DISCUSSION
The lesion was initially believed to be an ulcerating melanoma, and a deep shave of the entire lesion was performed and submitted for histologic evaluation. The specimen was interpreted as basal cell carcinoma (BCC), pigmented, ulcerated, and inflamed.
Comment Skin cancer is uncommon in blacks (about 1.5% of all malignancies) compared with its incidence in whites (27% of all malignancies); squamous cell carcinoma is the most common form of skin cancer and melanoma, the second most common.1-3 BCC is considered to be rare (1.8%- 20% of reported cases) among the black population.2,3 In contrast, BCC is the most common skin cancer in whites. Because of the significant pigmentation associated with these lesions on blacks, they are often confused with melanomas or seborrheic keratoses.
The lower incidence of BCC in blacks has been thought to be a result of the higher melanin content in darker skin, which is thought to be protective from UV light damage. BCC occurs more commonly in albino blacks compared with nonalbino blacks.1,2 The distribution of BCC in blacks is similar to whites—occurring on the head and neck. But these lesions also occur in atypical, non-sun-exposed areas, such as the trunk (as in this case), the extremities, and the nipple.1,3 These lesions are almost always heavily pigmented. Pigmented BCC, in general, comprises 8% to 9% of all BCC lesions, with most occurring in blacks.1,2
Skin cancer studies that involved 2,000 African Bantu people showed that 8% of all skin cancers in this population were BCC.1 Studies done in Uganda and Nigeria showed that 2.5% of cutaneous carcinomas among nonalbino black persons were BCC.2
Multiple BCC lesions occur in blacks, as in whites, but much less frequently. Case reports of BCC arising from nevus sebaceous in blacks have also been reported.1 In addition, rare reports can be found in the literature of morpheaform BCC in blacks. Morpheaform BCC comprises only 3% of all basal cell types. The incidence of this subtype in blacks is not known.3
Treatment The same methods are used to treat BCC lesions in blacks as in whites. Electrodessication and curettage, wide excision, Mohs micrographic surgery, and radiotherapy are the available treatment options.1
In summary, these data show that although BCC can be found in the black patient, it is very rare and often mistaken for the more common seborrheic keratosis or the more serious malignant melanoma. One must be ready to think outside the box when it comes to evaluating pigmented lesions on the black patient. JAAPA
Sandra Morris and Mark Ling practice in clinical dermatology at Newnan Dermatology, Newnan, Georgia. The authors have indicated no relationships to disclose relating to the content of this article.
Joe Monroe, PA-C, MPAS, department editor
REFERENCES
1. Altman A, Rosen T, Tschen JA, et al. Basal cell epithelioma in black patients. J Am Acad Dermatol. 1987;17(5 pt 1):741-745.
2. Kalter DC, Goldberg LH, Rosen T. Darkly pigmented lesions in dark-skinned patients. J Dermatol Surg Oncol. 1984;10(11):876-881.
3. Nadiminti U, Rakkhit T, Washington C. Morpheaform basal cell carcinoma in African Americans. Dermatol Surg. 2004;30(12 pt 2):1550-1552.