Poornima Bukke

Title : Expect the unexpected: An unusual occurrence of basal cell carcinoma in two distinct cases

Abstract:

Background: Basal cell carcinoma (BCC) is the most common malignant cutaneous neoplasm worldwide (80-90%), typically associated with sun exposure. Congenital melanocytic naevi (CMN) are common skin lesions harbouring the risk of malignant transformation, usually melanoma or other malignancies reflecting the nevus’ cell lines. However, occurrence of BCC on congenital melanocytic nevi (CMN) is an unexpected and infrequently documented phenomenon, with only one case of BCC on CMN that has been reported in 2017. We present two unique cases that defy conventional expectations: BCC arising on a CMN and BCC mimicking squamous cell carcinoma (SCC).
Case Report One: A 61-year-old female presented with a clearly demarcated hyperpigmented plaque with central ulceration over face. The lesion was present since childhood. Initially asymptomatic, the lesion evolved into a symptomatic state over the past 5 months. A provisional diagnosis of malignant melanoma on CMN was made. Dermoscopy revealed ambiguous findings. Surprisingly, histopathological examination was indicative of an Adenoid Basal Cell Carcinoma.
Case Report Two: A 88 year old male patient presented with a well-defined hyperpigmented plaque with central depigmentation and ulceration over face. Initially asymptomatic, the lesion evolved into a symptomatic state over the past 6 months. A provisional diagnosis of squamous cell carcinoma was made with a differential diagnosis of basal cell carcinoma. Dermoscopy revealed ambiguous findings. Histopathological examination indicated a Basal Cell Carcinoma.

Audience Take Away Notes:

• The occurence of BCC in such scenarios is a rareity
• These case reports underscore the necessity for heightened awareness among dermatologists regarding the potential for BCC to present in atypical scenarios
• Urges the need for a high index of suspcion
• Reemphasizes the importance of  our age old biopsy in an era of digitalization
• Urges the need for a high index of suspcion especially in cases of clinical and dermoscopic dilemma.
•  No conflicts of interest

Biography:

Dr. Poornima Bukke, a second year dermatology resident at RVM Institute of Medical Science and Research Centre, Hyderabad, India. She graduated with distinction from Osmania Medical College. She is a member of IADVL National Resident Committee(NRC) 2024 and has worked as the South Zone Coordinator for the NRC 2023. With a penchant for dermatosurgery, clinical and cosmetic dermatology, she presented papers and posters at national and state conferences. She spoke on ‘Navigating Opportunities in Dermatology: A guide to stay updated’ at DERMACON 2024. Beyond medicine, she's an avid reader and basketball player, embodying a passionate enthusiasm for entrepreneurship and technology.