Reflections on a Basal Cell Carcinoma on the Nose of an Adolescent Monozygotic Female Twin

Dealing with basal cell carcinomas (BCC) is daily routine for a dermatologist. Their pathogenesis therefore receives little attention and interest. If a BCC is observed at an early age or if there is a tendency for multiple BCC’s, hereditary predisposing factors like decreased DNA repair (xeroderma pigmentosum), BCC’s in the family [Guarneri et al., 2000] or the basal cell naevus syndrome (Gorlin’s syndrome) must be excluded. UV-specific mutations of p53 and loss of heterozygosity (LOH) at chromosome 9q22.3 are supposed to be the main pathogenetic steps for tumour formation in hereditary as well as sporadic BCC [Ratner et al., 2001]. Besides scientifically confirmed findings concerning the pathogenesis of skin diseases, dermatologists are aware that psychologic factors may also have an impact on skin diseases. Proposing an epistemology of psychosomatic dermatology, Panconesi and Argentieri [2000] classified dermatoses as ‘affections with high incidence of psychoemotional factors’, ‘conditions with strong emotional repercussion’ or ‘psychiatric diseases with cutaneous expressions’. Malignant skin tumours are not included in their lists. The coincidence of body dysmorphic disorders (BDD), the clinical picture and characteristic behaviour patterns of patients with dermatitis artefacta as well as the histopathologically revealed diagnosis of a BCC raises the question: May emotional distress be a co-factor in the development of a sporadic BCC? Reflections on a Basal Cell Carcinoma on the Nose of an Adolescent Monozygotic Female Twin