bcc grows by direct extension and appears to require the surrounding stroma to support its growth . bcc occurs at the site of previous trauma such as thermal burn , scars , and ionizing radiation . approximately 85% of bccs appear on the head and neck region , areas receiving maximum sun exposure . tumors also occur in sites protected from sun such as genitals and breast but the occurrence of tumor in axilla is extremely rare,1 and , to our knowledge , only a few cases have been reported . unusual sites for bcc include the axilla , hand , areola or nipple , buttock , perineal and genital regions.2 a 35-year - old kashmiri rural male presented to us as a case of vegetative ulcerated growth in right axilla of 4 years duration . the growth was around 85 cm with round cerebriform vascular margins which bled on palpation as the tissue was friable . the floor of the ulcer was deep which showed accumulation of pus along with granulation tissue . there was no previous personal history of skin cancer , and no other significant cutaneous or medical history was elicited . notably , he had no history of trauma , chronic axillary inflammation , immune deficiency , or exposure to artificial ionizing radiation or arsenic . the patient did not seek early medical help because of his low social milieu , inadequate hygienic culture and a low level of knowledge about skin tumors . laboratory studies , including a complete blood cell count , blood chemistry and urinalysis , were within normal limits . his chest radiography , ultrasonography of abdomen and computed tomography ( ct ) of chest and abdomen were also normal . sonography and ct scans were done to rule out systemic involvement in view of large , long standing and aggressive nature of growth . mantoux test , vdrl and serology for human immunodeficiency virus ( 1 & 2 ) were negative or nonreactive . pus collected at the base of ulcer showed inflammatory cells with gram - positive cocci on staining , and staph aureus on culture . histopathologic examination of the biopsy taken from the outgrowth at the edge showed normal epidermal lining with underlying dermis showing masses of basaloid cells with palisading at the periphery . the cells were arranged in intertwining strands and radially around islands of connective tissue , resulting in a tumor with a lace - like pattern , features consistent with adenoid variant of basal cell carcinoma ( figure 2 ) . the patient was referred to the plastic and reconstructive surgery department at a tertiary center , where he underwent wide surgical excision of the tumor . bcc is the most common skin cancer derived from basaloid epithelia located in the follicular bulges , the anagen hair bulb , the follicular matrix cells and specific basaloid cells of the interfollicular epidermis.3 bcc most commonly occurs in sun - exposed sites such as the face and neck ( 8090% ) . ten to fifteen percent of bccs occur in non - sun - exposed sites such as the axilla , groin , buttocks , nipple , breast , penis and scrotum.46 among these , the occurrence of bcc in axilla is extremely rare . bcc can be classified histologically into nodulocystic , mixed , infiltrative , superficial , micronodular , adenoid , metatypical , morpheaform and fibroepithelioma types.7 adenoid variant is rare compared to nodulocystic bcc , which is the most common type of bcc . only a few such cases of adenoid variant have been reported to date.8 ultraviolet radiation is considered the single most important risk factor for bcc . additional risk factors include arsenic , coal tar derivatives , irradiation , scars , burn sites , chronic inflammation , ulcer and immune deficiency.3 genetic syndromes such as xeroderma pigmentosum and basal cell nevus syndrome are also associated with occurrence of bcc.9 in our case , no such risk factors or genodermatoses were found . skin cancer is a common disease that can be treated in a variety of ways including mohs micrographic surgery , surgical excision , curettage and electrodesiccation , cryosurgery , radiotherapy , immunotherapy with interferon or fluorouracil , or photodynamic therapy depending on the tumor , the patient and the preferences of the physician.10 generally , bcc rarely metastasizes and is best treated by surgical excision if detected early . wolf et al propose that larger tumors and more aggressive histologic types are best treated by surgical excision with a 2- to 4-mm safe margin.11 the recurrence of bcc is usually associated with incomplete excision . when bccs are completely excised , only 1% will recur , as compared with 33%39% if they are incompletely excised.12,13 in our patient , the growth was removed by wide surgical excision , and no evidence of recurrence has been found during the follow - up period of 6 months . because the axilla is the site that is less likely to be monitored by the patient , there is possibility of delay in diagnosis and treatment and therefore extensive surgery may be required with increased risk of recurrence . the aim of this report is to highlight the occurrence of the most common skin malignancy at unusual sites so that its pathogenesis , diagnostic criteria , therapeutic modalities and prognosis can be better understood and to alert the physicians to the importance of early detection at unusual sites to prevent complications . basal cell carcinoma , though rare in non - sun exposed areas , can occasionally be seen and a complete skin examination should be a part of a routine physical examination .
basal cell carcinoma ( bcc ) is the most common skin cancer . 
 the most significant risk factor is ultraviolet radiation and the most frequent site of bcc is head and neck , with around 7580% occurring on face . 
 bcc occurs infrequently in non - sun - exposed skin . 
 the axilla is one of the least sun - exposed areas of our body , and as such bcc at this site is very rare . 
 we present a case of large neglected axillary bcc in a 35- year - old male .