23
COM Outlook . Winter 2014
Two medical challenges stand out
among the many Dr. Favreau has
faced—rare and unusual cases of lep-
rosy and metastatic basal cell carcino-
ma that manifested in a patient’s face.
Through her studies on leprosy,
Dr. Favreau was familiar with the
highly contagious disease. When
a patient from the Specialty Care
Center in Fort Lauderdale visited
the dermatology clinic, he mani-
fested the ailment’s classic features.
A biopsy confirmed lepromatous
leprosy bacteria had attacked the
cartilage of the man’s ears and nose,
displaying the features of a collapsed
saddle nose and circular depressions
in the cartilage around his ears. As a
result, the mandatory notification of
the Broward County Health Depart-
ment and Hansen’s Clinic in Miami
was completed and examinations of
family members and others who had
been in close contact with the man
were also performed. Fortunately,
the patient did very well thanks to
modern medicine.
The importance of a biopsy was
also the core of the second case, which
occurred when Dr. Favreau was
called to the Broward Health Medical
Center Emergency Room to examine
a man with facial pain. When she
removed the gauze on his cheek, she
saw the flesh had eroded all the way
down to the bone.
The cancer had first been discov-
ered two years prior to her examina-
tion, when the man was incarcerated.
“The biopsy performed by the infir-
mary physician came back positive for
basal-cell carcinoma. The infirmary
physician had performed plastic sur-
gery on the man’s cheek and covered
the area of defect with a skin graft
taken from his thigh and upper arm.
Unfortunately, the surgical excision
pathology results came back positive
with basal-cell carcinoma still in one
margin,” Dr. Favreau said.
The patient had a consultation with
a radiation oncologist to discuss treat-
ment. Radiation treatment would have
required the removal of the patient’s
teeth because the tooth enamel would
absorb the radiation, making the treat-
ment less effective. The patient de-
cided against removing his teeth and
didn’t receive further treatment.
By the time Dr. Favreau examined
him, the man couldn’t even open his
mouth—and the pain had become
excruciating. Sadly, the beard he had
grown could not disguise his disfig-
urement. When the skin breakdown
was too obvious, he decided to hide
the cancer under gauze taped to that
side of his face. Sadly, the cancer took
over almost half of his face.
“I ordered a CAT scan of his head,
abdomen, and lungs and an aspira-
tion biopsy. These exams revealed
multiple nodules inside his lungs. The
diagnosis was proven histologically
to be metastatic basal-cell carcinoma,
wherein the cancer is able to grow at
sites distant from the primary site of
origin,” she said. “Only 0.003 percent
of the population worldwide has been
diagnosed with this form of cancer.”
The patient was only 41 years old,
but the disease had developed too far
to cure him. “We helped him with
pain medication and high doses of
morphine. The beautiful thing about
the whole situation is that it brought
his family closer together, despite the
sad situation,” Dr. Favreau said. A
report she later authored about the
experience led to a $15,000 grant.
“I enjoy regular dermatology, the bread-and-butter cases of acne, eczema, contact dermatitis, or
psoriasis, but I really like the hard-to-solve mysteries that other physicians find difficult to solve, so
they send them here to Nova Southeastern University and my team works hard to analyze these
rare diseases and discover the diagnoses and treatment plans,” Dr. Favreau explained.
Drs. Tracy Favreau (left)
and Jacqueline Thomas
working with a patient
