Basal Cell Carcinoma Mimicking Dermatofibrosarcoma Protuberans: Case Report

Authors

  • Edgar Miguel Olmos Pérez 1Dermatology Surgeon, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá D. C., Colombia
  • Claudia Gonzalez Radiologist, Vice Chair of the Dermatologic Ultrasound Community and Member at the American Institute of Ultrasound in Medicine
  • María Camila Toscano-Madero Dermatology Resident, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá D. C., Colombia
  • Carolina Andrea Morales Cardenas Dermatology Resident, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá D. C., Colombia

DOI:

https://doi.org/10.31907/2414-2093.2022.08.01.2

Keywords:

Basal Cell Carcinoma, Carcinoma, Dermatofibrosarcoma Protuberans, High-Frequency Ultrasonography, Pathology

Abstract

Introduction: Basal cell carcinoma (BCC) is the most common type of carcinoma worldwide. BCC development is
the result of a complex interaction between environmental, phenotypic and genetic factors. Presentation is highly
heterogeneous, presenting from superficial or nodular lesions with a good prognosis to very extensive lesions in atypical
locations clinically and radiologically mimicking other tumors. Case presentation: We present the case of a 34-year-old man
with no past medical history, with an asymptomatic nodule that was increasing in size on the right thigh. High-frequency
ultrasonography (HFUS) evaluation revealed an oval-shaped lesion with mixed echogenicity and posterior enhancement, with
Doppler showing increased vascularization. A biopsy of the lesion was performed with suspicion of dermatofibrosarcoma
protuberans, reporting unexpectedly an infiltrative basal cell carcinoma. The tumor was excised with free margins in the final
pathology report. Conclusions: HFUS is an increasingly utilized tool that can accompany the study of a malignant lesion.
Further studies are required to define more specific criteria for different skin tumors, always in conjunction with histology.

References

Verkouteren JAC, Ramdas KHR, Wakkee M, Nijsten T. Epidemiology of basal cell carcinoma: scholarly review. Br J Dermatol. 2017 Aug;177(2):359-372. Epub 2017 Feb 20. https://doi.org/10.1111/bjd.15321

Hernandez LE, Mohsin N, Levin N, Dreyfuss I, Frech F, Nouri K. Basal cell carcinoma: An updated review of pathogenesis and treatment options. Dermatol Ther. 2022 Jun;35(6):e15501. Epub 2022 Apr 12. https://doi.org/10.1111/dth.15501

Muzic JG, Schmitt AR, Wright AC, Alniemi DT, Zubair AS, Olazagasti Lourido JM, Sosa Seda IM, Weaver AL, Baum CL. Incidence and Trends of Basal Cell Carcinoma and Cutaneous Squamous Cell Carcinoma: A PopulationBased Study in Olmsted County, Minnesota, 2000 to 2010. Mayo Clin Proc. 2017 Jun;92(6):890-898. Epub 2017 May 15. PMID: 28522111. https://doi.org/10.1016/j.mayocp.2017.02.015

Cameron MC, Lee E, Hibler BP, Barker CA, Mori S, Cordova M, Nehal KS, Rossi AM. Basal cell carcinoma: Epidemiology; pathophysiology; clinical and histological subtypes; and disease associations. J Am Acad Dermatol. 2019 Feb;80(2):303-317. Epub 2018 May 18. Erratum in: J Am Acad Dermatol. 2021 Aug ;85(2):535. https://doi.org/10.1016/j.jaad.2018.03.060

Firnhaber JM. Diagnosis and treatment of Basal cell and squamous cell carcinoma. Am Fam Physician. 2012 Jul 15;86(2):161-8.

Bichakjian CK, Olencki T, Aasi SZ, Alam M, Andersen JS, Berg D, Bowen GM, Cheney RT, Daniels GA, Glass LF, Grekin RC, Grossman K, Higgins SA, Ho AL, Lewis KD, Lydiatt DD, Nehal KS, Nghiem P, Olsen EA, Schmults CD, Sekulic A, Shaha AR, Thorstad WL, Tuli M,

Urist MM, Wang TS, Wong SL, Zic JA, Hoffmann KG, Engh A. Basal Cell Skin Cancer, Version 1.2016, NCCN Clinical Practice

Guidelines in Oncology. J Natl Compr Canc Netw. 2016 May;14(5):574-97. https://doi.org/10.6004/jnccn.2016.0065

Work Group; Invited Reviewers, 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 Mar;78(3):540-559. doi: 10.1016/j.jaad.2017.10.006. https://doi.org/10.1016/j.jaad.2017.10.006

Dika, Emi et al. “Basal Cell Carcinoma: A Comprehensive Review.” International journal of molecular sciences vol. 21,15 5572 4 Aug

https://doi.org/10.3390/ijms21155572

Lombardi M, Pampena R, Borsari S, Bombonato C, Benati E, Pellacani G, Longo C. Dermoscopic Features of Basal Cell Carcinoma

on the Lower Limbs: A Chameleon! Dermatology. 2017;233(6):482-488. https://doi.org/10.1159/000487300

Kasumagic-Halilovic E, Hasic M, OvcinaKurtovic N. A Clinical Study of Basal Cell Carcinoma. Med Arch. 2019 Dec;73(6):394-

PMID: 32082007; PMCID: PMC7007603. https://doi.org/10.5455/medarh.2019.73.394-398

Sánchez G, Nova J, de la Hoz F. Factores de riesgo de carcinoma basocelular. Un estudio del Centro Nacional de Dermatología de

Colombia [Risk factors for basal cell carcinoma: a study from the national dermatology center of Colombia]. Actas Dermosifiliogr. 2012

May;103(4):294-300. Spanish. Epub 2011 Nov 10. PMID: 22078143. https://doi.org/10.1016/j.ad.2011.07.012

Kim HS, Kim TW, Mun JH, Song M, Ko HC, Kim BS, Kim MB. Basal cell carcinoma-mimicking lesions in korean clinical settings. Ann Dermatol. 2014 Aug;26(4):431-6. https://doi.org/10.5021/ad.2014.26.4.431

Amir Hooshang, E., Pedram, N., Ali, S., Sara, H., Maedeh, A., Sara, S., Arghavan, A., Maryam, N. (2017). 'Basal cell carcinoma of the lower extremities', Iranian Journal of Dermatology, 20(4), pp. 118-121.

Pranteda G, Grimaldi M, Lombardi M, Pranteda G, Arcese A, Cortesi G, Muscianese M, Bottoni U: Basal cell carcinoma: differenc- es according to anatomic location and clini- cal-pathological subtypes. G Ital Dermatol Venereol 2014;149:423–426.

Suppa M, Micantonio T, Di Stefani A, Soyer HP, Chimenti S, Fargnoli MC, Peris K: Dermoscopic variability of basal cell carcinoma according to clinical type and anatomic location. J Eur Acad Dermatol Venereol 2015;29: 1732–1741. https://doi.org/10.1111/jdv.12980

Wolner ZJ, Bajaj S, Flores E, Carrera C, Navarrete-Dechent C, Dusza SW, Rabinovitz HS, Marchetti MA, Marghoob AA: Variation in dermoscopic features of basal cell carcino- ma as a function of anatomic location and pigmentation status. Br J Dermatol 2018;

:e136–e137. https://doi.org/10.1111/bjd.15964

Pearson G, King LE, Boyd AS. Basal cell carcinoma of the lower extremities. Int J Dermatol. 1999 Nov;38(11):852-4. doi: 10.1046/j.1365-4362.1999.00787.x. PMID: 10583619. https://doi.org/10.1046/j.1365-4362.1999.00787.x

Zou MH, Huang Q, Yang T, Jiang Y, Zhang LJ, Xie Y, Zheng RQ. Role of ultrasound in the diagnosis of primary and recurrent dermatofibrosarcoma protuberans. BMC Cancer. 2021 Aug 10;21(1):909. https://doi.org/10.1186/s12885-021-08476-2

Bobadilla F, Wortsman X, Munoz C, Segovia L, Espinoza M, Jemec GB. Pre-surgical high resolution ultrasound of facial basal cell carcinoma: correlation with histology. Cancer Imaging 2008; 8:163–172.https://doi.org/10.1102/1470-7330.2008.0026

Diago A, Llombart B, Serra-Guillen C, Arana E, Guillén C, Requena C, Traves V, Bancalari B, Bernia E, Ríos-Viñuela E, Sanmartín O. Usefulness of ultrasound in dermatofibrosarcoma protuberans and correlation with histopathological findings: A series of 30 cases. Skin Res Technol. 2021

Sep;27(5):701-708. https://doi.org/10.1111/srt.13003

Mujtaba B, Wang F, Taher A, Aslam R, Madewell JE, Spear R, Nassar S. Dermatofibrosarcoma Protuberans: Pathological and Imaging Review. Curr Probl Diagn Radiol. 2021 Mar-Apr;50(2):236-240. https://doi.org/10.1067/j.cpradiol.2020.05.011

Wortsman X. Sonography of facial cutaneous basal cell carcinoma: a first-line imaging technique. J Ultrasound Med 2013; 32:567–572. https://doi.org/10.7863/jum.2013.32.4.567

Hernández-Ibáñez C. Aguilar-Bernier M, Fúnez-Liébana R. De Boz J, Blázquez N, de Troya M. The usefulness of high-resolution ultrasound in detecting invasive disease in recurrent basal cell carcinoma after nonsurgical treatment. Actas Dermosifiliogr.2014;105:935-9.

https://doi.org/10.1016/j.adengl.2014.05.021

Published

2022-12-30 — Updated on 2023-10-17

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