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We report a patient with unilateral basal cell carcinomas successfully treated with photodynamic therapy. This uncommon entity represents a diagnostic challenge in its inherent absence of the classic clinical and radiographic findings of nevoid basal cell carcinoma syndrome. Like nevoid basal cell carcinoma syndrome, unilateral basal cell carcinomas poses a therapeutic challenge with the sheer number of cutaneous tumors. The use of photodynamic therapy carries a proven therapeutic efficacy, a low rate of adverse events and excellent cosmesis.

We describe an infant with propionic acidemia who developed a generalized exfoliative eruption. Preceding the eruption, he was on an amino acid restricted formula. Within days of liberalizing his restricted diet, the eruption resolved completely. A similar dermatitis has been reported in infants with inborn errors of metabolism who were on amino acid modified formulas. However, in most instances, the eruption was predominantly limited to the periorificial regions. Most critical in the etiology of cutaneous eruptions in these patients is low serum isoleucine. Amino acid malnutrition should be considered in the differential diagnosis of generalized exfoliative dermatosis in an infant. Supplementation with isoleucine-containing dietary proteins results in rapid clinical resolution.

We report a patient with unilateral basal cell carcinomas successfully treated with photodynamic therapy. This uncommon entity represents a diagnostic challenge in its inherent absence of the classic clinical and radiographic findings of nevoid basal cell carcinoma syndrome. Like nevoid basal cell carcinoma syndrome, unilateral basal cell carcinomas poses a therapeutic challenge with the sheer number of cutaneous tumors. The use of photodynamic therapy carries a proven therapeutic efficacy, a low rate of adverse events and excellent cosmesis.

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A 5-year-old boy from Bolivia who had arrived in Spain only 15 days previously was referred to our department with a 3-week history of worsening cutaneous lesions. The lesions started with erythema and induration, and gradually progressed to become ulcerative plaques localized on his right leg, lumbar region, right temple, and right eyebrow. All lesions were asymptomatic and the patient was afebrile.Examination of the lumbar region demonstrated a 5 cm erythematous, indurated plaque containing small punched-out ulcers with a yellow base. A similar, smaller lesion was nearby. On the right leg he had a large indurated plaque with extensive ulceration (Fig. 1). Similar plaques on the right temple and right eyebrow had superficial yellow crusting. Examination of the oral cavity revealed black tooth remnants, and two yellow papules on the upper gingiva (Fig. 2).Lymphadenopathy was found in the right groin. Ear, nose, and throat examinations showed no abnormality. Complete blood count, liver function tests, glucose, urea, creatinine, lipoproteins, and protein electrophoresis were within normal range. Chest radiograph was unremarkable. Mantoux skin test, leishmania serology, and cultures from surface swabs for mycobacteria and leishmania were all negative. Skin biopsy was performed. On the basis of the findings (Fig. 3) further investigations were undertaken.

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