An unusual location of basal cell carcinoma: The clitoris and the vulva

Abstract

Vulvar basal cell carcinoma (BCC) is rare, accounting for less than 5% of all vulvar neoplasms and less than 1% of all BCCs. Vulvar BCCs are usually diagnosed late because they are often asymptomatic and tend to grow at slow rates. They may be invasive and destructive if neglected or improperly treated. Nevertheless, they have a very low propensity for metastatic spread, but frequently recur after simple excision. We report a 78 year-old woman presenting with the complaint of painful vulvar ulceration and vaginal bleeding. The physical examination revealed a 3 × 2 cm indurated nodulo-ulcerative lesion involving the clitoris, both labia minora and left labium majus. The histopathology was consistent with the “solid type BCC” that invaded the subcutaneous tissue without lymph node metastasis. The patient underwent wide local excision with clitoral amputation and remained disease free at post-surgical follow-up after 18 months.

Vulvar basal cell carcinoma in a 20-year-old: Case report and review of the literature

“…The biologic behavior of BCC is that of a slow-growing tumor which is locally invasive, but confined to the dermis, allowing definitive surgical treatment with local excision or destruction. Similarly, vulvar BCC typically demonstrates a locally confined tumor (Breen et al, 1975;Mulayim et al, 2002;Asuman et al, 2008), but there is a pattern of local recurrence in up to 20% of cases which is thought to be a result of inadequate resection (De Giorgi et al, 2005;Pisani et al, 2006;Mulayim et al, 2002;Asuman et al, 2008). Metastatic disease is rare, on the order of 0.1% (Breen et al, 1975;Mulayim et al, 2002;Asuman et al, 2008).…”

“…Systemic chemotherapy is not indicated in the treatment of localized BCC, though some evidence has suggested its use in metastatic disease (Mulayim et al, 2002). Surgical excision remains the accepted treatment for primary and recurrent localized vulvar BCC (Pisani et al, 2006;Mulayim et al, 2002;Benedet et al, 1997;Feakins and Lowe, 1997;Asuman et al, 2008). Mohs micrographic surgery should be considered for challenging cases, especially if the tumor is recurrent, or if tissue sparing is required to preserve critical anatomic sites, such as the clitoris (Stiller et al, 1993).…”

“…The standard of care for treatment of BCC is wide local excision with pathologically-proven clear margins of approximately 1 cm (Pisani et al, 2006;Mulayim et al, 2002;Benedet et al, 1997;Feakins and Lowe, 1997;Asuman et al, 2008). Postoperative radiation does not appear to affect recurrence rate or overall survival and is associated with unpleasant side effects and poor cosmetic results (Mulayim et al, 2002;Feakins and Lowe, 1997).…”

Basal cell carcinoma of the vulva: a case report and systematic review of the literature

“…In most case reports, lesion size, specific anatomic site, patient age, treatment, recurrence, associated metastases, and provider specialty were available. These data were noted and tabulated yielding 96 reports in the English literature describing 437 patients with BCCs of the vulva . Of the 96 reports, 41 were published in the gynecology or gynecologic oncology literature, 29 in the dermatology literature, and 26 in nongynecology, nondermatology literature (pathology, surgery, oncology, medicine).…”

Basal Cell Carcinoma in an Unusual Site - Vulva

“…Approximately, 300 cases have been reported till date. 3,4,5 Although the aetiology of vulvar BCC is not deciphered, several predisposing factors like chronic irritation and infection, trauma, arsenic, radiotherapy and syphilis 4 have been implicated in the pathogenesis. 5,6 They are slow growing indolent tumours, but are locally invasive and destructive, necessitating adequate surgical excision.…”