Clinicalimage: An unusual pigmented basal cell carcinoma arisingfrom vulva
R. Yaghoobi, T. Razi, A. Feily
KEY WORDS
pigmented BCC, vulva
Basal cell carcinoma (BCC) is the most common human malignancy. It occurs most often in elderly patients on the sun-exposed skin of the head and neck (1). It accounts for approximately 75% of all non-melanoma skin cancer and is uncommon on unexposed skin such as the genital and perianal region (2). We report a 78-year-old otherwise healthy woman that was seen with a pigmented lesion originating on the right vulva. The lesion had started as a small macula 20 years ago. It later became pigmented and extensive and transformed into a large, neglected pigmented patch on the right side of the vulva. Physical examination was notable for a 2 X 4 cm, well-demarcated and pigmented patch on the right labium majus. A biopsy specimen was obtained and the lesion was diagnosed histopatho-logically as a pigmented basal cell carcinoma. The patient underwent a wide radical local excision and ipsi-lateral superficial inguinal lymph node dissection.
BCCs can develop in sun-protected areas (3). The most important factor in the pathogenesis of BCC is lifetime ultraviolet radiation damage, but the etiology of BCC in sun-protected areas remains unknown and some factor other than ultraviolet radiation seems to be involved (3, 4). Although BCCs can develop in sun-protected areas, genital involvement is very rare, accounting for fewer than 1% of all cases (4, 5). Impor-
tantly, BCC accounts for 2 to 4% of all vulvar cancers, it occurs most commonly in post-menopausal women, and approximately 200 cases have been reported in the literature (4, 5). Notably, vulvar BCCs are usually diagnosed late because they are often asymptomatic and grow at slow rates (4). In additional, vulvar BCC may be locally invasive and destructive, and the local recurrence rate is as high as 20% in some series after simple excision. Metastases have also been reported (4—6). Reasonably early diagnosis and treatment are essential. The patient we profile here had a neglected
Figure 1. Pigmented basal cell carcinoma located on the vulva in a 78-year-old woman.
case of vulvar BCC that was diagnosed and treated after 20 years of development. Accordingly, because of
Figure 2. Superficial location of BCC tumor nests with peripheral palisading nuclei (Hema-toxylin-eosin stain X40).
the high probability of a local recurrence mentioned above, close long-term follow-up is necessary.
Figure 3. BCC cells originate from the basal layer of the epidermis, grow in a serpiginous fashion, and form solid-pigmented nests. (Hematoxylin-eosin stain X100).
References -
1.	Gibson GE, Ahmed I. Perianal and genital basal cell carcinoma: a clinicopathologic review of 51 cases. J Am Acad Dermatol. 2001;45:68-71.
2.	Pisani C, Poggiali S, De Padova L, Andreassi A, Bilenchi R. Basal cell carcinoma of the vulva. J Eur Acad Dermatol Venereol. 2006 Apr;20(4):446-8.
3.	Giorgi V, Salvini C, Massi D, Raspollini MR, Carli P. Vulvar basal cell carcinoma: retrospective study and review ofliterature. Gynecol Oncol. 2005;97:192-4.
4.	Asuman C, Ozlem A, Burgak T, Onder P. An unusual location of basal cell carcinoma: the clitoris and the vulva. Indian J Dermatol. 2008;53(4):192-4.
5.	Mulayim N, Sliver DF, Ocal IT, et al. Vulvar basal cell carcinoma: two unusual presentations and review of the literature. Gynecol Oncol. 2002;85:532-7.
6.	Miller ES, Fairley JA, Neuburg M. Vulvar basal cell carcinoma. Dermatol Surg. 1997;23:207-9.
authors ' Amir Feily, Skin and Stem Cell Research Center, Tehran University of addresses Medical Sciences, Tehran, Iran.
Jundishapur University ofMedicalSciences, Ahvaz, Iran, corresponding author, E-mail: dr.feily@yahoo.com
Reza Yaghoobi,MD,professor ofDermatology, Department of Dermatology,
same address, E-mail: Yaghoobi_rz@yahoo.com
Taghi Razi,MD, Associate Professor ofObstetrics and Gynecology,
Department ofObstetrics and Gynecology, same address, E-mail:
dr. taghirazi@gmail.com