Sclerodermiform Cell Epithelioma of the Palpebromalar Region

Abstract

This report describes a recurrent sclerodermiform basal cell epithelioma of the malar region next to the inferior eyelid in a 57-year-old woman. Three interventions were necessary to obtain a clear margin of resection. The area of resection was closed with a local cutaneous flap. We report a rare basal cell carcinoma subtype underestimated in its aggressiveness with often inadequate medical and surgical management. This tumor, generally localized in the face, often requires aggressive surgery, and aesthetic results can be poor. The patients require close long-term follow-up even when margins are clear. General practitioners, dermatologists, and surgeons should be aware of sclerodermiform basal cell carcinoma, which is a malignant, aggressive, and recurrent tumor.

Fig. 1.

Photograph of recurrence of scleroderma BCC resected 3 years previously. The suspected lesion is marked with a dotted line. The resection area is indicated by a line with margins of 10 to 15 mm. Drawing of the preoperative advancement flap.

Fig. 2.

Photograph of the wound 22 days after the last revision showing advancement of the flap with an extension of the latter under the mandible.

Fig. 3.

Microscopic magnification 40× of the histopathologic specimen; note the proliferation of keratinocytes in carcinomatous trabeculae that extend like an iceberg in dermal sclerosis.

Fig. 4.

Microscopic magnification 100× of the histopathological specimen; note that the tumor cells are arranged in small more or less anastomosed cords composed of two to three fusiform basal cell layers.