Case Number : Case 2912 - 03 September 2021 Posted By: Dr. Richard Carr

Regressed BCC. 

Multifocal , superficial BCC.  Background changes of chronic venous hypertension, with pigment in dermis probably haemosiderin.

agree superficial spreading BCC, with a component of stasis

But may be i am missing something as Prof CARR  will not give something so simple

4 hours ago, Krishnakumar subramanian said:

agree superficial spreading BCC, with a component of stasis

But may be i am missing something as Prof CARR  will not give something so simple

Yes, I agree.  Need S100 to make sure there isn't a co-existent desmoplastic MM lurking there, especially with those lymphocytes.

Imagine the superficial BCC had not been posted with the other images (as I'd intended). Does the other pattern call any thoughts to mind?

On 03/09/2021 at 13:19, vincenzo said:

Regressed BCC. 

Agree with Vincenzo..

looks like van Gieson stain showing elastolysis (PXe like?)

On 04/09/2021 at 21:40, Dr. Richard Carr said:

Imagine the superficial BCC had not been posted with the other images (as I'd intended). Does the other pattern call any thoughts to mind?

Oedema, vascular proliferation and loss of elastic fibers reminds me of the entity described by you i.e. Poikilodermatous plaque-like hemangioma.  

Thanks for all the comments and especially Meenakshi. I received the biopsy with initial levels that did not include the BCC and apart from a relative lack of lichenification I was struck the be similarities to so-called poikilodermatous plaque-like haemangioma which in my experience is more likely to be a reaction pattern (typified by lichenification, reactive microvenular proliferation in the upper dermis with loss of elastic fibres) to several possible insults. We've typically seen the findings overlying bony prominences and and therefore have long suspected it's due to pressure effects and tissue ischaemia in most cases but I've also seen the pattern following lichenoid inflammation and here we see a similar pattern as a response to a superficial BCC. Lesson if the clinical colleagues supsect a BCC or bowen's etc. and all you have is reactive changes such as these then consider levels completely through the biopsy until you find a lesion and if not maybe suggest the biopsy might not be representative of the clinical lesions or might be accounted for by regression of a thin lesion such as superficial BCC.