Basal cell carcinoma of the vulva presenting as unilateral pruritus

Basal cell carcinoma (BCC) is the most common human malignancy, which often occurs as a result of ultraviolet light on sun-exposed areas. A more rare location for the presentation of BCC is the non-sun-exposed genital area, where squamous cell cancer occurs frequently in the setting of human papilloma virus and chronic inflammatory lesions (i.e., lichen sclerosus et atrophicus). Consequently, such tumors may escape detection by the dermatologist and be mistaken by the gynecologist for an inflammatory condition. A delay in diagnosis can result in wider surgical margins and potential recurrences. We present a case of BCC of the vulva with involvement of the clitoris presenting with unilateral pruritus and treated as an allergic contact dermatitis with topical corticosteroids. The patient was treated with Mohs micrographic surgery in conjunction with topical imiquimod to spare surrounding tissue.