INTRODUCTION
Basal cell carcinoma (BCC) is the most common skin malignancy among Caucasians, Asians, and Hispanics and the second most common amongst African-Americans.1 There are several recognized subtypes of BCC, including superficial, nodular, and morpheaform.1 Additional subtypes occasionally discussed in the literature include pigmented, red-dot, fibroepithelial, infundibulocystic, and infiltrative.1 The clinical features and prevalence of BCC subtypes can differ by race, ethnicity, and Fitzpatrick phototype as well as age, gender, and anatomic location.1-4 Nodular BCC followed by superficial BCC is the most common subtype overall, while pigmented BCC is the most common subtype within skin of color (SOC) populations.1 Amongst African Americans, roughly 50% of BCCs are pigmented, compared to only 5-6% amongst Caucasians.1 Pigmented BCCs are twice as likely amongst Hispanics than Caucasians.1 The classification system for BCC, however, is inconsistent, with some reports failing to include pigmented BCC as a subtype. Additionally, there is a paucity of literature discussing the various clinical features of pigmented BCC outside of its relation to SOC.
In our clinical experience, pigmented BCCs may present with varied morphologies that overlap with the recognized subtypes of BCC, specifically superficial, nodular, and morpheaform. These recognized BCC subtypes are reported to vary not only in clinical presentation, but prognosis and treatment as well. Similar differences likely exist amongst the various morphologies of pigmented BCC. Such differences, however, remain unexplored due to lack of subcategorization as well as limited investigation on diseases primarily affecting patients with SOC. We, therefore, propose a sub-classification system specific to pigmented BCC. Based upon morphology, we suggest pigmented BCCs be precisely categorized as pigmented-superficial (Figure 1), pigmented-nodular, or pigmented-morpheaform BCC (Figure 2). This additional
In our clinical experience, pigmented BCCs may present with varied morphologies that overlap with the recognized subtypes of BCC, specifically superficial, nodular, and morpheaform. These recognized BCC subtypes are reported to vary not only in clinical presentation, but prognosis and treatment as well. Similar differences likely exist amongst the various morphologies of pigmented BCC. Such differences, however, remain unexplored due to lack of subcategorization as well as limited investigation on diseases primarily affecting patients with SOC. We, therefore, propose a sub-classification system specific to pigmented BCC. Based upon morphology, we suggest pigmented BCCs be precisely categorized as pigmented-superficial (Figure 1), pigmented-nodular, or pigmented-morpheaform BCC (Figure 2). This additional
