A low-risk tumour, at a high-risk site? Basal cell carcinoma of the nipple-areola complex

Abstract

Funding sources: none. Conflicts of interest: none declared. Madam, A 42‐year‐old caucasian man presented with a lesion on the right nipple–areola complex (NAC), highly suspicious clinically of recurrent basal cell carcinoma (BCC). His past medical history was significant for Gorlin syndrome and a renal transplant for end‐stage renal failure secondary to glomerulonephritis. His regular medications comprised ciclosporin and prednisolone. In 2009 a biopsy‐proven primarily superficial BCC affecting the right nipple and areola region was treated, at that time successfully, with two cycles of photodynamic therapy. In July 2011, however, a 33 × 21 mm poorly defined plaque affecting the right upper outer quadrant of the NAC was noted (Fig. 1). Repeat biopsies confirmed this to be a multifocal BCC with a mixed superficial and nodular growth pattern. Clinical examination revealed no puckering or tethering of the NAC itself and no lymphadenopathy in the draining lymph node basin. In view of the ill‐defined clinical margins, the recurrent nature of the tumour and the need for tissue preservation in this cosmetically sensitive site, Mohs micrographic surgery (MMS) was performed. Tumour‐free margins were achieved following one stage and two sections and the resulting 36 × 23 mm defect (Fig. 2) closed primarily with an excellent cosmetic outcome at review 3 months later.