Title of presentation- Suprapubic Basal cell carcinoma- A RARE CASE REPORT.
Abstract
Basal cell carcinoma (BCC) is the most common malignancy. BCC predominantly occurs on sun exposed and sun damaged skin and BCC affecting the lower abdomen is extremely uncommon. Only 10 percent of all BCC’s occur on trunk.
We report the case of a 45-year-old female who presented with a BCC measuring 2 by 2 cm. Excision of skin with wide margin of 1cm was done and the defect was closed by primary closure.
Introduction: –
Basal cell carcinoma (BCC) is the most common paraneoplastic disease in the human neoplasms. The tumor affects mainly sunlight exposed areas, most often in the head and seldom appears on genitalia and peri genital region. BCC shows slow progression and metastases are found in less than 0.5% of the cases; however, significant local destruction and mutilation could be observed when treatment is neglected or inadequate. Different variants of BCC are nodular, cystic, micro nodular, superficial, pigmented described in literature and the differential diagnosis in some cases could be difficult. The staging of BCC is done by following Tumor, Node, Metastasis (TNM) classification and is essential for the adequate treatment. Numerous therapeutic modalities are available for treatment of BCC, with their respective advantages or disadvantages, but do not absolutely remove the risk of relapse. Early diagnosis based on good knowledge and timely organized treatment is a precondition for better prognosis. Despite the slow growth and availability of numerous treatment methods, the basal cell carcinoma should not be underestimated.
We present a patient who was operated on for suprapubic BCC. This case allows us to review and discuss BCC occurrence and management.
Case report
A 45-year-old female was admitted with complaint of small ulcer on lower abdomen on suprapubic region. It was non healing, with raised edges, hard in consistency. The original lesion was provisionally diagnosed as an infected mole and excised at a peripheral center. On biopsy of the mole it was diagnosed as nodular basal cell carcinoma with positive resected margins.
She had no history of disease like D.M., H.T., or tuberculosis.
On physical examination a 2×2 cm ulcer on suprapubic area. The ulcer base was mobile with no fixity to underlying structures. The ulcer had characteristic rolled out margins. Preoperative assessment was done and was fixed for surgery.
During surgery wide excision of the ulcer was done, the tumor involved skin and subcutaneous tissue. The underlying fascia was free. The abdominal skin was lax. Primary closure was done in layers with placement of rhombovac drain which was removed after one day. Her postoperative course was uneventful and she was discharged.
Discussion
The BCC affects mainly sun exposed areas, in about 80% of patients the lesion appears in the head, and in half of them affects the cheeks and the nose. [1] The other sun exposed areas like the trunk and limbs are less affected and in only 4% of patients lesions can appear on genitals and perianal area. [2]
The main etiological agent responsible for BCC is the chronic UV exposure consisting of mostly UVB rays with length 290-320 mm. [3] This causes the activation of proto-oncogenes and inactivation of tumor suppressive genes in the keratinocytes. High doses of UV light produce free oxygen radicals, which in combination with the reduced antioxidant protection system result in different degeneration processes including carcinogenesis. The UV rays cause production of pyrimidine dimers and loss of heterozygosity of both tumor suppressive (protective) genes-TP53 and PTCH, resulting in BCC.
Other proposed causes of BCC are exposure to arsenic, X-rays, coal-tar derivatives, and thermal burns. [4].
Immune system suppression in the pathogenesis of skin carcinomas is also suspected since the occurrence of BCC increased among immune suppressed patients and the lesions affect mainly the non-exposed skin of the body and the upper limbs.
Surgery is the first line therapeutic method. The results of 5-year follow-up after the surgical excision of BCC with up to 1.5 cm diameter size of the primary tumor show the reappearance in 12% of the cases, while in primary tumor with size above 3 cm diameter the rate is 23%. [5] It is believed that the reoccurrence of tumor is from the periphery nests of the tumor that could not always be detected by routine histology.
Other putative causes of BCC are exposure to arsenic,
X-rays or coal-tar d
To conclude, BCC is a disease which is frequently diagnosed at the outpatients’ practice. The early diagnosis based on good knowledge and adequate treatment is a precondition for better prognosis. Numerous methods of treatment do not absolutely remove the risk of relapses and if the case is neglected, BCC may destroy the underlying tissues and metastasize.
References
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