Resident Rounds Part III: Plaque on Left Areola of an African-American Woman
June 2014 | Volume 13 | Issue 6 | Features | 767 | Copyright © June 2014
Lindsey Goddard BBA,a Todd Mollet MD,b and Travis Blalock MDb
aUniversity of Oklahoma College of Medicine, Oklahoma City, OK
bUniversity of Oklahoma Department of Dermatology, Oklahoma City, OK
Basal cell carcinoma (BCC) is the most common cutaneous malignancy, and usually presents on sun-exposed areas of the skin.
Unsurprisingly, BCC appearing on the nipple-areola complex (NAC) is rare, and even more so in females and dark skin types. BCC
of the NAC is more aggressive than other locations, thus diagnosis and treatment are imperative. We present a case of an African
American female with a lichenified, scaly plaque on her left areola that was unresponsive to clobetasol. After biopsy, the lesion was
identified as pigmented BCC of the NAC. The patient denied surgical treatment and was treated with topical 5-fluorouracil. The BCC
initially resolved but recurred at 22 month follow-up. We plan to treat the recurrence with Mohs surgery.
A 66-year-old African-American female presented with a
two centimeter lichenified, scaly, and excoriated plaque
on the left areola (Figure 1). The asymptomatic plaque
had been present for less than one year. Palpation revealed
minimal substance without other associated physical findings.
It failed to improve after two months of treatment with clobetasol
0.05% ointment. The patient reported a negative breast ultrasound
and mammogram in the recent past. Biopsy revealed
pigmented basal cell carcinoma of the superficial subtype with
overlying epidermal excoriation (Figures 2-3).
Basal cell carcinoma (BCC) is the most common skin malignancy
with numerous intrinsic and extrinsic factors that
contribute to its pathophysiology.1 A major etiologic factor in
BCC is believed to be ultraviolet radiation, correlating with the
fact that BCC frequently presents in sun-exposed areas such
as the head and neck.2
We present a case of BCC associated with the nipple areola
complex (NAC) in an African-American female. BCC of the
NAC is rare, with 33 cases presented in the literature.3 Only 13
of these cases are in female patients, likely due to decreased
truncal sun exposure in females.3,4 BCC of the NAC is even
rarer in dark skin types. In published cases of BCC of the
NAC in females, the demographics and photographs suggest
Caucasian patients. However, some articles do not indicate
demographic data for their patients. Thus, to our knowledge, this is the first case of BCC of the NAC reported specifically in
an African-American female.
Our patient used 5-flourouracil twice daily for six weeks after
declining imiquimod or any surgical procedure. The BCC initially
resolved clinically and was followed with regular skin exams.