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Pediatrics International (2014) 56, 799–800

doi: 10.1111/ped.12444

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Girl with small ulcer of the nose: Infiltrative basal cell carcinoma Elísabeth Gómez-Moyano,1 Luis M Pérez-Belmonte,4 Ángel Vera-Casaño,1 Andrés Sanz-Trelles,2 Leticia Herrero-Lifona3 and Antonio Crespo-Erchiga1 1 Pediatrics Dermatology Unit, Department of Dermatology, Departments of 2Pathology and 3Allergology, Carlos Haya University Hospital and 4Department of Internal Medicine, County Hospital of the Axarquía, Málaga, Spain

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Fig. 1 (a) Small ulcer of the nose of 2 mm. (b) Dermoscopy showing ulceration and fine telangiectasias. (c) Histopathology (HE stain): basal neoplastic cells in the dermis, infiltrating to the level of deep dermis.

Correspondence: Luis M Pérez-Belmonte, MD, Department of Internal Medicine. County Hospital of the Axarquía, Finca El Tomillar, s/n. 29700, Torre del Mar, Vélez-Málaga, Spain. Email: luismiguelpb @hotmail.com

© 2014 Japan Pediatric Society

Received 27 February 2014; revised 17 June 2014; accepted 24 June 2014.

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E Gómez-Moyano et al.

An 11-year-old Caucasian girl was referred to the Dermatology Department with a small ulcer on her nose of 2 mm (Fig. 1a). The lesion had appeared 4 months previously and she had been treated with antibiotic cream without improvement. Her medical history was otherwise unremarkable and no history of sunburn or family history of skin cancer was noted. Non-pigmented lesion and some large-diameter arborizing vessels branching irregularly into fine capillaries were observed on dermoscopy (Fig. 1b). Diagnostic biopsy indicated nests of basal neoplastic cells in the dermis, infiltrating to the level of deep dermis, confirming the diagnosis of infiltrative basal cell carcinoma (Fig. 1c). Systemic examination, including orthopantomography and central nervous system magnetic resonance imaging, was normal without features of Gorlin syndrome (pits on palms or soles, odontogenic keratocyst of the jaw or ectopic calcification of cranial membranes), therefore sequencing of PTCH1 was not done. Excision was highly effective, and there were no signs of recurrence after 4 years of follow-up.

© 2014 Japan Pediatric Society

Basal cell carcinoma is the commonest skin tumor in adults but it is exceedingly rare in childhood.1 It is important to perform surgery promptly, because this tumor in early life has a more aggressive phenotype as compared with later adult years and it can be associated with other syndromes, including Gorlin syndrome.2 This case suggests that basal cell carcinoma should be considered as an unusual cause of skin ulcer in children. Frequently the diagnosis is delayed due to a low index of suspicion of malignancy.

References 1 Telfer NR, Colver GB, Morton CA. Guidelines for the management of basal cell carcinoma. Br. J. Dermatol. 2008; 159: 35–48. 2 Skellett AM, Hafiji J, Greenberg DC, Wright KA, Levell NJ. The incidence of basal cell carcinoma in the under-30s in the UK. Clin. Exp. Dermatol. 2012; 37: 227–9.

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Girl with small ulcer of the nose: infiltrative basal cell carcinoma.

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