A Case of Multiple Atypical Nevi With Co-Localized Basal Cell Carcinomas on the Scalp: Insight into the Pathogenesis
May 2015 | Volume 14 | Issue 5 | Case Reports | 502 | Copyright © May 2015
Lixia Z. Ellis MD PhD,a Joel L. Cohen MD,a,b Whitney High MD JD MEng,a,c and Theresa A. Scholz MDd
aDepartment of Dermatology, University of Colorado, Aurora, CO
bAboutSkin Dermatology and DermSurgery, Englewood, CO
cSection of Dermatopathology, University of Colorado, Aurora, CO
dAccent Dermatology and Laser Institute, Golden, CO
The authors report a case of a 29-year-old female with multiple lesions on the scalp containing an atypical nevus and a co-localized basal
cell carcinoma (BCC) in the same specimen. This is the first description of such a case in the literature. The peculiar co-existence of
these 2 neoplasms in the same specimen in multiple skin lesions raises the possibility of an unknown mutation(s) that increases the
risk of developing both conditions; and this case illustrates that the signaling pathways mediating the development of atypical nevi
may interact with those associated with BCCs. Additionally, crosstalk between melanocytes and basal keratinocytes, which are both
located in the basal layer of the epidermis, may contribute to the development of these coexisting neoplasms. J Drugs Dermatol.
Both atypical nevi and basal cell carcinomas (BCCs) are
common skin neoplasms occurring more frequently in
fair-skinned individuals and associated with increased
sun exposure. Atypical nevi represent a significant marker for
increased risk of melanoma. Genetic diseases such as dysplastic
nevus syndrome, also known as familial atypical multiple
mole and melanoma syndrome (FAMMM syndrome), and nevoid
BCC syndrome have advanced our understanding of the
molecular pathogenesis of atypical nevi and BCCs. It has traditionally
been thought that distinct cellular signaling pathways
mediate these 2 skin neoplasms arising from different cell origins.
However, recent evidence points to significant crosstalk
between the signaling pathways mediating the development
of dysplastic nevi and melanomas, along with those thought
to increase the risk of BCCs.1-4 This view is supported by our
case report of a young female with multiple lesions showing
atypical nevi and BCCs in the same specimens on her scalp.
A 29-year-old female presented to a dermatologist for a
“skin check” upon referral by her primary care physician.
She grew up in California and moved to Colorado in her
teens. She denied “more-than-usual amount of sun exposures”
when she grew up, but did swim and play softball
frequently. She had a few sunburns on the cheeks and nose,
but no blistering sunburns. She used a tanning bed once.
She denied significant sun exposure at work. She always
had long hair, but did think her hair was “fine and thin”.
She had a history of a mildly atypical nevus biopsied from
her leg over 10 years prior, and had no personal history of
melanomas or non-melanoma skin cancers. She underwent
bilateral oophorectomy for borderline ovarian serous
cystadenomas of the ovaries at age 24. In addition, she was
born blind in her left eye, and had a history of diverticulitis,
genital lichen sclerosus et atrophicus, and multiple skin
tags. She had no history of jaw cysts, bifid ribs, calcification
of the falx cerebri, hypohidrosis, hypotricosis, or arsenic
exposure. Her pertinent family history was significant for
ocular melanoma and leiomyosarcoma in her mother, mesothelioma
in a maternal uncle and paternal grandfather (both
thought to be related to asbestos exposure), and Down syndrome
in her sister and a paternal first cousin.
On examination, the patient had multiple irregular appearing
nevi on the scalp. Scattered regular appearing nevi were