Gorlin Syndrome
A 60-year-old man, of low socioeconomic status presented with complaints of mole like skin lesions in his face, back, and scalp since childhood. These lesions were insidious in onset and gradually increasing in size. On dermatological examination there were multiple, discrete, pigmented, well defined, nontender mobile plaques and nodules of varying sizes present over the face, around eyelids, forehead, and scalp, and few on back []. Most of the lesions had ulceration. Larger lesions were of size 3-4 cm over face having rolled out border and central ulceration covered with hemorrhagic crusts. His hairs, nails, and mucosa were normal. There was no family history of similar lesions.\nOn general examination the patient was of average built having Kyphoscoliosis, Macrocephaly, frontal bossing, broad depressed nasal bridge, high arched palate, [] and hypertelorism. Ophthalmic examination was not contributory except left eye having divergent squint. Other systemic examinations were within normal limits. Routine investigations were within normal limits. Histopathology from one of the lesion was suggestive of BCC. Orthopantomogram (OPG) of the patient showed multiple jaw cysts present in maxilla. Skull X-ray and computed tomography (CT) scan brain showed calcification of Falx cerebri but magnetic resonance imaging (MRI) could not be done []. Chest X-ray showed bifid ribs. Ultrasonography of abdomen and pelvis were normal.\nIn the next visit, after 6 months, patient had new similar lesions and older lesions over back had increased in size and causing discomfort. Hence, different treatment modalities were approached. The larger lesions and few smaller lesions were excised, while rest lesions were treated with topical 5 fluorouracil (5-FU). Retinoid in high dose and prolonged duration is a good agent for treatment and prevention of BCC, but could not be tried, looking at his economic status.