A camouflaged carcinoma and it's surgical encounter - A case report

Basal Cell Carcinoma (BCC) is the most prevalent form of skin cancer, typically arising in sun-exposed areas, especially the head and neck. However, its occurrence in sun-protected regions, such as the axilla, is exceedingly rare and often leads to diagnostic challenges. This report highlights an uncommon presentation of axillary BCC, emphasizing the need for heightened clinical suspicion and histopathological confirmation in atypical locations.

We report the case of a 58-year-old male presenting with a slowly enlarging left axillary mass over three years, associated with bluish discoloration and a small ulcer. Initial wedge biopsy suggested squamous cell carcinoma, prompting wide local excision with axillary lymph node dissection. Histopathology subsequently revealed nodular basal cell carcinoma with clear surgical margins and no nodal metastasis. The patient had an uneventful recovery and remains disease-free at one-year follow-up.

BCC rarely affects non-sun-exposed areas, and when it does, differential diagnosis becomes complex. Chronic irritation, immunosuppression, and genetic syndromes like Gorlin syndrome may contribute to pathogenesis. This case underscores the importance of considering BCC even in uncommon anatomical locations. A review of current literature and treatment modalities, including surgical excision, Mohs surgery, and targeted Hedgehog pathway inhibitors, is presented.

BCC of the axilla is rare but should be considered in the differential diagnosis of chronic axillary lesions. Histopathology remains essential for accurate diagnosis. Early identification and appropriate management can lead to excellent outcomes even in atypical presentations.