Dermatology: Practical and Conceptual


Letter  |  Dermatol Pract Concept 2019;9(3):20 239

Dermatology Practical & Conceptual

Introduction

Basal cell carcinoma (BCC) is the most frequent nonmela-

noma skin neoplasm in Caucasians. BCC is mostly located 

in photo-exposed areas; however, it can be observed in non-

exposed areas such as armpits, genital and perianal regions, 

palms and soles, and in oral mucosa. Vulvar BCC is infre-

quent, being about 1% of all BCCs and 2%-4% of vulvar 

neoplasms. The dermoscopic aspect of BCC in this location 

has been described in very few cases.

Case Presentation

A 73-year-old woman presented with a 5-month history of 

a gradually enlarging tumor with gray-black coloration in 

the right upper labia majora, 0.5 × 0.5 mm, rounded, with 

raised edges and central ulceration (Figure 1A). The lesion 

was indurated on palpation; inguinal adenopathies were not 

identified. Dermoscopy showed the presence of irregularly 

shaped blue-black clods and structureless blueish areas. 

Structureless red-pink areas were also observed. The lesion 

was surrounded by a whitish halo; no specific vascular pat-

tern was identified (Figure 1B). Full excisional biopsy was 

performed and histology evaluation reported the diagnosis 

of BCC (Figure 2).

Conclusions

Although it is believed that ultraviolet radiation is the main 

risk factor for the development of BCC, physiopathogen-

esis behind the occurrence in sun-protected areas is not 

yet defined. It has been suggested that advanced age, local 

trauma, chronic inflammation, and radiotherapy can con-

tribute to the appearance in this area, as well as risk factors 

commonly associated with BCC including artificial ultraviolet 

radiation, exposure to arsenic, immunodeficiency, and genetic 

mutations.

Vulvar BCC occurs more frequently in postmenopausal 

women, aged between 50 and 70 years. Labia majora mucosa 

is the usual location in most cases. Clinical findings are 

diverse and do not always suggest BCC. Vulvar BCC usually 

presents as a single lesion, superficial, exophytic, ulcerated, 

infiltrating or nodular; only 3% of the lesions are pigmented. 

Dermoscopy of Pigmented Vulvar  
Basal Cell Carcinoma

Carolina Bertaina1, Gabriel Salerni1,2, Melisa Celoria1, Silvina Lombardo1,  
Mario Gorosito3, Ana Molteni1, Ramón Fernández-Bussy1

1 Hospital Provincial del Centenario de Rosario, Argentina; Faculty of Medicine, Universidad Nacional de Rosario, Argentina

2 Diagnóstico Médico Oroño, Rosario, Argentina

3 Pathology Department, Universidad Nacional de Rosario, Argentina

Key words: basal cell carcinoma, dermoscopy, skin cancer, imaging techniques

Citation: Bertaina C, Salerni G, Celoria M, Lombardo S, Gorosito M, Molteni A, Fernández-Bussy R. Dermoscopy of pigmented vulvar 
basal cell carcinoma. Dermatol Pract Concept. 2019;9(3):239-240. DOI: https://doi.org/10.5826/dpc.0903a20

Accepted: January 22, 2019; Published: July 31, 2019

Copyright: ©2019 Bertaina et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Gabriel Salerni, MD, Bv. Oroño 1441, CP 2000, Rosario, Argentina. Email: gabrielsalerni@hotmail.com



240 Letter  |  Dermatol Pract Concept 2019;9(3):20

They are usually diagnosed in advanced 

stages, since most are asymptomatic and 

slow-growing; eventually the presence 

of itching, burning, or bleeding may 

raise concern.

The dermoscopic characteristics are 

usually the same as those observed in 

cutaneous BCC [1]; blue-gray ovoid 

nests and arborizing vessels have been 

reported in pigmented vulvar BCC [2].

Vulvar BCC is usually locally aggres-

sive, so it requires complete excision 

with 4-mm margins to minimize recur-

rences; Mohs surgery is recommended. 

Prognosis is usually favorable, since 

it rarely metastasizes, but the risk of 

recurrence demands strict periodic 

monitoring.

In this case, dermoscopy was shown 

to be a helpful tool for the identification 

of vulvar pigmented BCC, improving 

diagnostic accuracy and allowing a cor-

rect therapeutic approach.

References

1. de Giorgi V, Massi D, Mannone F, et al. 

Dermoscopy in vulvar basal cell carci-

noma. Arch Dermatol. 2007;143(3):426-

427.

2. Dobrosavljevic Vukojevic D, Djurisic I, 

Lukic S, Kastratovic-Kotlica B, Vukicevic 

J. Dermatoscopy in vulvar basal cell car-

cinoma. J Eur Acad Dermatol Venereol. 

2017;31(4):e180-e181.

Figure 1. (A) Clinical aspect of the lesion. (B) Dermoscopy image: Irregularly shaped blue-

black clods and structureless bluish and red-pink areas were observed. The lesion was sur-

rounded by a whitish halo. [Copyright: ©2019 Bertaina et al.]

A B

Figure 2. Neoplastic proliferation with basaloid pattern, with neoplastic nodules in the der-

mis and in contact with the surface epithelium. (A) The stroma exhibits leukocytic infiltrate 

and numerous melanophages (H&E, ×20). (B) Ulceration and presence of basaloid nodules 

and infiltrating cords were observed (H&E, ×40). H&E = hematoxylin and eosin. [Copy-

right: ©2019 Bertaina et al.]

A B