Rippled Pattern Basal Cell Carcinoma - A Rare Variant with a Diagnostic Approach

Area of Science:

• Dermatopathology
• Oncology
• Histopathology

Background:

• Basal cell carcinoma (BCC) is the most common skin cancer.
• Uncommon variants of BCC can present diagnostic challenges.
• The rippled pattern is a rare histological subtype of BCC.

Observation:

• A 52-year-old male presented with an 8-year history of an ulcerated scalp lesion.
• Wedge biopsy revealed an infiltrating tumor with a distinctive rippled pattern.
• Tumor cells exhibited monomorphic features with brisk mitosis, apoptosis, and necrosis.

Findings:

• Immunohistochemistry showed positivity for p63 and focal positivity for androgen receptor, Bcl-2, and CD10.
• Tumor cells were negative for epithelial membrane antigen and CK20.
• The histological findings confirmed a rare rippled pattern of basal cell carcinoma.

Implications:

• Recognizing the rippled pattern is crucial for accurate BCC diagnosis.
• Understanding the immunohistochemical profile aids in differential diagnosis.
• This case contributes to the literature on rare BCC variants and their clinicopathological features.