Giant vulvar basal cell carcinoma.

To cite: Garg M, Sharma P, Gupta S, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013200180 DESCRIPTION We report a case of 30-year-old woman presented with giant, foul smelling ulcerated growth involving the vulva. The growth was involving the whole of labia majora, minora and adjacent skin associated with itching, bleeding and discharge (figure 1). The lesion was atypical in its large size and gross morphology. Structures such as clitoris, vagina and urethral meatus were found to be uninvolved (figure 2). Owing to embarrassment, the patient did not present in earlier stage of disease. Inguinal lymph nodes were not palpable and pelvic CT showed no abnormality. Histopathology showed closely packed uniform basaloid cells with scant cytoplasm along with spherical or oval dark nuclei suggestive of basal cell carcinoma (BCC; figure 3). The patient was managed by radical local excision with skin grafting and was asymptomatic in follow-up period. BCC accounts for 1–2% of vulvar cancers and usually affect the elderly. Typically, BCC are small elevated lesions with clinical appearance that mimics eczema or psoriasis that rarely metastasise. BCC may be confused with basaloid squamous cell carcinoma (BSCC) or other basaloid tumours but may be differentiated clinically, as BSCC are more aggressive tumours and capable of deep invasion and distant metastases. On histopathology, BSCC usually show mitotic figures and comedonecrosis along with palisading basaloid cells. Careful search may also reveal intercellular bridges or keratin formation. Nevertheless, immunocytochemistry stainings are required for accurate diagnosis as BCCs are negative for epithelial membrane antigen and are positive for BCL2 and two Ber-EP4 while BSCCs are positive for 34βE12 and EMA markers.