Indian Journal of Pathology and Microbiology
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CASE REPORT  
Year : 2012  |  Volume : 55  |  Issue : 4  |  Page : 583-584
Vulvar basal cell carcinoma


1 Department of Obstetrics and Gynecology, Bozok University Medical Faculty, Yozgat, Turkey
2 Department of Dermathology, Bozok University Medical Faculty, Yozgat, Turkey
3 Department of Pathology, Bozok University Medical Faculty, Yozgat, Turkey

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Date of Web Publication4-Mar-2013
 

   Abstract 

Although the basal cell carcinoma (BCC) is the most common malignancy of skin, it is rarely seen in vulva and constitutes 2% to 4% of all vulvar cancers. The cause is unknown but, chronic vulvar irritation is the most important underlying factor. The patients over 60 years are affected more frequently than younger ones.

Keywords: Basal cell carcinoma, skin, vulvar cancer, vulva

How to cite this article:
Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol 2012;55:583-4

How to cite this URL:
Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol [serial online] 2012 [cited 2014 Oct 24];55:583-4. Available from: http://www.ijpmonline.org/text.asp?2012/55/4/583/107835



   Introduction Top


Basal cell carcinoma (BCC) is a neoplastic tumor originates from skin. Although it is usually located in sun-exposed sites of the skin, the atypical sites may be involved such as vulva. To our best knowledge, there are only 300 cases have been reported in the literature. In this case report, we aimed to review the diagnosis and treatment of vulvar basal cell carcinoma which is rarely seen via the light of the current knowledge.

A female patient, at the age of 53, reported to our clinic with the complaint of a painless ulcerated lesion of about 2 cm in size over the mons pubis of one year duration. Vulvar pruritus had been present for 6 months. There was no specific finding in her anamnesis or family history. The contours of the tumor were irregular [Figure 1]. Lichen sclerosus et atrophicus and lichen simplex chronicus were thought of as differential diagnoses. Punch biopsy was taken and diagnosis was made as basal cell carcinoma. The nodules of basal cell carcinomas in dermis showed adenoid differentiation [Figure 2]. On immunohistochemistry of the tumor cells showed diffuse cytoplasmic bcl-2 but Ki67 proliferation marker was only seen in the basal layer [Figure 3]. Wide local excision was performed with a 1 cm tumor-free margin.
Figure 1: Irregularly shaped and ulcerated tumor on vulva area

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Figure 2: The nodules of basal cell carcinomas in dermis showed adenoid differentiation (H and E, x10)

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Figure 3: Diffuse cytoplasmic bcl-2 immonostaining (IHC, x40)

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Vulvar BCC is a rare clinical entity and might present as a nodule or as an ulcerated or pigmented lesion. It had started as a nodule containing partially ulcerated lesion in our case. de Giorgi et al. reported that the most common symptoms were pruritus (35%), swelling (30%), bleeding (25%) and pain (18%). [1] Pruritus was the starting complaint of our case. Celik et al.[2] reported a BCC with clitoral involvement. The lesion was on the right labium majus in our case. It is usually seen in patients over sixty years of age. [1],[2] Although the etiology is unknown chronic vulvar irritation, radiation, exposure to arsenic are risk factors. [3] BCC is described as a sun exposed malignancy and rarely seen in closed areas such as vulva. Therefore, chronic irritation and ultra-violet radiation play important role in pathogenesis. There was no underlying factor in our case except chronic infection. Vulvar BCC might be diagnosed lately because of misunderstanding as Paget disease, Lichen sclerosus et atrophicus and lichen simplex chronicus. [4] It usually grows slowly. Ramidial et al.[5] was reported superficial and nodular BCCs are indolent slow-growing tumours with high bcl-2 labeling, the aggressive BCCs are infiltrative, desmoplastic tumours with low bcl-2 labeling.

The diagnosis could be delayed as long as 20 years. [3] The lesion started 1-year ago in our patient. Treatment is surgical and wide local excision is preferred intervention. Although high local recurrence rates are reported after simple excision and inguinal lymph node dissection to the primary procedure is controversial. It is only recommended in deep and extensive cases. It is difficult to assess the prognosis. Because these patients are in advanced ages and probably the deaths mostly are due to old age or other systemic diseases. [2]

In conclusion, any chronic, persistent lesion in the vulvar region, especially in advanced ages should be subjected to histological examination. Vulvar BCC might be misdiagnosed because of the similarity of other diseases (e.g., Paget's disease, lichen sclerosus et atrophicus and lichen simplex chronicus). Therefore, the clinician should pay attention to avoid a neglected case.

 
   References Top

1.de Giorgi V, Salvini C, Massi D, Raspollini MR, Carli P. Vulvar basal cell carcinoma : r0 etrospective study and review of literature. Gynecol Oncol 2005;97:192-4.  Back to cited text no. 1
[PUBMED]    
2.Celik H, Gurates B, Yavuz A, Dogan Z, Cobanoglu B, Saral Y. Vulvar basal cell carcinoma with clitoral ýnvolvement. Acta Derm Venereol 2009;89:191-2.  Back to cited text no. 2
[PUBMED]    
3.Yaghoobi R, Razi T, Feily A. Clinical image : A0 n unusual pigmented basal cell carcinoma arising from vulva. Acta Dermatovenereol Alp Panonica Adriat 2011;20:81-2.  Back to cited text no. 3
    
4.Kanitakis J, Arbona-Vidal E, Faure M. Extensive pigmented basal cell carcinoma presenting as pruritus in an elderly woman. Dermatol Online J 2011;17:8.  Back to cited text no. 4
    
5.Ramdial PK, Madaree A, Reddy R, Chetty R. Bcl-2 protein expression in aggressive and non-aggressive basal cell carcinomas. J Cutan Pathol 2000;27:283-91.  Back to cited text no. 5
    

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Correspondence Address:
Mustafa Kara
Bozok University Medical Faculty, Adnan Menderes Boulevard No 19066200 Yozgat
Turkey
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DOI: 10.4103/0377-4929.107835

PMID: 23455815

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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