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