Abstract
Although Basal Cell Carcinoma (BCC) is the most common malignancy, it is highly unexpected in young patients and in sites with limited to no sun exposure such as the vulva. Indeed, only 6% are diagnosed in patients under 44 and only 1-2% involve the vulva. We report on a case of BCC localized to the left labium majus in a 39-year-old Caucasian female with no personal or family history of skin cancer. She presented with a tan-pink cauliflower-like mass with arborizing telangiectasia and ulceration. The patient first noticed the lesion five years prior, when it appeared as a small mole that bled and increased in size with attempted cryotherapy. Wide radical excision was performed. Post-surgical abdominal magnetic resonance imaging showed findings consistent with reactive inguinal lymphadenopathy and complete surgical excision. Grossly, the lesion measured 3 x 2.5 x 1.5 centimeters and had tan-white cut surfaces. Hematoxylin-eosin sections showed large circumscribed dermal nests of basaloid cells with pools of mucin, peripheral palisading, and retraction clefts between tumor nests and fibromyxoid stroma, consistent with BCC, nodular subtype. All margins were negative. There was no evident recurrence or metastasis on 3-month follow-up. We aim to increase awareness of an otherwise unusual presentation of BCC, as delayed diagnosis is associated with higher rates of recurrence and metastasis. We differentiate it from the more suspected squamous cell carcinoma, the most common vulvar cancer that may present in younger patients in association with human papillomavirus. Finally, we provide insight into the potential pathogenesis.
Financial Disclosure:
No current or relevant financial relationships exist.