Two Decades in Plain Sight: Pigmented Basal Cell Carcinoma of the Scalp

Basal cell carcinoma (BCC) is the most frequently encountered cutaneous malignancy and is characteristically slow-growing with minimal metastatic potential. Pigmented basal cell carcinoma is an uncommon histological variant that may clinically mimic malignant melanoma and other pigmented lesions, often resulting in delayed diagnosis. We report a case of a long-standing pigmented bcc of the parietal scalp that remained indolent for more than two decades in an otherwise healthy male patient. The patient was managed at Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Varanasi, India. The lesion was asymptomatic, with no regional or distant spread. Management consisted of a wide local excision followed by immediate reconstruction using a parieto-occipital scalp rotation flap under general anesthesia. Histopathological examination confirmed pigmented basal cell carcinoma with tumor-free margins. This case highlights the indolent nature of pigmented BCC and underscores the importance of considering this entity in the differential diagnosis of long-standing pigmented scalp lesions.