PMC9831639_01
Clinical photograph of lump with the left side of image pointing distally towards thumb.
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On examination, he had a 4 x 3 cm, mobile, cystic mass (Fig. 1).
Ultrasound of left forearm with region of interest.
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Ultrasound of the forearm revealed a 2.8 x 2.3 x 6 mm hypoechoic fusiform mass within the subcutaneous adipose tissue (Fig. 2).
MR T1 coronal view of the left forearm showing concerning lump.
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A subsequent MRI, showed a hyper intense 23 x 5 x 15 mm subcutaneous mass, with prominent adjacent feeding vessels, overlying the muscle bellies of abductor pollicis longus and extensor pollicis brevis (Fig. 3).
(A) Excision of lesion with cut undersurface in view with stitch at 12 o'clock; (B) surgical bed following excisional biopsy showing previous location of cut tumour.
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(A) Haematoxylin and eosin x 2. Low magnification view showing nodular nests of hyperchromatic basaloid cells with myxoid matrix, retraction artefact and peripheral nuclear palisading characteristic of BCC. There is also central cystic change because of degeneration of neoplastic cells; (B) haematoxylin and eosin x 10. Higher magnification of an area of cystic degeneration. Some of the cystic spaces are filled with red blood cells, mimicking vascular spaces.
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Nodulocystic and focally infiltrative BCC that invades the subcutis with clear excision margin. No peripheral or lymphovascular invasion was seen (Fig. 5A and B).