PMC3881082_01
Clinical appearance: 2 cm erythematous patch with focal crusting and scaling.
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A 21-year-old female presented a 2 cm erythematous macule on the pubis that had been slowly enlarging over a period of 18 months (Figure 1).
A: Panoramic view of first section showing well demarcated area of ulceration of the epidermis with crust. Original magnification (objective) x20; B: Epidermis with ulceration and irregular acanthosis; dense inflammatory infiltrate composed mainly of lymphocytes in superficial and mid-dermis. Original magnification (objective) x100; C: Detail of epidermis with scale crust and prominent spongiosis with inflammatory cells in exocytosis. Original magnification (objective) x200.
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Histological sections (Figures 2A, 2B, 2C) showed a well-demarcated area of ulceration with crust.
A: Panoramic view after step sectioning. Ulcerated area was associated to a superficial neoplasia demonstrating slit-like retraction from the subjacent dermis. Original magnification (objective) x20; B: Closer view of superficial basal cell carcinoma. Original magnification (objective) x100; C: Detail of neoplastic blocks with palisaded basaloid cells and characteristic separation from papillary dermis. Original magnification (objective) x200.
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New sections (Figures 3A, 3B and 3C) surprisingly showed neoplastic blocks attached to the epidermis demonstrating slit-like retraction of the palisaded basaloid cells from the adjacent stroma.
A: Clinical aspect before treatment; B: Three weeks after imiquimod cream with severe inflammation; C: Six weeks after imiquimod cream with partial healing and focal crusting; D: Six months after treatment. Complete healing and no signs of recurrence.
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The patient started topical imiquimod cream (Figure 4A), five days a week for six weeks. Severe inflammation was noticed in week three (Figure 4B), followed by crusting in week six (Figure 4C), and complete healing. No signs of recurrence was seen at a six-month follow-up (Figure 4D).