Vulva
Malignant neoplasms
Basal cell carcinoma (BCC)

Author: Priya Nagarajan, M.D., Ph.D. (see Authors page)
Editor: Sara Peters, Ph.D., M.D.

Revised: 6 October 2017, last major update March 2014

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Basal cell carcinoma [title] vulva

Cite this page: Nagarajan, P. Basal cell carcinoma (BCC). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vulvabasalcellcarc.html. Accessed December 17th, 2017.
Definition / general
Epidemiology
Sites
  • Tumors usually arise from cutaneous surface but rarely affect mucosal epithelia of vulva
Pathophysiology
  • Chronic vulvar irritation (e.g. long term use of diapers) appears to be the most important contributing factor
  • Other proposed factors: ionizing radiation, arsenic, chronic inflammation, hamartomas, immune deficiency
  • Molecular alterations:
Clinical features
  • Slow growing, painless lesion that may ulcerate
  • Itching, discomfort, bleeding, mass or swelling, ulcer and pain
  • Younger women ( < 50 years) may not have many symptoms
  • Often mimics eczema, psoriasis or other inflammatory dermatoses that do not respond to standard therapies
  • Diagnosis of vulvar BCC almost never made at clinical examination
Radiology description
Radiology images

Images hosted on other servers:

Low intensity area

Prognostic factors
  • Early diagnosis and complete excision are the most important prognostic factors
  • When diagnosed at an advanced stage (which happens frequently), patients are at a high risk for local recurrence and distant metastases (Int J Gynecol Pathol 1997;16:319)
  • Incomplete resection with positive margins is common with the infiltrative, micronodular and morpheaform types of BCC
  • Presence of perineural invasion can predict local recurrence
  • Metastasis is common in patients with lymphovascular space invasion
Case reports
Treatment
  • Surgical resection: (Dermatol Online J 2011;17:8)
    • Partial or total vulvectomy or conservative wide excision
    • Mohs micrographic surgery
    • Inguinofemoral lymph node dissection may also be considered for deep or large tumors
  • Adjuvant or palliative radiation therapy
  • Immunomodulators such as topical imiquimod
Clinical images

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Irregularly shaped and ulcerated tumor

Well limited plaque with a pigmented border

Multiple indurated nodules

Gross description
  • Vegetating, ulcerated, pedunculated, infiltrative, nodular or pigmented lesions
Microscopic (histologic) description
  • Histologic examination is essential for diagnosis
  • Features are similar to BCC elsewhere
  • Proliferation of nests of small basal cells with high nuclear to cytoplasmic ratio, peripheral palisading and no obvious intercellular bridges
  • Epidermal connection can often be identified
  • Mitotic figures and apoptosis are frequently seen within the same nest
  • Surrounding stroma is loose and mucin rich (hyaluronic acid), leading to retraction artifacts due to mucin shrinkage during tissue processing
  • Presence of perineural infiltration and lymphovascular space involvement should be documented
  • Wide variety of histologic types have been described; the following patterns are also clinically significant for management and prognosis:
    • Nodular / ulcerative
    • Diffuse (infiltrating, micronodular and morpheaform)
    • Superficial (multifocal)
    • Pigmented
    • Fibroepithelioma of Pinkus
Microscopic (histologic) images

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Vuvlar BCC


Vulvar BCC

Adenoid differentiation

Basophilic nodules with peripheral palisading

Nodular BCC

Dermal tumor masses


Infundibulocystic BCC

With Paget disease

Diffuse BCL2+

Positive stains
Negative stains
Electron microscopy description
  • Usually not performed
Differential diagnosis