Basaloid Proliferations in Palmar Lesions of Gorlin Syndrome: A Distinct Entity or Precursor Lesion?

A 9-year-old boy with Gorlin syndrome (GS) developed asymptomatic palmar papules. Histopathologic examination of these lesions revealed angulated basaloid nests surrounded by sclerotic stroma in the upper dermis, with overlying epidermal atrophy and hypogranulosis. These findings align with previously described basaloid proliferations in palmoplantar lesions of GS, distinct from the typical basal cell carcinomas found in other skin areas. Unlike basal cell carcinomas, these lesions remained stable during follow-up. This case highlights the unique histopathologic features of palmoplantar lesions in GS and raises questions about their pathogenesis and potential origin.