Case Number : Case 831 - 23rd August Posted By: Guest

Basaloid follicular hamartoma + Basal cell carcinoma

Agree. The absence of mitotic figures, apoptosis and nuclear atypia is shown in the small hamartomatous lesions, as contrasted with BCC. Immunostains with Ki-67, CD34 and bcl-2 will certainly emphasize the differences between the two conditions.

Agree, BFH and BCC..

Agree with above comments - BFH and BCC

I agree with the opinion of BFH and BCC (given aberrant mitoses and apoptotic figures [bottom right photo]). The lesion has been traumatized.
The differential would include a trichoepithelioma in conjunction with a basaloid follicular hamartoma.

I reported this as BFH (this is really a very typical example) and BCC. BFH lesions were present in multiple areas of the patients excision biopsy. Importantly BFH lesions are superficial (limited to upper dermis) and clearly limited to pre-existing (abnormal/hamartomatous) follicular units and mitoses are inconspicuous. This case was from afar and I do not know if it was part of a larger congenital unilateral case as I would suspect. In contrast to TE/TB, BFH lack stromal condensations of papillary mesenchymal cells but in my experience do have reactive Merkel cells (as were present in this case). Note the stromal clefts in the BFH that are common in benign follicular lesions. I have an exactly similar case in a patient with multiple BCC in the field of a large unilateral congenital BFH on the face. The latter patient was fair skinned and had significant solar damage.