Ulcerative BCC

Age: 80 years
Gender: Female
Site: Cheek
Duration: One year

Morphology: An old woman with Fitzpatrick type 1 skin presented with an irregular ulcer about 2X1 centimeters in maximum diameters with rolled up border. A 0.5 cm incisional biopsy was taken which showed an ulcerative BCC on histological examination.

Multiple leiomyomas

Age: 30 year
Gender: Male
Site: Shoulder & Arm
Duration: 10 years

Morphology: multiple skin-colored to pinkish  nodules of10 years duration. Upper lesions were itchy whereas lower lesions were painful and tender. A syrian dermatologist had treated some of the lesions with laser (type of laser ?) and many lesions recurred with itching. O/E upper lesions (recurred ones) were firm to hard to palpation while lower lesions were smooth to ruberry in consistency. Skin biopsy revealed leiomyomas whereas recurred lesions were in fact keloidal scars (complicated laser therapy).

Keratoacanthoma

Age: 80 year

Gender: Male

Duration: 10 months

Site: Leg

Morphology: An asymptomatic, dome-shaped, pinkish-red nodule with central crater filled with heaped-up keratin. It has been excised with a suitable safe margin and sent for HP examination which was consistent with KA.

Pigmented BCC

Age: 65 year

Gender: Male

Site: Chest/ Back

Duration: 2 years

History: Two rounded red plaques with well-demarcated, thread-like pigmented borders about 2 cm diameter  involving the chest and back. Both lesions cured with twice daily applications of Efudix (5 FU) ointment for 8 weeks.

* The interesting and peculiar aspect in this case is the occurrence of two BCCs simultaneously and on covered part of the body (trunk) in a patient with no risk factor except his age. 

Bowen's disease

Age: 66 year

Gender: Male

Site: Shoulder (Upper back)

Duration: > 5 years

Morphology: An asymptomatic, erythematous, partially crusted, indurated plaque with well-demarcated polycyclic border involved the right shoulder area (upper back) of more than 5 years duration. Biopsy was consistent with Bowen's disease.

Basal cell carcinoma

Age: 75 year
Gender: Male
Site: Nose
Duration: 1 year
Morphology: An asymptomatic, oval, slightly crusted patch with thread-like border. Excisional biopsy with safe margin has removed the tumor totally.

Recurrent BCC

Age: 77 years

Gender: Female

Site: Cheek

Duration: 6 months

Morphology: At the periphery of scar of a previously excised BCC (three years ago), a newly developed superficial ulcer with thread-like beaded border was noticed. Excisional biopsy with a suitable safe margin was done. Biopsy confirmed a completely excised ulcerative BCC.

SCC on LSC

Age: 45-year
Gender: Male
Site: Lower leg
Duration: 1.5 year

History: Long history of lichen simplex chronicus at the right lower leg of > 5 years duration. At last one and a half year an ulcer has developed and progressed slowly. O/E, an ulcer about 12X7 cm with an irregular outline, clean red base and punched out border surrounded by thickened dyspigmented skin was seen. Incisional biopsy revealed SCC.

Nodular BCC

Age: 74 year

Gender: Female

Site: Scalp

Duration: 3 years

Morphology: A large, rounded (3 cm diameter), pinkish-red nodule with easily bleeding tendency on the top of the scalp. 

Ulcerative BCC

Age: 57 year

Gender: Male

Site: Lower legs

Duration: 10-12 months

Morphology: Asymptomatic, bilateral symmetrical, purplish plaques involved both lower legs with no lymph node involvement or distant metastasis.

Paget's disease

Age: 63 year

Gender: Female

Site: Areola and nipple of the breast

Duration: > one year

History: A  persistent, moderately pruritic, unilateral, slightly infiltrative red plaque involved the left nipple and surrounding areolar region. The patient claimed partial improvement on topical steroid treatment which had been prescribed from time to time. O/E many left axillary lymph nodes were palpable. Skin biopsy confirmed the diagnosis of Paget's disease and immunohistochemical assessment revealed positive CEA, EMA and negative S-100 protein. The patient had been referred to surgery.

Nodular BCC

Age: 73 year

Gender: Male

Site: Scalp

Duration: 2 years

Morphology: An asymptomatic, solitary, dome-shaped nodule (1.5 cm diameter) covered with thick crust and has a rolled up border. Excisional biopsy showed nodular BCC.

Basal Cell Carcinoma

Age: 80 year
Gender: Male
Site: Face (Temporal region)
Duration: 3 years

Morphology: A slowly growing oval ulcer covered with bloody-purulent crust and has rolled up border with easily bleeding tendency.

Nodular BCC

Age: 65 year
Gender: Male
Site: Scalp
Duration: 3 years

History: An asymptomatic, solitary, oval red nodule with an easily bleeding tendency. It has been removed surgically with 0.5 cm safe margin and primarily sutured.

Secondary cutaneous plasmacytoma

Age: 34 year

Gender: Male

Site: Abdomen

Duration: 3-4 months

History: An asymptomatic, solitary, mushroom-like, slightly crusted red nodule. The patient had no other complaint. Excisional biopsy revealed secondary cutaneous plasmacytoma. Further assessment by an oncologist disclosed an asymptomatic hidden multiple myeloma.

Nodular BCC

Age: 74 year
Gender: Female
Site: Scalp
Duration: 3 years
Morphology: An asymptomatic, red nodule (1.5X1.5 cm) with peripheral pigmentation and central ulceration with easy bleeding tendency. The second photo shown was after surgical excision of the tumor.

Secondary metastasis (Ca breast)

Age: 59 years
Gender: Female
Site: Anterior trunk
Duration: 1 year

History: Two years after mastectomy for Ca breast, this woman presented with asymptomatic, red, hard plaques and nodules involved most of the anterior trunk of one year duration (post-mastectomy). Skin biopsy disclosed secondary metastasis due to Ca breast. Axillary lymph nodes were positive and both lungs and liver were also involved by secondary metastasis.

SCC complicating venereal wart

Age: 65 years
Gender: Male
Site: Penile shaft
Duration: Wart (3 years) - SCC (6-8 months)
History: Genital wart involved the penile shaft and suprapubic region. Some wart lesions had been treated with electrocautery two years ago. At last 6-8 months an eroded red nodule developed on top of wart lesions. Excisional biopsy with a suitable safe margin showed SCC invading the dermis.
For more histologic details visist: www.globalskinatlas.com

SCC

Age: 63 year
Gender: Male
Site: Lower lip
Duration: 8-10 months
Morphology: An asymptomatic, crusted, keratotic nodule about 1 cm diameter on the lateral side of the lower lip. Excisional biopsy showed SCC. 

Pigmented BCC

Age: 50 year

Gender: Female

Site: Lower eyelid

Duration: 18 months

Morphology: An asymptomatic, pigmented, oval nodule with rolled up border. Excisional biopsy showed pigmented BCC.

Destructive BCC

Age: 83 year

Gender: Female

Site: Nose

Duration: 5 years

Morphology: An irregular destructive ulcer with rolled up border and crusted base. The tip and part of the dorsal surface of the nose had been destroyed. There was no lymph node enlargement or distant metastasis.

Benign cephalic histiocytosis

Age: 14 months

Gender: Male

Site: Face (Cheeks)

Duration: 6 months

History: Multiple, slightly raised, red-yellowish papules, few millimeters in diameter involving the cheeks and neck. The mucosae and the viscera were not involved. Skin biopsy showed diffuse dermal infiltration of non-lipidized histiocytic cells.   

Bowenoid papulosis

Age: 28 year

Gender: Male

Site: Penis

Duration: 10 months

History: Multiple, asymptomatic, seborrhoeic keratosis-like brownish papules with some black dots involved the penile shaft. One lesion was taken as a biopsy and showed Bowen's disease-like (Ca in situ) histologic picture.

Adenoma sebaceum

Age: 23 year
Gender: Female
Site: Cheek & Nose
Duration: Since early childhood
Morphology: Asymptomatic, skin-coloured to brownish, firm papules without other manifestations of tuberous sclerosis. The lesions on the left cheek had been treated with dermabrasion with bad cosmetic outcome (atrophic scar).

Multiple BCCs

Age: 78 year
Gender: Female
Site: Face
Duration: 3 years
History: Multiple crusted ulcers with easily bleeding tendency involved  different areas in the face.

Recurrent BCC within skin graft

Age: 53 years

Gender: Male

Site: Cheek

Duration: 1 year

History: An ulcerative BCC had been surgically removed with skin grafting two years before. One year later, two translucent nodules with some pigmentation have developed within the graft. Biopsy showed nodular BCC.
*Submitted by: Dr. Khalil Al-Hamdi 

Basal Cell Carcinoma

Age: 57 year

Gender: Female

Site: Forehead

Duration: 2 years

Morphology: An asymptomatic, superficial, irregularly-shaped patch with thready pigmented border.

Kaposi sarcoma

Age: 66 year

Gender: Female

Site: Leg

Duration: One year

Morphology: Asymptomatic, multiple, hard, dark blue-purplish nodules. No L.N or distant metastasis.

Ulcerative-Pigmented BCC

Age: 80 years

Gender: Male

Site: Nose

Duration: 18 months

Morphology: Rounded ulcer (1.5 cm in diameter) with rolled up pigmented border and crusted centre with an easily bleeding tendency. No lymph node involvement.

* Submitted by: Dr. Khalil Al-Hamdi

Nodular BCC

Age: 82 years

Gender: Female

Site: Upper lip

Duration: 2 years

Morphology: An asymptomatic, dome-shaped, slightly crusted, red nodule with rolled up border. Excisional biopsy showed nodular BCC.

Kaposi sarcoma

Age: 56 year
Gender: Male
Site: Limbs
Duration: 9 months
Morphology: Asymptomatic, irregularly-shaped, firm, scaly, purplish plaques and nodules. No lymph node or distant metastasis. HIV antibody was non reactive.

Acral lentiginous melanoma

Age: 24 year

Gender: Female

Site: Big toe

Duration: > 1 year

Morphology: An asymptomatic, irregular hyperpigmented patch about 2.5 x 2 cm with central crust. No lymph node involvement or distant metastasis.

KS in a patient with CRF

Age: 68 years
Gender: Male
Site: Leg & Foot
Duration: > one year
History: A crippled, wheelchair-bound man with chronic renal failure of more than five years duration. He had many, asymptomatic, hard, purplish nodules and plaques. No lymph node or organ involvement.

Superficial BCC

Age: 50 years

Gender: Female

Site: Face (Upper mandibular area)

Duration: 2 years

Morphology: An asymptomatic, rounded, red plaque with an irregular thready pigmented border. The lesion was slightly pigmented.

Intra-oral Kaposi sarcoma

Age: 60 year
Gender: Male
Site: Tongue (Ventral surface)
Duration: 8 months
Morphology: Asymptomatic, multiple purple-bluish nodules. No other body sites were affected. HIV-Ab was negative.

Kaposi sarcoma

Age: 60 year
Gender: Male
Site: Hands & Feet
Duration: < one year
Morphology: Asymptomatic, firm purplish plaques and nodules. No lymph node enlargement or distant metastasis.

Kaposi sarcoma

Age: 67 year
Gender: Male
Site: Face & Hands
Duration: 9 months
History: Asymptomatic, purplish, infiltrative, firm nodules and plaques confined to the face and hands. No lymph node enlargement or distant metastasis. HIV antibody was non-reactive.

XP with nodular BCC

Age: 8 years
Gender: Female
Site: Cheek

Duration: One year
History: A girl with diffuse freckling due to XP had a rounded, dome-shaped nodule about 1.5 cm diameter with central crustation. Excisional biopsy revealed BCC.

Kaposi sarcoma

Age: 73 years
Gender: Female
Sites: Face/ Mouth/ Chest/ Hands & Feet
Duration: One year
History: Asymptomatic, multiple, purplish, widely distributed hard nodules and plaques. No lymph node involvement or distant metastasis.