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| LETTER TO THE EDITOR |
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| Year : 2016 | Volume
: 53
| Issue : 3 | Page : 380-381 |
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Pigmented basal cell carcinoma: A rare case report
K Singh1, A Sharma2, T Chatterjee1
1 Department of Pathology, 166 Military Hospital, Jammu, Jammu and Kashmir, India
2 Department of Hematology, AIIMS, New Delhi, India
| Date of Web Publication | 24-Feb-2017 |
Correspondence Address:
K Singh
Department of Pathology, 166 Military Hospital, Jammu, Jammu and Kashmir
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-509X.200673
How to cite this article:
Singh K, Sharma A, Chatterjee T. Pigmented basal cell carcinoma: A rare case report. Indian J Cancer 2016;53:380-1 |
Sir,
The histopathological examination (HPE) of pigmented lesions of skin sometimes reveals unique and interesting findings, thereby leading to change in entire treatment profile. Here, we present a rare case, presenting as pigmented lesion chest wall.
A 64-year-old dark-skinned male patient from Jammu and Kashmir reported to the Skin Outpatient Department of 166 Military Hospital, Jammu, with a chief complaint of black-colored lesion over the skin of the chest wall (left side) of more than 1 year duration with minimal itching and mild increase in size since last 3–4 months. No increase in pigmentation in the lesion was noted. There was no history of exposure to radiation.
On clinical examination, the presence of irregular hyperpigmented growth, approximately 1.8 cm × 1 cm, was noted. Growth was moderately firm and nontender. The skin around the growth was normal. Considering the history and clinical examination, a provisional diagnosis of pigmented lesion of the chest wall (left) with differential diagnosis of malignant melanoma versus basal cell carcinoma (BCC) was considered.
Incisional biopsy was performed to overcome the diagnostic dilemma and tissue was sent for HPE.
HPE showed skin tissue lined by irregularly hyperkeratotic locally stratified squamous epithelium. Underlying dermis revealed epithelial islands and nodules of basaloid cells with hyperchromatic nuclei, scanty cytoplasm, and few mitotic figures [Figure 1]a. The peripheral cells of these islands showed palisading appearance with many foci showing retraction artifact in the form of clefted spaces [Figure 2]. Melanin pigmentation was seen in overlying epithelium and within the islands. Numerous pigment-laden melanophages were noted within the stroma [Figure 1]b. The melanin pigment was confirmed by positive Fontana-Masson stain. Immunohistochemistry for S-100 was negative. The final diagnosis of pigmented BCC was made. | Figure 1: (a) The skin lining by keratinized stratified squamous epithelium showing flattened rete ridges and the presence of solid nests of atypical basaloid cells with pigmentation in the dermis (H and E, ×20). (b) Melanin pigment is present within the tumor cells and in macrophages between the islands of tumor cells (H and E, ×40)
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 | Figure 2: Nodules of proliferating atypical basaloid cells with characteristic clefting artifact between tumor nests and stroma (H and E, ×20)
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BCCs originate from the basal cells of the epidermis and are one of the most common malignant tumors of the skin. One of the peculiar characteristics of BCCs is that they rarely undergo metastasis. Pigmented BCC comprises a small proportion of BCCs that contain pigment. A histological study revealed the incidence of pigmented BCCs ranging from 6.7% to 8.5% with some racial predilection.[1] Pigmented BCC can be confused and misdiagnosed as malignant melanoma [2] because of hyperpigmentation; however, pigmented BCC is marked by its firm consistency, translucence, and occasional surface ulceration.[3] This is in line with our case, in which this tumor was confused with malignant melanoma.
The risk of primary BCCs is increased by male gender, elderly age (over 60 years), and truncal site.[4] This is in line with our case, in which this tumor was located in the chest wall in older male patient.
Tan et al. proposed the predilection for African, Hispanic, and Asian populations owing to the greater melanogenic capacity of dark-haired patients.[5] This is in line with our case, in which this tumor was diagnosed in the chest wall in dark-skinned male patient.
In our case, the diagnosis was determined by characteristic HPE findings of the benign proliferation of melanocytes throughout the basaloid tumor islands and numerous pigment-laden melanophages within the stroma.
Despite the fact that only small proportion of BCCs is pigmented, pigmented BCC should be included in the differential diagnosis of atypical pigmented lesions in patients.
This case report describes pigmented lesion chest wall suspected as malignant melanoma, finally turned out to be one of the rare variants of BCC, i.e. pigmented type. The precise and detailed knowledge of clinical and HPE of pigmented BCC and its differentials can lead to definitive diagnosis as this will immensely change the therapeutic modalities and prognosis.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | |  |
| 1. | Betti R, Gualandri L, Cerri A, Inselvini E, Crosti C. Clinical features and histologic pattern analysis of pigmented basal cell carcinomas in an Italian population. J Dermatol 1998;25:691-4.  |
| 2. | Maloney ME, Jones DB, Sexton FM. Pigmented basal cell carcinoma: Investigation of 70 cases. J Am Acad Dermatol 1992;27:74-8. |
| 3. | Bigler C, Feldman J, Hall E, Padilla RS. Pigmented basal cell carcinoma in hispanics. J Am Acad Dermatol 1996;34(5 Pt 1):751-2. |
| 4. | Lear JT, Smith AG, Heagerty AH, Bowers B, Jones PW, Gilford J, et al. Truncal site and detoxifying enzyme polymorphisms significantly reduce time to presentation of further primary cutaneous basal cell carcinoma. Carcinogenesis 1997;18:1499-503. |
| 5. | Tan WP, Tan AW, Ee HL, Kumarasinghe P, Tan SH. Melanization in basal cell carcinomas: Microscopic characterization of clinically pigmented and non-pigmented tumours. Australas J Dermatol 2008;49:202-6. |
[Figure 1], [Figure 2]
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