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Basal cell carcinoma (BCC) is the most common skin cancer. The gold standard therapy for BCC is surgery. Mohs micrographic surgery is the treatment of choice for those BCCs with high risk for recurrence because Mohs micrographic surgery provides the highest cure rates. Ibrutinib is an agent that irreversibly inhibits “Bruton’s kinase” which is an essential tyrosine kinase for B lymphocyte signalization. Ibrutinib is used for the treatment of chronic lymphocytic leukemia (CLL) and other B cell lymphomas. Traditional oral anticoagulants and antiplatelet drugs including aspirin, warfarin and clopidogrel are very well-known drugs that cause bleeding complications during dermatologic surgery and are routinely checked before surgery in daily practice. However, it is not well known that ibrutinib has similar bleeding side effects.

Ibrutinib-associated hematoma and ecchymosis in a patient with basal cell carcinoma who underwent Mohs micrographic surgery