Case and Research Letters
Palmar Basal Cell Carcinoma: An Unusual Site?
Carcinoma de células basales palmar: ¿una localización inusual?
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"tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "623" "paginaFinal" => "624" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Palmar Basal Cell Carcinoma: An Unusual Site?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1663 "Ancho" => 2166 "Tamanyo" => 294642 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Lesión ulcerada palmar con costra hemática superficial. B. Dermoscopia: ausencia de retículo pigmentado, costra hemática y áreas brillantes blanco-rojizas. C. Nódulos de células basaloides, con distintos puntos de conexión con la epidermis que se encuentra adelgazada y con presencia de paraqueratosis (H-E ×<span class="elsevierStyleHsp" style=""></span>10). D. Placa eritematosa ulcerada palmar en la segunda paciente.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J. Alonso-Corral, M.P. Gómez-Avivar, M.M. Berenguel-Ibañez, R. Ruiz-Villaverde" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Alonso-Corral" ] 1 => array:2 [ "nombre" => "M.P." "apellidos" => "Gómez-Avivar" ] 2 => array:2 [ "nombre" => "M.M." "apellidos" => "Berenguel-Ibañez" ] 3 => array:2 [ "nombre" => "R." 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"tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "623" "paginaFinal" => "624" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.J. Alonso-Corral, M.P. Gómez-Avivar, M.M. Berenguel-Ibañez, R. Ruiz-Villaverde" "autores" => array:4 [ 0 => array:3 [ "nombre" => "M.J." "apellidos" => "Alonso-Corral" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "M.P." "apellidos" => "Gómez-Avivar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M.M." "apellidos" => "Berenguel-Ibañez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" "email" => array:1 [ 0 => "ismenios@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Torrecárdenas, Almería, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Complejo Hospitalario Torrecárdenas, Almería, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario de Jaén, Jaén, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma de células basales palmar: ¿una localización inusual?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1041 "Ancho" => 1349 "Tamanyo" => 214239 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Ulcerated lesion with a hemorrhagic crust on the palm. B, Dermoscopic image showing absence of pigmented network and presence of a hemorrhagic crust and shiny white-red areas. C, Nodules of basaloid cells connected to the epidermis at different points, with epidermal thinning and parakeratosis (hematoxylin-eosin, original magnification ×10). D, Ulcerated erythematous palmar plaque in the second patient.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Basal cell carcinoma (BCC) is the most common cancer in white-skinned individuals; 80% of tumors occur in chronically sun-exposed areas, such as the face and neck, but the palms and soles of the feet can also be affected, albeit much less frequently. BCC of the palms and soles has been linked to other pathogenic factors such as arsenic exposure, ionizing radiation, repeated trauma, and hereditary syndromes, such as Gorlin syndrome, Bazex-Dupre-Christol syndrome, and xeroderma pigmentosum.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We report 2 cases of BCC of the palm recently diagnosed in our department.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 74-year-old woman with no past medical history of interest consulted for an ulcerated lesion of 2 years’ duration on the palm of her right hand; she reported that the lesion had originated from a rose thorn injury. There were no similar skin lesions on any other part of the body and no signs of chronic actinic damage. She denied contact with chemical substances such as arsenic and had not undergone radiation therapy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The clinical examination revealed an ulcerated lesion measuring approximately 0.5 cm next to the thenar eminence (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Dermoscopic examination showed a hemorrhagic crust and shiny white-reddish areas (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B); there was no evidence of a pigmented network or atypical vessels.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Complete surgical excision of the lesion was performed and the histopathologic study confirmed the suspected clinical diagnosis of superficial BCC with disease-free margins (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 2</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 64-year-old woman with a history of chronic lymphocytic leukemia, currently not being treated, consulted for a lesion on the palm of her right hand that had been present for 8 years; she denied previous trauma to the area (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). Her family doctor had prescribed several topical treatments, but there had been no improvement. The patient denied use of chemical substances such as arsenic and had not undergone radiation therapy. There were no significant findings in the rest of the clinical examination.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A 3-mm punch biopsy of the lesion confirmed a diagnosis of superficial BCC. We prescribed treatment with 5% imiquimod 5 times a week for 6 weeks, but there was no improvement. The lesion was therefore excised and the defect covered with a full-thickness skin graft. The surgical bed and margins were free of disease.</p><p id="par0035" class="elsevierStylePara elsevierViewall">It now appears that the pathogenesis of both familial and sporadic BCCs is linked to aberrant activation of the hedgehog pathway. Most sporadic BCCs have been found to contain mutations in the hedgehog signaling pathway, generally induced by UV rays. The majority of cases (90%) are due to mutations with a loss of Patched1 function, while a minority (10%) are due to gain-of-function mutations of smoothened.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">BCC of the palm is rare. It has been associated with Gorlin syndrome (nevoid basal cell carcinoma), in which it originates from palmar pits, which are considered to be true BCCs in situ,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> but a review of the literature detected at least 20 cases of spontaneous onset.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Mleczko et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> recently suggested that BCC of the palm might originate from common progenitor cells of eccrine glands based on the finding that the antibody BerEP4, which is usually positive in almost all variants of BCC and negative in squamous cell carcinoma and trichoblastomas,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> is negative in palmar BCC.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinically, there is no distinctive morphologic pattern, although most lesions are well-circumscribed hyperkeratotic or ulcerated lesions with nonspecific features. Dermoscopy is useful in the differential diagnosis of BCC. Most of the cases reported to date have described dotted vessels, blue-gray ovoid nests, cartwheel structures, and ulceration, without arborizing telangiectasia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In our first case, the only dermoscopic sign that suggested a possible diagnosis of superficial BCC was the presence of shiny white-red areas.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Nodular BCC is the most common subtype seen in palmar locations, and not counting our first case, there have only been 2 reports indicating a clear association with prior trauma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, despite the rarity of BCC of the palm and its clinical variability, BCC should be included in the differential diagnosis of single, long-standing lesions on the palm of the hand.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alonso-Corral M, Gómez-Avivar M, Berenguel-Ibañez M, Ruiz-Villaverde R. Carcinoma de células basales palmar: ¿una localización inusual?. Actas Dermosifiliogr. 2014;105:623–624.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1041 "Ancho" => 1349 "Tamanyo" => 214239 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Ulcerated lesion with a hemorrhagic crust on the palm. B, Dermoscopic image showing absence of pigmented network and presence of a hemorrhagic crust and shiny white-red areas. C, Nodules of basaloid cells connected to the epidermis at different points, with epidermal thinning and parakeratosis (hematoxylin-eosin, original magnification ×10). D, Ulcerated erythematous palmar plaque in the second patient.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A palmar injury that failed to heal diagnosis: Basal cell carcinoma of the palm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Lateo" 1 => "F.G. Charlton" 2 => "P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 5 | 13 |
| 2024 October | 65 | 47 | 112 |
| 2024 September | 56 | 18 | 74 |
| 2024 August | 79 | 45 | 124 |
| 2024 July | 63 | 31 | 94 |
| 2024 June | 70 | 37 | 107 |
| 2024 May | 58 | 38 | 96 |
| 2024 April | 62 | 24 | 86 |
| 2024 March | 65 | 25 | 90 |
| 2024 February | 62 | 32 | 94 |
| 2024 January | 33 | 33 | 66 |
| 2023 December | 57 | 19 | 76 |
| 2023 November | 44 | 21 | 65 |
| 2023 October | 52 | 21 | 73 |
| 2023 September | 57 | 29 | 86 |
| 2023 August | 34 | 18 | 52 |
| 2023 July | 64 | 43 | 107 |
| 2023 June | 58 | 26 | 84 |
| 2023 May | 75 | 25 | 100 |
| 2023 April | 71 | 24 | 95 |
| 2023 March | 77 | 24 | 101 |
| 2023 February | 51 | 20 | 71 |
| 2023 January | 62 | 24 | 86 |
| 2022 December | 56 | 40 | 96 |
| 2022 November | 37 | 29 | 66 |
| 2022 October | 37 | 16 | 53 |
| 2022 September | 64 | 37 | 101 |
| 2022 August | 49 | 38 | 87 |
| 2022 July | 43 | 32 | 75 |
| 2022 June | 41 | 24 | 65 |
| 2022 May | 53 | 39 | 92 |
| 2022 April | 47 | 42 | 89 |
| 2022 March | 36 | 44 | 80 |
| 2022 February | 28 | 25 | 53 |
| 2022 January | 44 | 41 | 85 |
| 2021 December | 35 | 44 | 79 |
| 2021 November | 35 | 42 | 77 |
| 2021 October | 36 | 66 | 102 |
| 2021 September | 31 | 36 | 67 |
| 2021 August | 22 | 32 | 54 |
| 2021 July | 44 | 27 | 71 |
| 2021 June | 20 | 21 | 41 |
| 2021 May | 31 | 32 | 63 |
| 2021 April | 67 | 74 | 141 |
| 2021 March | 52 | 16 | 68 |
| 2021 February | 52 | 29 | 81 |
| 2021 January | 23 | 10 | 33 |
| 2020 December | 21 | 13 | 34 |
| 2020 November | 14 | 15 | 29 |
| 2020 October | 19 | 6 | 25 |
| 2020 September | 29 | 10 | 39 |
| 2020 August | 21 | 12 | 33 |
| 2020 July | 30 | 13 | 43 |
| 2020 June | 21 | 23 | 44 |
| 2020 May | 19 | 25 | 44 |
| 2020 April | 24 | 9 | 33 |
| 2020 March | 21 | 18 | 39 |
| 2020 February | 4 | 1 | 5 |
| 2020 January | 4 | 1 | 5 |
| 2019 December | 4 | 4 | 8 |
| 2019 November | 4 | 2 | 6 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 4 | 8 | 12 |
| 2019 August | 4 | 1 | 5 |
| 2019 July | 4 | 12 | 16 |
| 2019 June | 4 | 6 | 10 |
| 2019 May | 4 | 24 | 28 |
| 2019 April | 2 | 6 | 8 |
| 2019 March | 0 | 6 | 6 |
| 2019 February | 4 | 0 | 4 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 1 | 2 | 3 |
| 2018 August | 0 | 12 | 12 |
| 2018 July | 0 | 8 | 8 |
| 2018 June | 0 | 1 | 1 |
| 2018 May | 0 | 7 | 7 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 0 | 2 | 2 |
| 2018 February | 93 | 3 | 96 |
| 2018 January | 67 | 5 | 72 |
| 2017 December | 101 | 6 | 107 |
| 2017 November | 58 | 4 | 62 |
| 2017 October | 54 | 4 | 58 |
| 2017 September | 52 | 5 | 57 |
| 2017 August | 41 | 9 | 50 |
| 2017 July | 29 | 3 | 32 |
| 2017 June | 49 | 31 | 80 |
| 2017 May | 47 | 12 | 59 |
| 2017 April | 42 | 12 | 54 |
| 2017 March | 18 | 22 | 40 |
| 2017 February | 44 | 6 | 50 |
| 2017 January | 26 | 14 | 40 |
| 2016 December | 61 | 17 | 78 |
| 2016 November | 50 | 15 | 65 |
| 2016 October | 59 | 14 | 73 |
| 2016 September | 58 | 4 | 62 |
| 2016 August | 46 | 10 | 56 |
| 2016 July | 30 | 5 | 35 |
| 2016 June | 5 | 2 | 7 |
| 2016 May | 5 | 1 | 6 |
| 2016 April | 3 | 6 | 9 |
| 2016 March | 3 | 11 | 14 |
| 2016 February | 10 | 10 | 20 |
| 2016 January | 15 | 10 | 25 |
| 2015 December | 13 | 1 | 14 |
| 2015 November | 16 | 1 | 17 |
| 2015 October | 13 | 0 | 13 |
| 2015 September | 17 | 3 | 20 |
| 2015 August | 12 | 2 | 14 |
| 2015 July | 44 | 2 | 46 |
| 2015 June | 32 | 4 | 36 |
| 2015 May | 48 | 5 | 53 |
| 2015 April | 21 | 6 | 27 |
| 2015 March | 21 | 6 | 27 |
| 2015 February | 25 | 4 | 29 |
| 2015 January | 17 | 2 | 19 |
| 2014 December | 11 | 6 | 17 |
| 2014 November | 16 | 4 | 20 |
| 2014 October | 13 | 1 | 14 |
| 2014 September | 0 | 1 | 1 |
| 2014 August | 0 | 1 | 1 |
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