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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 5 | 14 |
| 2024 Octubre | 65 | 47 | 112 |
| 2024 Septiembre | 56 | 18 | 74 |
| 2024 Agosto | 79 | 45 | 124 |
| 2024 Julio | 63 | 31 | 94 |
| 2024 Junio | 70 | 37 | 107 |
| 2024 Mayo | 58 | 38 | 96 |
| 2024 Abril | 62 | 24 | 86 |
| 2024 Marzo | 65 | 25 | 90 |
| 2024 Febrero | 62 | 32 | 94 |
| 2024 Enero | 33 | 33 | 66 |
| 2023 Diciembre | 57 | 19 | 76 |
| 2023 Noviembre | 44 | 21 | 65 |
| 2023 Octubre | 52 | 21 | 73 |
| 2023 Septiembre | 57 | 29 | 86 |
| 2023 Agosto | 34 | 18 | 52 |
| 2023 Julio | 64 | 43 | 107 |
| 2023 Junio | 58 | 26 | 84 |
| 2023 Mayo | 75 | 25 | 100 |
| 2023 Abril | 71 | 24 | 95 |
| 2023 Marzo | 77 | 24 | 101 |
| 2023 Febrero | 51 | 20 | 71 |
| 2023 Enero | 62 | 24 | 86 |
| 2022 Diciembre | 56 | 40 | 96 |
| 2022 Noviembre | 37 | 29 | 66 |
| 2022 Octubre | 37 | 16 | 53 |
| 2022 Septiembre | 64 | 37 | 101 |
| 2022 Agosto | 49 | 38 | 87 |
| 2022 Julio | 43 | 32 | 75 |
| 2022 Junio | 41 | 24 | 65 |
| 2022 Mayo | 53 | 39 | 92 |
| 2022 Abril | 47 | 42 | 89 |
| 2022 Marzo | 36 | 44 | 80 |
| 2022 Febrero | 28 | 25 | 53 |
| 2022 Enero | 44 | 41 | 85 |
| 2021 Diciembre | 35 | 44 | 79 |
| 2021 Noviembre | 35 | 42 | 77 |
| 2021 Octubre | 36 | 66 | 102 |
| 2021 Septiembre | 31 | 36 | 67 |
| 2021 Agosto | 22 | 32 | 54 |
| 2021 Julio | 44 | 27 | 71 |
| 2021 Junio | 20 | 21 | 41 |
| 2021 Mayo | 31 | 32 | 63 |
| 2021 Abril | 67 | 74 | 141 |
| 2021 Marzo | 52 | 16 | 68 |
| 2021 Febrero | 52 | 29 | 81 |
| 2021 Enero | 23 | 10 | 33 |
| 2020 Diciembre | 21 | 13 | 34 |
| 2020 Noviembre | 14 | 15 | 29 |
| 2020 Octubre | 19 | 6 | 25 |
| 2020 Septiembre | 29 | 10 | 39 |
| 2020 Agosto | 21 | 12 | 33 |
| 2020 Julio | 30 | 13 | 43 |
| 2020 Junio | 21 | 23 | 44 |
| 2020 Mayo | 19 | 25 | 44 |
| 2020 Abril | 24 | 9 | 33 |
| 2020 Marzo | 21 | 18 | 39 |
| 2020 Febrero | 4 | 1 | 5 |
| 2020 Enero | 4 | 1 | 5 |
| 2019 Diciembre | 4 | 4 | 8 |
| 2019 Noviembre | 4 | 2 | 6 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 8 | 12 |
| 2019 Agosto | 4 | 1 | 5 |
| 2019 Julio | 4 | 12 | 16 |
| 2019 Junio | 4 | 6 | 10 |
| 2019 Mayo | 4 | 24 | 28 |
| 2019 Abril | 2 | 6 | 8 |
| 2019 Marzo | 0 | 6 | 6 |
| 2019 Febrero | 4 | 0 | 4 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 1 | 2 | 3 |
| 2018 Agosto | 0 | 12 | 12 |
| 2018 Julio | 0 | 8 | 8 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 7 | 7 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 0 | 2 | 2 |
| 2018 Febrero | 93 | 3 | 96 |
| 2018 Enero | 67 | 5 | 72 |
| 2017 Diciembre | 101 | 6 | 107 |
| 2017 Noviembre | 58 | 4 | 62 |
| 2017 Octubre | 54 | 4 | 58 |
| 2017 Septiembre | 52 | 5 | 57 |
| 2017 Agosto | 41 | 9 | 50 |
| 2017 Julio | 29 | 3 | 32 |
| 2017 Junio | 49 | 31 | 80 |
| 2017 Mayo | 47 | 12 | 59 |
| 2017 Abril | 42 | 12 | 54 |
| 2017 Marzo | 18 | 22 | 40 |
| 2017 Febrero | 44 | 6 | 50 |
| 2017 Enero | 26 | 14 | 40 |
| 2016 Diciembre | 61 | 17 | 78 |
| 2016 Noviembre | 50 | 15 | 65 |
| 2016 Octubre | 59 | 14 | 73 |
| 2016 Septiembre | 58 | 4 | 62 |
| 2016 Agosto | 46 | 10 | 56 |
| 2016 Julio | 30 | 5 | 35 |
| 2016 Junio | 5 | 2 | 7 |
| 2016 Mayo | 5 | 1 | 6 |
| 2016 Abril | 3 | 6 | 9 |
| 2016 Marzo | 3 | 11 | 14 |
| 2016 Febrero | 10 | 10 | 20 |
| 2016 Enero | 15 | 10 | 25 |
| 2015 Diciembre | 13 | 1 | 14 |
| 2015 Noviembre | 16 | 1 | 17 |
| 2015 Octubre | 13 | 0 | 13 |
| 2015 Septiembre | 17 | 3 | 20 |
| 2015 Agosto | 12 | 2 | 14 |
| 2015 Julio | 44 | 2 | 46 |
| 2015 Junio | 32 | 4 | 36 |
| 2015 Mayo | 48 | 5 | 53 |
| 2015 Abril | 21 | 6 | 27 |
| 2015 Marzo | 21 | 6 | 27 |
| 2015 Febrero | 25 | 4 | 29 |
| 2015 Enero | 17 | 2 | 19 |
| 2014 Diciembre | 11 | 6 | 17 |
| 2014 Noviembre | 16 | 4 | 20 |
| 2014 Octubre | 13 | 1 | 14 |
| 2014 Septiembre | 0 | 1 | 1 |
| 2014 Agosto | 0 | 1 | 1 |
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