The Unexpected Guest: Basal Cell Carcinoma on a Covered Site

Basal cell carcinoma (BCC) is the most prevalent form of skin cancer; it is slow-growing and locally invasive with an extremely low likelihood of metastasis. The activation of the Hedgehog (HH) signaling pathway is implicated in nearly all cases, with ultraviolet radiation being the primary risk factor. While BCC typically occurs in areas of chronic sun exposure, it can rarely develop in non-sun-exposed areas, as demonstrated by our case of a 68-year-old Indian woman presenting with a BCC lesion on her left hip. Dermoscopy revealed features suggestive of basal cell carcinoma which was subsequently confirmed as adenoid type on histopathological examination. The patient underwent a successful wide excision of the lesion with clear margins, and post-operative healing was satisfactory. This case highlights the rare occurrence of BCC in non-sun-exposed areas and underscores the importance of early diagnosis and treatment. Regular follow-up is essential, as patients with a history of BCC are at high risk for subsequent skin cancers.