DermDx: Hyperpigmented Macule With Irregular Border - Clinical Advisor

DermDx: Hyperpigmented Macule With Irregular Border

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A 66-year-old Hispanic woman is referred for evaluation of a skin lesion located on her left axilla. The patient states that the lesion has been present for years and has gradually increased in size and darkened in color. She denies family and personal history of skin cancer and has never smoked or used an indoor tanning device. Upon physical examination, a 1.5 cm hyperpigmented macule with an irregular border is observed. Axillary lymph nodes are nonpalpable. Scattered nevi are noted elsewhere on her body.

The patient was diagnosed with pigmented basal cell carcinoma (BCC) after a biopsy of the lesion. BCCs are the most common form of skin cancer with more than 2 million cases diagnosed each year in the United States.1 The neoplasm...

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The patient was diagnosed with pigmented basal cell carcinoma (BCC) after a biopsy of the lesion. BCCs are the most common form of skin cancer with more than 2 million cases diagnosed each year in the United States.1 The neoplasm is usually associated with fair-skinned White individuals who often have a history of abundant sun exposure. 

Hispanic patients, defined by the US Census Bureau as “persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race,” have a broad range of skin types ranging from very dark type 4 skin to very light type 1 skin.2

Pigmented BCCs represent less than 10% of total BCC cases.3 A study by Bigler et al found that the incidence of pigmented BCCs in Hispanic patients significantly exceeded that found in White patients (66% vs 11%, respectively).4

Pigmented BCCs are often suspected on clinical examination, although recognition may be more difficult in patients with darker skin. Definitive diagnosis is made by histology, which reveals increased pigment produced by benign melanocytes interspersed throughout the tumor.5

Sara Mahmood, DPN, is a podiatry/dermatology fellow under the auspices of St. Lukes Hospital and DermDox Dermatology Centers. Stephen Schleicher, MD, is director of the DermDox Center for Dermatology in Pennsylvania, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.  

References

  1. Asgari MM, Moffet HH, Ray GT, Quesenberry CP. Trends in basal cell carcinoma incidence and identification of high-risk subgroups, 1998-2012JAMA Dermatol. 2015;151(9):976-981. doi:10.1001/jamadermatol.2015.1188
  2. US Census. Hispanic or Latino origin. Accessed January 7, 2021. https://www.census.gov/quickfacts/fact/note/US/RHI725219
  3. Nouri K, Ballard CJ, Patel AR, Brasie RA. Skin cancer. In: Nouri K, ed. Basal Cell Carcinoma. McGraw Hill; 2007:61-85.
  4. Bigler C, Feldman J, Hall E, Padilla RS. Pigmented basal cell carcinoma in HispanicsJ Am Acad Dermatol. 1996;34(5 Pt 1):751-752. doi:10.1016/s0190-9622(96)90007-9
  5. Deepadarshan K, Mallikarjun M, Noshin NA. Pigmented basal cell carcinoma: a clinical variant, report of two cases. J Clin Diagn Res. 2013;7(12):3010-3011. doi: 10.7860/JCDR/2013/7568.3831
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