Subcutaneous Basal Cell Carcinoma: A Case Report

Abstract

An unusual case of a patient who presented with a subcutaneous soft tissue lesion of the back is described. The patient had no preceding history of cutaneous malignancy or local trauma. Excision of the lesion revealed a diagnosis consistent with basal cell carcinoma with deep infiltration. The site was re-excised with a generous margin to ensure complete removal. There has been no recurrence for 18 months. This case is presented to underscore the rarity and importance of its existence.Key Words: Basal cell cancer; Subcutaneous; Subdermal Rapport de cas d'un carcinome basocellulaire sous-cutané Est décrit le cas inhabituel d'un patient qui s'est présenté avec une lésion des tissus mous sous-cutanés dans le dos. Le patient ne présentait aucun antécédent de malignité cutanée ou de traumatisme local. L'excision de la lésion a révélé un diagnostic confirmant la présence d'un carcinome basocellulaire avec infiltration profonde. Une nouvelle excision, comportant une marge plus importante, a été effectuée au foyer de la lésion afin d'en garantir l'extraction complète. Aucune récurrence ne s'est manifestée depuis 18 mois. Ce cas est présenté pour en souligner la rareté et l'importance. B asal cell carcinoma (BCC) is the most common cutaneous malignancy that humans acquire in the course of a lifetime (1). Approximately 85% of all BCCs appear in the head and neck region, with only 10% occurring in the torso and trunk (2,3). Basal cell lesions that occur in areas not exposed to the sun occasionally have a propensity for aggressive and locally invasive behavior. This characteristic underscores the importance of wide local excision to achieve excisional control and to avoid recurrence. The following report depicts an unusual case of a patient who presented with a subcutaneous soft tissue lesion of the back. Excision of the lesion revealed a diagnosis consistent with basal cell carcinoma with deep infiltration. CASE PRESENTATIONA 21-year-old white woman presented in June 2000 with a soft tissue mass near the midline of the upper back. The lesion had been slowly enlarging over the preceding six months to the point that it was noticeable to the patient during activities of daily living. There was no pain or tenderness associated with the mass. On physical examination, a 1.2 cm × 1.2 cm subcutaneous lesion was identified with no evidence of overlying skin abnormality. A presumptive diagnosis of lipoma was made followed by its direct excision. During the surgical resection, dissection was more arduous; the specimen exhibited a deeper color and did not have the discrete boundaries that are often seen with lipomas. Serial pathological sections revealed an intact epidermis with a deeply infiltrating BCC at the level of the dermis. The tumour reached both lateral lines of resection, including the deep subcutaneous margin. Mitotic figures were not attached to the epidermis. After confirmation of the diagnosis from a second pathologist, the patient was returned to the operating theatre for re-excision. A wide resection of the lesion was...

Subcutaneous basal cell carcinoma

“…1 In 2003, Tenley Vouris et al reported a 21-year-old white woman who presented with a 6-month history of a slowgrowing, subcutaneous lesion, described as measuring 1.2 9 1.2 cm on her mid upper back. 2 Salih et al described a 40-year-old male Kurdish driver, who presented with a tender, mobile, round, soft mass, with a reported measurement of 4 9 2.5 cm, on the sacrococcygeal area just to the right of the midline. 3 Our case highlights that in addition to common causes such as lipoma and epidermoid cyst, rarer conditions such as subcutaneous BCC need to be considered in the differential diagnosis of a subcutaneous soft tissue mass.…”