Basosquamous Cell Carcinoma of the Nipple-Areola Complex-Report of a Case

Abstract

Basosquamous cell carcinoma (BSCC) is a rare malignancy usually arising on sun-exposed areas of the skin. BSCC is described as a rare variant of Basal cell carcinoma (BCC) which shows clinical and microscopic features of both BCC and of Squamous cell carcinoma (SCC). We report the case of a 70-year-old male with a cutaneous lesion of the nipple-areola complex (NAC); to the best of our knowledge, this is the first ever reported patient with BSCC in this area. The lesion had a fast growth, but, due to the COVID19 crisis, the patient only came to our observation one year after onset of this condition. Physical examination showed a bleeding red ulcerated lesion that involved the NAC, measuring 27 mm × 20 mm. Biopsy showed a BSCC. Pre-operative breast ultrasound scan, mammogram and MRI were all performed before surgery, which consisted of simple mastectomy and sentinel lymph-node biopsy. The patient was discharged home on the 4th post-operative day, and at 18-month follow-up there are no signs or clinical evidence of local recurrence or metastases. Diagnosis of BSCC of the nipple-areola complex requires high index of suspicion and a thorough differential diagnosis, management, and suitable radical treatment due to well described high rates of recurrence and of metastases. Differential diagnosis with similar lesions (e.g., Paget's disease, Bowen's disease, BCC, and SCC) should also be taken into account.

Keywords: basosquamous cell carcinoma; mastectomy; nipple areola complex; non-melanoma skin cancers; sentinel lymph node biopsy; squamous cell carcinoma.

Figure 1

Enlarged left nipple-areola complex. Clinical appearance of BSCC on the nipple. Erosion on the surface represents the biopsy site. Dermoscopy showed absence of a pigment network and the presence of arborizing vessels, large blue-gray ovoid nests, multiple blue-gray globules, leaf-like areas, spoke wheel areas, and ulceration.

Figure 2

BSCC. (A): Islands of basaloid cells with peripheral palisading, limit with the overlying epidermis (HEX50) (B): Evidence of squamous differentiation in the basaloid island in the center of this image (HEX100).