Pigmented Nodular Basal Cell Carcinoma from a Congenital Melanocytic Nevus in a 68-year old female

Authors: Angela E. Sison MD, Joanne Kate M. Martinez MD, Karla Phoebe B. Castaños MD

Abstract

Introduction: Basal cell carcinoma (BCC) is the most common skin malignancy seen in sun-exposed areas. Pigmented nodular basal cell carcinoma (PBCC) is a clinical and histologic variant of BCC. Aside from displaying features seen in nodular BCC, it also contains increased brown or black pigment, the presence of which makes it necessary to rule out melanoma. Congenital melanocytic nevi (CMN), on the other hand, are common skin lesions that carry a risk of malignant transformation, especially melanoma.

Case Report: We report a case of a 68-year old female with a congenital well-defined light-brown macule measuring approximately 3 mm at the right deltoid area. It has been stable ever since until in a span of 1 year, the macule gradually increased in size associated with pruritus and easy bleeding upon minor trauma and progressing to become ulcerated. Dermoscopically, multiple gray globules, blue-gray ovoid nests, arborizing vessels, and micro-ulcerations were seen while histologically, it showed clusters of basaloid cells with palisading of nuclei. Artefactual retraction spaces between the tumor and stroma as well as pigment-containing cells were also noted. These findings are consistent with PBCC. The patient was treated with standard excision.

Conclusion: PBCC from a CMN is a rarity. Prompt diagnosis and management gives  a favorable prognosis. Though CMN is a common skin lesion capable of transforming into a malignancy, to the best of our knowledge, PBCC arising from them has rarely been reported.

 

Citation

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Keywords

basal cell carcinoma, pigmented basal cell carcinoma, pigmented nodular basal cell carcinoma

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