A 70-year-old woman is referred for evaluation of a skin lesion situated on her right temple. She states that the site first became apparent ~1 year ago and has steadily increased in size. Recently the area has started to bleed. The patient notes a history of skin cancer removed from her left arm several years ago as well as liquid nitrogen treatment of precancerous skin growths affecting her cheeks and hands. Examination reveals an erythematous, fibrotic plaque with a depressed center.
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Biopsy of the lesion revealed a morpheaform basal cell carcinoma (mBCC), which is an infrequently encountered variant of BCC representing under 10% of all cases.1 Also termed sclerosing BCC, lesions may be scar-like in appearance and classically present as a solitary, erythematous to porcelain-white indurated plaque with an ill-defined border and depressed center. Telangiectasias are often absent.
Dermoscopic examination is nonspecific and may reveal structureless hypopigmentation along with arborizing vessels.2 Diagnosis is confirmed by histology, which demonstrates narrow strands of basaloid cells interspersed with dense collagen.
Morpheaform basal cell carcinoma is associated with aggressive growth characteristics and if neglected may result in extensive local tissue destruction. It is considered a high-risk tumor and will recur if not adequately excised.3 As such, Mohs microscopically-controlled excision is the preferred treatment modality.4
Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
1. Scrivener Y, Grosshans E, Cribier B. Variations of basal cell carcinomas according to gender, age, location and histopathological subtype. Br J Dermatol. 2002;147(1):41-47. doi:10.1046/j.1365-2133.2002.04804.x
2. Reiter O, Mimouni I, Dusza S, Halpern AC, Leshem YA, Marghoob AA. Dermoscopic features of basal cell carcinoma and its subtypes: a systematic review. J Am Acad Dermatol. 2021;85(3):653-664. doi:10.1016/j.jaad.2019.11.008
3. Duarte B, Vieira L, Pessoa E Costa T, et al. Predicting incomplete basal cell carcinoma excisions – a large multidisciplinary retrospective analysis in a tertiary center. J Dermatolog Treat. 2020;31(6):583-588. doi:10.1080/09546634.2019.1687815
4. Kim JYS, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018;78(3):540-559. doi:10.1016/j.jaad.2017.10.006