Basal cell carcinoma of the nipple: a case report and review of the literature

Basal Cell Carcinoma of the Nipple-Areola Complex: A Comprehensive Review of the World Literature

Background

Basal cell carcinomas (BCCs) usually occur in sun-exposed areas. However, they may also occur—albeit infrequently—in unusual locations, such as the nipple-areola complex.

Methods

Using the PubMed database, an extensive literature search was performed for the following keywords: areola, basal cell carcinoma, and nipple. Papers and references cited in those papers were reviewed to accumulate reports of patients with BCC of the areola and nipple.

Results

BCC of the areola and nipple has been described in 55 individuals: 35 males and 20 females. The onset age ranged from 35 to 86 years. The median onset age in males was 61 years, whereas the median onset age in females was 66 years. BCC of the NAC predominantly occurred in Caucasians (75.7%). BCC of the nipple-areola complex (NAC) was observed on the left (54.9%) more frequently than the right (45.1%). Clinical presentation was variable and commonly included scaly or ulcerated plaques and nodules. This tumor was typically associated with the nodular (42.9%) or superficial (30.9%) subtype of BCC. The most common treatment was excision. There were three reported patients who had metastatic disease to their lymph nodes; one of the patients died from his tumor.

Conclusion

The nipple and areola are uncommon sites of BCC. BCC of the nipple-areola complex is less frequently observed in females (36.4%), as this is more commonly a photo-protected site. BCC of the NAC has been considered to behave more aggressively than BCCs at other anatomical sites; however, the BCCs are frequently associated with a non-aggressive histologic subtype. Treatment usually involves complete excision of the BCC. Tumor recurrence was uncommon following successful treatment of the primary neoplasm.

Pigmented Basal cell carcinoma of the nipple-areola complex in an elderly woman

Basal cell carcinoma (BCC), which frequently occurs in sun-exposed areas of the head and neck region, is the most common cutaneous malignancy. The nipple-areola complex (NAC) is an uncommon site for BCC to develop. BCCs in this region display more aggressive behavior and a greater potential to spread than when found in other anatomical sites. This paper outlines the case of 67-year-old female with a solitary asymptomatic black plaque on the right areola. The lesion was initially recognized as Paget's disease of the nipple by a general surgeon. However, the histopathological features showed a tumor mass of basaloid cells, a peripheral palisading arrangement and scattered pigment granules. Finally, the patient was diagnosed with pigmented BCC of the NAC and was referred to the department of dermatology. Positron emission tomography-computed tomography revealed the absence of distant metastasis. A wide excision was done. The lesion resolved without recurrence or metastasis during 14 months of follow-up.

Basal cell carcinoma of the nipple: an uncommon but ever-increasing location

Basal cell carcinoma (BCC) is the most common malignancy of the skin. It is most frequently seen on the sun-exposed areas of the head and neck region. Occurrence of BCC on the nipple is extremely rare, though the number of the reported cases has been increasing steadily. It has metastatic potential to regional lymph nodes; therefore a more aggressive course can be expected when compared to BCCs located at other sites. Hence, early diagnosis and treatment of BCCs located on this region is of importance. There are 39 reported cases of BCC of nipple-areola complex (NAC) in the English literature. We present an additional case of BCC located on the nipple, presenting with enlargement of the nipple as a sole clinical finding in a 60-year-old man.

Basal cell carcinoma of the nipple-areola complex: a case report

Basal cell carcinoma (BCC) of the nipple-areola complex is very rare. Only 24 cases were reported in the literature and 17 (70.8%) of these cases arose in men. Most of the cases were treated with simple excision. We report on a case of BCC of the nipple-areola complex in a 46-year-old woman, treated with partial mastectomy. Metastasis to the axillary lymph nodes had been noted in 3 (12.5%) of the 24 reported cases of BCC of the nipple-areola complex. Thus, we applied the concept of the sentinel lymph node to detect possible metastases of axillary lymph nodes, letting us avoid the unnecessary axillary lymph node dissection and possible future morbidity.