c
10.4103/ijd.ijd_972_22
E–IJD®: Correspondence
A Case of Severe Facial Swelling Mimicking Facial Nerve Paralysis after Cryotherapy to the Basal Cell Carcinoma in a Xeroderma Pigmentosum Patient
Semiz Yavuz
Bayram Avni Akin 1
Aktas Ezgi 2
From the Department of Dermatology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey E-mail: yavuzsemz@gmail.com
1 Department of Otolaryngology, Okmeydanı Training and Research Hospital (Prof Dr Cemil Taşcıoğlu City Hospital), Istanbul, Turkey
2 Department of Dermatology, Okmeydanı Training and Research Hospital (Prof Dr Cemil Taşcıoğlu City Hospital), Istanbul, Turkey
Jul-Aug 2024
19 8 2024
69 4 366366
12 2022
5 2024
Copyright: © 2024 Indian Journal of Dermatology
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcSir,

Xeroderma pigmentosum (XP), a rare autosomal recessive disorder of DNA repair mechanisms, is characterized by a high incidence of cutaneous malignancies.[1]

Here, we report a patient with XP who developed severe facial swelling after cryotherapy application to a BCC on the right cheek.

A 63-year-old man with a diagnosis of XP had developed multiple BCCs on the face in the past years. Surgical treatment or cryotherapy was performed for previous BCCs. He had been using sun protection since the diagnosis was made. A pigmented papule was noticed on the right nasolabial area, which had been present for only a few weeks. Dermoscopic examination revealed blue-grey ovoid nests and a scar-like whitish appearance surrounding a structureless pigmented, slightly ulcerated papule. Based on the dermoscopic findings and the patient’s history, we considered the lesion to be a superficial type of BCC [Figure 1]. The patient preferred cryotherapy instead of surgery. Two cycles of 10 seconds of cryotherapy were performed, and wound care was described to the patient. Two days later, the patient presented with swelling on the right malar area and neck. He reported that the swelling started the next day after the cryotherapy on the right cheek and then extended to the neck. He had no complaints including pain, pruritus, or burning sensation. Dermatologic examination revealed erosions, ulceration on the site of cryotherapy, swelling on the right malar area and anterior neck, and crepitation or tenderness were not noticed. Upon examination, facial droop on the right part of the lip was observed due to smiling, suggestive of facial nerve paralysis. Otolaryngologic examination ruled out facial nerve paralysis. Facial and cervical computerized tomography revealed no abnormalities including emphysema or edema. Laboratory tests revealed no abnormalities. Three days later, the swelling began to regress, and at 3 weeks, the swelling had completely resolved, and post-inflammatory hypopigmentation at the site of cryotherapy remained [Figure 2]. Written consent was obtained from the patient for the publication of this study and accompanying images.

Figure 1 0.5 × 0.5 cm well-demarcated papule on the right malar area. Dermoscopic examination of the lesion blue-gray ovoid nests and scar-like whitish appearance surrounding a structureless pigmented slightly ulcerated papule (MoleMax HD digital dermoscopy; Derma Medical Systems, Wien, Austria)

Figure 2 (a-c) Swelling on the right malar area and anterior neck, 2 days after cryotherapy, on the malar area erosion is noted created by cryotherapy. Please note the facial droop on the right part of the lip due to smiling, suggestive of facial nerve paralysis (d and e). Hypopigmented patch on the right malar area where cryotherapy was applied, resolution of the swelling at month 1

There is no cure for XP due to its genetic nature; the main approach is to avoid UVR exposure and provide early detection of cutaneous carcinomas by follow-up schedules.[12]

Cryotherapy is a safe treatment option for cutaneous malignancies with few side effects. Pain that ends soon after the treatment, blistering, and local edema are common temporary side effects, while hypopigmentation at the procedure site is the most common long-term complication.[3] Bleeding, infection, sensorial changes, scarring, systemic reactions, nerve paralysis, and subcutaneous nitrogen emphysema are rarely reported complications in cryotherapy.[4]

The patient presented had been under follow-up with XP for several years, and during this time, multiple actinic keratoses and BCCs occurred on his face. Cryotherapy was performed to treat the recently occurred papule on the right malar area which was considered as a BCC by dermoscopic examination. In two days, swelling developed on the malar area and extended to the cervical area, which created a false facial nerve paralysis appearance. Physical examination, laboratory, and imaging tests revealed no abnormalities, and the swelling resolved completely within 3 weeks. We believe that this swelling may have occurred due to an exaggerated inflammatory response. To date, no similar reactions after cryotherapy have been reported. The case is presented to share this uncommon reaction.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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2 Tehranchinia Z Rahimi H Ahadi MS Ahadi MS Aminolevulinic acid-photodynamic therapy of basal cell carcinoma and factors affecting the response to treatment: A clinical trial Indian J Dermatol 2013 58 327
3 Zouboulis CC Kryochirurgie in der Dermatologie [Cryosurgery in dermatology] Hautarzt 2015 66 834 48 26497955
4 İçke İ Başak PY Cryotherapy in dermatology Turkiye Klinikleri J Med Sci 2004 24 383 95
