Two cases of nevoid basal cell carcinoma syndrome: Usefulness of dermoscopic examination of palmar and plantar pits

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  • Sasaki Yu
    Department of Dermatology, National Hospital Organization Tokyo Medical Center （NTMC）
  • Yoshida Tetsuya
    Department of Dermatology, National Hospital Organization Tokyo Medical Center （NTMC）
  • Yano Yumiko
    Department of Dermatology, National Hospital Organization Tokyo Medical Center （NTMC）
  • Yamamoto Sakiko
    Department of Dermatology, National Hospital Organization Tokyo Medical Center （NTMC）
  • Shiraishi Jyunichi
    Department of Pathology, NTMC
  • Sato Tomotaka
    Department of Dermatology, National Hospital Organization Tokyo Medical Center （NTMC）

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  • 掌蹠の小陥凹の観察にダーモスコピーが有用であった母斑性基底細胞癌症候群の2例
  • ショウセキ ノ ショウカンオウ ノ カンサツ ニ ダーモスコピー ガ ユウヨウ デ アッタ ハハ ハンセイ キテイ サイボウガン ショウコウグン ノ 2レイ

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Abstract

Case 1 : A 70-year-old man who had a past history of surgery for basal cell carcinoma （BCC） on his chest and back seven years previously presented with black plaque on his left parietal region. Dermoscopic examination confirmed the clinical diagnosis of basal cell carcinoma; there were multiple blue-gray globules and arborizing vessels. A diagnosis of BCC was confirmed by histopathology. Furthermore, a complete skin examination revealed small pits measuring 2 to 3mm in diameter on each palm and sole. Dermoscopy improved the visualization of these pits by showing small pink-colored, irregular-shaped depressed lesions with sharp borders. In the pits, red globules are located on the furrows of the skin showing regular linear distribution. Histopathologically, thinning of keratin layer, irregularity of the epidermal rete ridges, and inflammatory infiltrate of lymphocytes in the epidermis and papillary dermis perivasucular lesion were observed, corresponding to pits. Additional history-taking showed previous surgery for a jaw cyst （keratocystic odontogenic tumor） and a family history of jaw cyst. CT scans revealed calcification of the cerebral falx. Thus the diagnosis of nevoid basal cell carcinoma syndrome （NBCCS） was confirmed. Case 2 : A 60-year-old man with palmar and plantar pits and relapsing jaw cyst since 30 years old, who was diagnosed NBCCS by his previous doctor, presented to our department complaining of tumors on the left thigh and right lower abdomen. Histopathologic study of these lesions was consistent with the diagnosis of BCC. His palmar and plantar pits measured approximately 1mm in diameter. Under dermoscopy, red globules showing linear distribution in the pitting lesions were observed. Histopathologic examination showed mild perivasucular infiltrates of the reticular dermis. We report these cases to emphasize on significance of observing palms and soles using dermoscopy for diagnosing NBCCS in case of multiple BCCs.

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