Indian Journal of Dermatology
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E-IJD CASE REPORT
Year : 2015  |  Volume : 60  |  Issue : 2  |  Page : 214
Basal cell carcinoma with halo phenomenon in a young female: Significance of dermatoscopy in early diagnosis


1 Department of Dermatology, Süleyman Demirel University Faculty of Medicine Isparta, Turkey
2 Department of Pathology, Süleyman Demirel University Faculty of Medicine Isparta, Turkey

Date of Web Publication3-Mar-2015

Correspondence Address:
Pinar Yuksel Basak
Süleyman Demirel Üniversitesi, Tip Fakültesi Dermatoloji AD, Isparta
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.152592

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   Abstract 

Halo phenomenon of nevus may be observed as a circular reaction, although it is unusual around tumors. A 29-year-old woman presented with a pigmented lesion on the cheek since three years. She noted whitening of the skin around the lesion almost after a year following its appearance. Dermatologic examination revealed a pigmented nodular lesion with a hypopigmented halo on the left infraorbital region. The clinical impression was halo nevus, whereas basal cell carcinoma (BCC) was considered in dermatoscopic differential diagnosis. The diagnosis was infiltrative-type BCC histopathologically. The persistence of a perilesional halo around an enlarging pigmented lesion should be carefully examined with accompanying dermatoscopic findings even in young patients for early diagnosis of tumoral lesions.


Keywords: Basal cell carcinoma, dermatoscopy, halo phenomenon


How to cite this article:
Basak PY, Meric G, Ciris M. Basal cell carcinoma with halo phenomenon in a young female: Significance of dermatoscopy in early diagnosis. Indian J Dermatol 2015;60:214

How to cite this URL:
Basak PY, Meric G, Ciris M. Basal cell carcinoma with halo phenomenon in a young female: Significance of dermatoscopy in early diagnosis. Indian J Dermatol [serial online] 2015 [cited 2019 Oct 23];60:214. Available from: http://www.e-ijd.org/text.asp?2015/60/2/214/152592

What was known?
Halo phenomenon is rarely observed around tumors. It has been reported in single cases of melanoma, BCC, neurofibroma, and angioma.



   Introduction Top


Halo phenomenon of melanocytic nevus is observed as a circular reaction of hypopigmentation, although it is an unusual circumstance around tumors. It has been reported as annular leukoderma in individual cases of melanoma, [1] basal cell carcinoma (BCC), neurofibroma, and angioma. [2],[3],[4] The cause of this reaction remains unknown, although proposed to be either a biological event or a result of shunting of blood away from the central lesion. [2]


   Case Report Top


An otherwise healthy, 29-year-old Caucasian woman presented with a pigmented lesion on the cheek since three years. She noted whitening of the skin around the lesion almost after a year following its appearance and spontaneous enlargement of the lesion during pregnancy, recently. She gave no history of sunburn or trauma.

Dermatologic examination revealed a 12 × 10 mm reddish brown nodular lesion surrounded by a 1 cm wide halo of depigmentation on the left infraorbital region [Figure 1]. There was no clinical evidence of scarring or inflammation in the hypopigmented halo. She had Fitzpatrick skin type 2.
Figure 1: Peripherally pigmented pinkish nodule on the face

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Dermatoscopic analysis of the partially pigmented central nodule was suggestive of a nonmelanocytic lesion with the absence of pigment network, accompanied by a subtle peripheral halo of depigmentation. Peripherally localized multiple blue-gray dots and globules, a blue-gray ovoid nest, spoke-wheel areas, and arborizing telangiectasia were prominently observed [Figure 2].
Figure 2: Dermatoscopic view of the lesion in three quadrants according to Figure 1

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Histopathologic characteristics of the totally excised lesion confirmed the diagnosis of infiltrative-type BCC. Melanin was observed in the squamous epithelium, and lymphocytic infiltration was present in the dermis of the neighboring tumoral region. The area of peripheral hypopigmentation showed a decrease in the number of melanophages [Figure 3].
Figure 3: Infiltrative-type basal cell carcinoma (H and E, ×100)

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   Discussion Top


Annular leukoderma is described around several benign and malignant lesions and could be mistaken as halo nevus. BCC is believed to develop hypopigmentation infrequently, and only a few cases have been reported. The previously reported three patients were older than 50 years, and BCC was located on the face in only one patient. Moreover, a history of multiple BCCs was noted in two of the patients. [2],[4] The features of interest in our patient were young age and a usual medical history. Therefore, the initial clinical impression was halo nevus and possibly melanoma, although findings of dermatoscopy made us consider BCC in differential diagnosis. In addition, dermatoscopy was useful to rule out regressing melanoma in this case. Recently, sclerodermiform BCC appearing on a vitiliginous patch was reported in a young female. [5] Differing from our case, the depigmented patch preceded sclerodermoid BCC in this young individual.

Previously reported cases of BCC with hypopigmented halo lacked dermatoscopic findings. Dermatoscopy is a fast, simple, and advantageous procedure for differentiating between halo nevus and BCC to avoid unnecessary surgery for the patient. Although very rare, young patients with BCC as was the case, might be mistakenly followed up as halo nevus for years, if initial examination including dermatoscopy was not done. In conclusion, the persistence of perilesional halo around an enlarging pigmented lesion should be carefully examined with accompanying dermatoscopic findings even in young patients, for early diagnosis of nonmelanocytic tumoral lesions.

 
   References Top

1.
Pantoja E, Wendth AJ, Beecher TS. Perilesional vitiligo in melanoma. Cutis 1977;19:51-3.  Back to cited text no. 1
    
2.
Johnson DB Jr, Ceilley RI. Basal cell carcinoma with annular leukoderma mimicking leukoderma acquisitum centrifugum. Arch Dermatol 1980;116:352-3.  Back to cited text no. 2
    
3.
Mooney MA, Barr RJ, Buxton MG. Halo nevus or halo phenomenon? A study of 142 cases. J Cutan Pathol 1995;22:342-8.  Back to cited text no. 3
    
4.
Pembroke AC, Liddell K. Basal cell epithelioma with a hypopigmented halo. Arch Dermatol 1981;117:317.  Back to cited text no. 4
    
5.
Rustemeyer J, Günther L, Deichert L. A rare association: basal cell carcinoma in a vitiliginous macula. Oral Maxillofac Surg 2011;15:175-7.  Back to cited text no. 5
    

What is new?
The features of interest in our patient were young age and lack of a history of multiple BCCs, as was reported in a few cases previously. This case of BCC with hypopigmented halo showed distinctive dermatoscopic findings. Therefore, initial examination including dermatoscopy is mandatory, even in young patients with perilesional halo around an enlarging pigmented lesion.


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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