Case Number : Case 2382 - 15 August 2019 Posted By: Uma Sundram

basal cell carcinoma

BCC accounts for less than 1 % of vulval neoplasms.

basaloid proliferative lesion

So, can you all think of other diagnoses that share ddx with basal cell carcinoma at this site? BCC is part of the ddx. Basaloid proliferative lesion could be anything; let's see if we can narrow it down some :)

I don't see any dermal tumor, otherwise some sort of basaloid proliferation over dermatofibroma could be another possibility

I believe this is a basal cell carcinoma. Clinical information tell us about "multiple pigmented papules". Clinically we could all think about SK, Nevi and even bowenoid papulosis, but the histological pictures are very supportive of BCC. With such many lesions, as described clinically, this patient could have nevoid basal cell carcinoma syndrome (Gorlin syndrome). Ddx would be with follicular infundibulum tumor, but it is not common at this site.

There is a proliferative vascular-fibroblastic change in superficial and medium dermis, resembling a dermatofibroma...It could be an atrophic DF with basaloid epidermal induction. 

I would consider basaloid follicular hamartoma

Looks like superficial trichoblastoma. CK20 and CD10 may help. The differential is superficial BCC.

Hi everyone! Thank you Vincenzo for reminding me to come back to this one. There are many ways to go with this, and I like all of the benign recommendations. The other pigmented papules were lentigos, so I threw a curve ball there. We went with tumor of the follicular infundibulum but I also like superficial trichoblastoma, basaloid follicular hamartoma, and follicular induction over an atrophic DF (although that would be pretty unusual). I know this can be pretty subjective, but in our opinion the atypia did not warrant a dx of BCC.

I go with melanotrichoblastoma.

Benign.