Basal Cell Carcinoma With Calcification: Case Report of Calcifying Basal Cell Carcinoma and Review of Calcinosis Cutis Associated With Basal Cell Carcinoma

Abstract

Basal cell carcinoma is the most common cutaneous neoplasm. Calcinosis cutis is the deposition of calcium within the dermis. An 80-year-old man presented with a pearly nodule on his left nasal ala; a shave biopsy confirmed the diagnosis of a nodular basal cell carcinoma with calcinosis cutis, which was removed with Mohs micrographic surgery. The incidence of basal cell carcinoma with calcinosis cutis as well as the classification, identification, and potential origin of calcium deposits in basal cell carcinoma are discussed. Basal cell carcinoma can be associated with calcinosis cutis; indeed, calcifying basal cell carcinoma has a calculated incidence of 14%. There are five categories of calcification in basal cell carcinoma. In addition, calcification observed in cancer-free initial sections of a suspected basal cell carcinoma may be a diagnostic clue that a neoplasm is present in deeper sections of the tissue specimen. Although nodular basal cell carcinoma has the greatest incidence (37%) of calcium deposition, infiltrative (29%) and micronodular (27%) basal cell carcinomas are also frequently associated with calcification; therefore, the presence of calcifying basal cell carcinoma may indicate a more aggressive tumor subtype. Basal cell carcinoma may also be suspected in the differential diagnosis of a superficial breast neoplasm in which calcification is observed in the dermis; in this situation, mammography has been an effective diagnostic approach for identifying the basal cell carcinoma with calcification. The pathogenesis of calcification in basal cell carcinoma remains to be definitively established; however, calcium-binding proteins found in poorly differentiated keratinocytes may contribute to the etiology of basal cell carcinoma with calcification. The treatment of basal cell carcinomas with calcinosis cutis is similar to that of non-calcifying basal cell carcinomas; it is based upon the histologic subtype, the size, and the location of the tumor.

Idiopathic calcinosis cutis with unusual histomorphology and negative von Kossa stain: A diagnostic pitfall

“…Calciphylaxis is associated with a particularly grim prognosis [1]. A list of diagnoses and pathologic processes associated with these CC subtypes is detailed elsewhere (Table 1) [1,2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Though our patient did not have autoimmune titers or recent serum calcium or phosphate levels, he also did not have clinical findings which would suggest a CTD or other systemic process.…”

Dystrophic calcinosis cutis in a patient with cutaneous sarcoidosis in remission

“…In addition, benign tumours associated with hair follicles such as pilomatricomas, trichilemmal cysts, and trichoepitheliomas also display calcinosis cutis 2 . Even when initial superficial histological sections of a tissue specimen revealed only calcium deposition in the dermis, malignant or benign tumours with calcinosis cutis could be found in deeper section 1 . Therefore, we made deeper sections and carefully reconfirmed that there was no histological finding of BCC or other tumours.…”

“…Given the patient's age, location of the skin lesions, and dermoscopic findings, BCC would be an important differential diagnosis in this case. It has been reported that the calculated incidence of BCC with calcinosis cutis is 14% 1 . In addition, benign tumours associated with hair follicles such as pilomatricomas, trichilemmal cysts, and trichoepitheliomas also display calcinosis cutis 2 .…”

“…It has been reported that the calculated incidence of BCC with calcinosis cutis is 14%. 1 In addition, benign tumours associated with hair follicles such as pilomatricomas, trichilemmal cysts, and trichoepitheliomas also display calcinosis cutis. 2 Even when initial superficial histological sections of a tissue specimen revealed only calcium deposition in the dermis, malignant or benign tumours with calcinosis cutis could be found in deeper section.…”

“… 2 Even when initial superficial histological sections of a tissue specimen revealed only calcium deposition in the dermis, malignant or benign tumours with calcinosis cutis could be found in deeper section. 1 Therefore, we made deeper sections and carefully reconfirmed that there was no histological finding of BCC or other tumours. In addition, idiopathic milia‐like idiopathic calcinosis cutis (MICC) and subepidermal calcified nodule (SCN) are also important differential diagnoses.…”