Red Dot Basal Cell Carcinoma: An Unusual Variant of a Common Malignancy

May 2016 | Volume 15 | Issue 5 | Case Reports | 645 | Copyright © May 2016


Tiffany Y. Loh BS and Philip R. Cohen MD

University of California San Diego, San Diego, CA

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Previous reports of red dot BCC have commented on the small superficial appearance of these tumors, which may be misleading when compared to the final clinical margins.6 Specifically, Tromber et al.6 notes that the lateral spread of the tumor may be more extensive than expected from clinical exam; oftentimes, a small red crust or dot vessel is seen that may only reveal subtle pearling of the epidermis if the surrounding skin is stretched. Our patient’s red dot BCC is consistent with this prior report; the wound diameter necessary to achieve malignancy-free excision margins was significantly larger than the size of the tumor observed on physical examination. These findings suggest that red dot BCC may potentially be more aggressive than clinical examination suggests.

CONCLUSION

Red dot BCC is an extremely rare, yet distinct, subtype of BCC; indeed, to the best of our knowledge, there are only a few reports of this BCC variant. Red dot BCC presents as a small erythematous macule or papule, measuring about 1-2 mm. However, its small size may be misleading; the margins of the excised tumor may be much larger than the clinical lesion. Hence, red dot BCCs may be locally destructive; however, they morphologically appear similar to benign telangiectasias or angiomas. Therefore, a high suspicion for red dot BCC is warranted, particularly in individuals with a history of multiple skin cancers. In the appropriate clinical setting, when red dot BCC and telangiectasia are being considered in the differential diagnosis of a new erythematous skin lesion, dermoscopy may be helpful. Biopsy provides definitive confirmation of the diagnosis when red dot BCC is suspected. The treatment of red dot BCC is complete excision using the Mohs micrographic surgical technique.

DISCLOSURES

The authors have no relevant disclosures or conflicts of interest to report relating to the content of this manuscript.

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AUTHOR CORRESPONDENCE

Philip R. Cohen MD……...................................... mitehead@gmail.com
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