pigmented basal cell carcinoma

Pigmented Basal Cell Carcinoma: A Rare Form of Skin Cancer

Pigmented basal cell carcinoma (BCC) is a rare variant of non-melanoma skin cancer, accounting for only 6% of all BCC cases [1]. This type of skin cancer is characterized by its pigmentation, where an area of the skin becomes darker than the surrounding skin.

Key Features:

• Pigmentation: Pigmented BCC exhibits increased pigmentation, making it more noticeable on dark-skinned individuals, particularly Asians [8].
• Firm Consistency: The tumor has a firm consistency and may be translucence with occasional surface ulceration [7].
• Dermoscopic Features: Absence of pigment network, linear, and arborising (branch-like) structures are characteristic dermoscopic features of pigmented BCC [9].

Prevalence:

Pigmented basal cell carcinoma is a relatively rare form of skin cancer, but it can occur in any individual. In the United States alone, an estimated 3.6 million cases of BCC are diagnosed each year, with pigmented BCC being a small fraction of these cases [5].

Treatment Options:

When treating pigmented basal cell carcinoma, healthcare providers consider various factors, including the size, location, and extent of the lesion, as well as the patient's overall health and preferences. Common treatment options for pigmented BCC include surgical excision, Mohs surgery, and topical treatments [10].

References:

[1] Deepadarshan K (2013) - Pigmented basal cell carcinoma is a clinical and histological variant of basal cell carcinoma that exhibits increased pigmentation. [5] Jain M (2012) - Basal cell carcinoma (BCC) is the most common form of skin cancer and the most frequently occurring form of all cancers. [7] Coleman CI (2013) - Pigmented BCC is marked by its firm consistency, translucence, and occasional surface ulceration. [8] - Pigmented basal cell carcinoma occurs in dark-skinned individuals, particularly Asians. [9] - Absence of pigment network, linear, and arborising structures are characteristic dermoscopic features of pigmented BCC. [10] - Treatment options for pigmented basal cell carcinoma include surgical excision, Mohs surgery, and topical treatments.

Recognizing Pigmented Basal Cell Carcinoma

Pigmented basal cell carcinoma (BCC) is a rare type of skin cancer that can be mistaken for other conditions, such as melanoma or moles. To identify pigmented BCC, look out for the following signs and symptoms:

• Changes in Pigmentation: Pigmented BCC often presents as a brown, blue, or black lesion on the skin, which may resemble a mole or melanoma [2].
• Hyperpigmentation: This type of BCC causes hyperpigmentation, which is an area of skin that becomes darker than the surrounding skin [4].
• Lesions and Patches: Basal cell carcinomas can have different looks, but pigmented BCC often presents as a brown or black lesion on the skin [12].

Other Warning Signs

In addition to these specific signs and symptoms, it's essential to be aware of other warning signs that may indicate basal cell carcinoma. These include:

• Open Sore: An open sore that doesn't heal, which might ooze liquid or blood or form a crust [12].
• Bumps, Lesions, and Patches: Basal cell carcinomas can present as bumps, lesions, or patches on the skin [13].

Risk Factors

Pigmented basal cell carcinoma is often caused by long-term exposure to ultraviolet (UV) radiation from sunlight. This type of skin cancer is more common in people with darker skin tones.

• UV Radiation Exposure: UV radiation exposure is a significant risk factor for developing pigmented BCC [1].
• Darker Skin Tones: In patients with darker skin, about half of BCCs are pigmented [5].

Early Detection

Early detection and prompt treatment are crucial in managing basal cell carcinoma. If you notice any unusual changes on your skin, consult a dermatologist for an accurate diagnosis and treatment plan.

References:

[1] Most basal cell carcinomas are thought to be caused by long-term exposure to ultraviolet (UV) radiation from sunlight [1]. [2] Symptoms and Signs of Pigmented Basal Cell Carcinoma. Recognizing pigmented basal cell carcinoma (BCC) symptoms and signs is crucial for early detection and prompt treatment [2]. [3] Frequently, two or more of these warning signs and symptoms are apparent in a BCC tumor [3]. [4] Pigmented: This is a rare symptom of basal cell cancer that causes irritation [11]. [5] In patients with darker skin, about half of BCCs are pigmented [5]. [12] Basal Cell Carcinoma Symptoms. Basal cell carcinomas can have different looks [12]. [13] Basal cell carcinoma (BCC) is the most common skin cancer, occurring in the basal (lower) cell layer of the skin [13].

Diagnosing Pigmented Basal Cell Carcinoma

Pigmented basal cell carcinoma (BCC) is a type of skin cancer that can be challenging to diagnose, especially when it presents with pigmentation. Here are some diagnostic tests and methods used to confirm the diagnosis:

• Biopsy: A biopsy is often required to confirm the diagnosis of pigmented BCC. This involves taking a sample of the suspicious lesion and sending it to a pathologist for further evaluation in a lab [9].
• Dermoscopy: Dermoscopy, also known as skin microscopy, can be helpful in diagnosing pigmented BCC. It allows dermatologists to examine the skin lesion in detail and identify specific features such as arborizing vessels, blue-gray ovoid nests, and ulceration [14][4].
• Clinical evaluation: A thorough clinical evaluation by a dermatologist is essential in diagnosing pigmented BCC. This includes examining the skin lesion for its size, shape, color, and texture, as well as assessing any changes over time [2].
• Imaging tests: While imaging tests are not typically required for basal cell carcinoma, they may be used in some cases to rule out other conditions or to assess the extent of disease spread. However, it's worth noting that pigmented BCC is a low-risk type of skin cancer and most people with this condition do not require imaging tests [11].

Key Features of Pigmented Basal Cell Carcinoma

Pigmented basal cell carcinoma can present with several key features, including:

• Nodular growth: The tumor cells in pigmented BCC often form large groups called "nodules" in a layer of the skin called the dermis [10].
• Pigmentation: Pigmented BCC is characterized by its distinctive pigmentation, which can range from brown to gray-blue [7][13].
• Vascular structures: Dermoscopy may reveal specific vascular structures such as arborizing vessels and blue-gray ovoid nests in pigmented BCC [14].

References

[2] Early detection and accurate diagnosis of pigmented basal cell carcinoma are crucial for initiating timely treatment and preventing disease progression.

[4] Several algorithms have been created for the dermoscopic diagnosis of basal cell carcinoma (BCC), based mainly on the identification of vascular structures, such as arborizing vessels, pigmented structures, such as blue-gray ovoid nests, and ulceration.

[7] Pigmented basal cell carcinoma typically has a nodular growth pattern and may exhibit stippled pigment.

[9] A biopsy is often required to confirm the diagnosis of pigmented BCC.

[10] The tumor cells in pigmented BCC often form large groups called "nodules" in a layer of the skin called the dermis.

[11] It's not common for squamous cell cancer to spread deeply below the skin or to other parts of the body, and even less common for basal cell cancers, so most people with these skin cancers don’t need imaging tests.

[13] Basal cell carcinoma (BCC), the most common form of skin cancer in Caucasians, will affect about two million Americans this year.

[14] Several algorithms have been created for the dermoscopic diagnosis of basal cell carcinoma (BCC), based mainly on the identification of vascular structures, such as arborizing vessels, pigmented structures, such as blue-gray ovoid nests, and ulceration.

Treatment Options for Pigmented Basal Cell Carcinoma

Pigmented basal cell carcinoma (BCC) is a rare form of non-melanoma skin cancer, accounting for only 6% of all BCC cases [4]. While surgery and radiation therapy are common treatment options for BCC, targeted drug therapies have emerged as effective alternatives, particularly in cases where the cancer has spread or cannot be cured with traditional methods.

Targeted Drug Therapies

In rare instances where basal cell carcinoma spreads to other parts of the body or cannot be treated with surgery or radiation therapy, targeted drugs such as vismodegib (Erivedge) [5] and cemiplimab may be considered. These medications target specific weaknesses present within cancer cells, allowing the immune system to attack and kill them.

• Cemiplimab: This drug blocks a particular checkpoint called PD-1 from working, enabling the immune system to release massive amounts of T cells to attack and kill cancer cells [3].
• Vismodegib (Erivedge): As a targeted drug therapy, vismodegib has shown effectiveness in treating basal cell carcinoma that cannot be cured with surgery or radiation therapy [5].

Other Treatment Options

While targeted drug therapies are available for pigmented BCC, other treatment options may also be considered, depending on the size, location, and extent of the lesion, as well as the patient's overall health and preferences.

• Surgery: The standard treatment for most basal cell carcinomas is surgery, which allows excision margin control and shows a low risk of recurrence [11].
• Radiation therapy: This treatment option has shown exceptional results in treating pigmented BCC without surgery or major side effects [4].

Photodynamic Therapy (PDT)

A non-invasive treatment, photodynamic therapy (PDT) selectively destroys tumor cells and tissues via the interaction of a photosensitizer, light, and molecular oxygen. This review summarizes the effectiveness of PDT in treating the pigmented subtype of basal cell carcinoma based on current literature [13].

Imiquimod

As a monotherapy, imiquimod has shown cure rates ranging from 70% to 100% with twice-daily, once-daily, and thrice-weekly regimens for both superficial and nodular BCCs [6].

Differential Diagnosis of Pigmented Basal Cell Carcinoma

Pigmented basal cell carcinoma (BCC) can be challenging to diagnose due to its similarity in appearance to other skin lesions, such as melanoma. The differential diagnosis for pigmented BCC includes:

• Melanoma: A type of skin cancer that originates from melanocytes. Melanomas can also be pigmented and may mimic the appearance of pigmented BCC.
• Seborrheic keratosis: A benign skin growth that can appear as a brown or black spot, similar to pigmented BCC.
• Pigmented actinic keratosis: A type of sun damage that can cause pigmentation in the skin, which may be mistaken for pigmented BCC.

Key Features to Distinguish Pigmented BCC from Other Conditions

To accurately diagnose pigmented BCC, it is essential to consider the following features:

• Pigment flecks around the base of the nodule: In pigmented BCC, there are often pigment flecks around the base of the nodule that are absent in melanoma.
• Blue globules of pigment: Dermoscopy of pigmented BCCs may reveal blue globules of pigment, which are not typically seen in other conditions.
• Gray and blue ovoid nests: Pigmented BCCs may also exhibit gray and blue ovoid nests, which can help distinguish them from other skin lesions.

Importance of Accurate Diagnosis

Accurate diagnosis of pigmented BCC is crucial to prevent misdiagnosis and ensure proper treatment. A dermatologist or a qualified healthcare professional should be consulted for an accurate diagnosis and treatment plan.

References:

• [3] Basal Cell Carcinoma Differential Diagnoses
• [5] Nodular basal cell carcinoma, especially when pigmented, can be in differential diagnosis with nodular melanomas, clinically and dermoscopically.
• [8] The differentiating feature, if completely pigmented, is that there are pigment flecks around the base of the nodule that are absent in melanoma.
• [13] Dermoscopy of pigmented BCCs revealed blue globules of pigment (p<0.05), gray and blue ovoid nests, which were absent in the entire non-pigmented carcinomas group.