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Chronic Ulceration on the Sole of an 81-year-old Man

Ming-Ya Mao1 Hsu-Jung Hsieh1 Tze-Yi Lin2 Meng-Tse Wu1

From the Department of Dermatology1, Pathology2, China Medical UniversityAccepted for publication: December 13,2007Reprint requests: Meng-Tse Wu, Department of Dermatology, China Medical University Hospital, No. 2, Yude Rd., North District, Taichung City 404, Taiwan.TEL: 886-4-2205-2121 ext. 2198 or 2113 E-mail : d5313@www.cmuh.org.tw

CaSE REpORT

An 81-year-old male presented with ulcerative lesion and crust overlying an inflammatory base on his right sole, which had been noted for about 1 year without healing. He had been in good health and, ex-cept for mild tenderness, barely any discomfort was noted on the lesion site. Previous focal trauma, irrita-tion, and exposure to possible offending agents were all denied. No palpable lymph node was noted. Tenta-tive clinical diagnosis was chronic ulcer with suspected skin malignancy (basal cell carcinoma, squamous tumor lobules, or melanoma). Microscopically, the skin biopsy section shows tumor lobules located along the dermo-epidermal junction. Nests of tumor cells separated frequently by retraction artifact demonstrate basoloid cell morphology and peripheral plisading. Non-specific chronic inflammatory infiltration was noted in upper dermis.

Resident Forum

Fig. 1Ulcerative lesions and crust overlying an inflammatory base on right sole.

Fig. 2A, B, Histologically characteristic basal cell carcinoma featuring basaloid cells with large nucleus, prominent peripheral palisading located along the dermo-epidermal junction without significant dermal involvement. (H&E, original magnification: A x100; B x200)

46 Dermatol Sinica, Mar 2008

dIaGnOSIS: Basal Cell Carcinoma (BCC) of the Sole

dISCUSSIOn

BCC of the sole is an extremely rare mor-bidity that no more than 25 cases have been reported in the past.1-4 Probably due to its rarity, most reported cases had been diagnosed other-wise (squamous cell carcinoma, melanocytic nevus, and verruca, etc.) rather than BCC prior to histological examination.4 Roth et al. had re-viewed 20 cases of plantar BCC,4 which showed more female prevalence, old-age predominance (average 73 years, range from 52 to 92 years) and relatively high incidence (6 out of 20) of histo-logical patterns characteristic of fibroepithelioma of Pinkus. No superficial or sclerosing BCC were noted in their report. Our case is unique in clini-

cal presentation as chronic ulcers and histopatho-logical features reminiscent of superficial BCC (multiple nests from epidermis with little dermal penetration). For clinicians, alert should be raised to any longstanding, unhealed plantar wounds, and biopsy is often mandatory to rule out pos-sible malignancy. REFEREnCES

1. Berger RA, Auerbach R, Orentreich N: Basal cell epithelioma of the sole: Arch Dermatol 94: 317-319, 1966.

2. Alcalay J, Goldberg LH: Pedal basal cell carci-noma. Int J Dermatol 30: 727-729, 1991.

3. Betti R, Facchetti M, Menni S, et al. : Basal cell carcinoma of the sole. J Dermatol 32: 450-453, 2005.

4. Roth MJ, Stern JB, Haupt HM, et al. : Basal cell carcinoma of the sole. J Cutan Pathol 22: 349-353, 1995.

Ming-Ya Mao, et al