ARTICLE
A 70-year-old, otherwise healthy man presented a pedunculated, partly
ulcerated tumor (Figs. 1 and
2) on the anterior aspect of his chest. The tumor measured
approximately 2 x 3 cm and was solid on palpation. The patient reported,
that the tumor had developed over several months. Several episodes of
spontaneous bleeding had occurred. At the site of the tumor no previous
trauma or scar was noted. Surgical exision was performed and the diagnosis
was established by histopathological examination.
Diagnosis: fungoid basal
cell carcinoma
Histopathologically the tumor showed typical features of basal cell
carcinoma. The aggregation of neoplastic cells showed mainly a solid growth
pattern with a palisade arrangement of the peripheral cell
layer. The tumor masses were clearly demarcated by small clefts in a dense
surrounding connective tissue (Fig.
3). Some cystic spaces were formed as a result of disintegration
of tumor cells. The von Kossa stain revealed foci of calcification.
Comment
Basal cell carcinomas may vary considerably with regard to their clinical
or histopathological appearance [1]. In this case the clinical appearance
was unusual.
In contrast to common basal cell carcinomas
that usually develop on sun exposed skin, fungoid basal cell carcinomas
appear to involve any region of the body [2]. The histopathological features
and the degree of aggressiveness are similar to those of common basal
cell carcinomas. Because of its unusual clinical appearance, this tumor
variant is sometimes misdiagnosed as, for example, an exophytic malignant
melanoma or an angiosarcoma. The presence of telangiectasias or ulceration
are hints for the correct clinical diagnosis. In any case, histopathological
examination will establish the diagnosis.
REFERENCES
1. Salfeld K. Die klinische Vielfalt der Basaliome. In: Eichmann F, Schnyder,
eds. Das Basaliom. Der häufigste Tumor der Haut. Berlin: Springer,
1981: 1-15.
2. Effendy I, van de Venne C. Kasuistik des fungösen Basalioms.
Hautarzt 1988; 39: 584-6.
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