Basal Cell Carcinoma of the Nipple-Areola Complex: A Comprehensive Review of the World Literature

Abstract

BackgroundBasal cell carcinomas (BCCs) usually occur in sun-exposed areas. However, they may also occur—albeit infrequently—in unusual locations, such as the nipple-areola complex.MethodsUsing the PubMed database, an extensive literature search was performed for the following keywords: areola, basal cell carcinoma, and nipple. Papers and references cited in those papers were reviewed to accumulate reports of patients with BCC of the areola and nipple.ResultsBCC of the areola and nipple has been described in 55 individuals: 35 males and 20 females. The onset age ranged from 35 to 86 years. The median onset age in males was 61 years, whereas the median onset age in females was 66 years. BCC of the NAC predominantly occurred in Caucasians (75.7%). BCC of the nipple-areola complex (NAC) was observed on the left (54.9%) more frequently than the right (45.1%). Clinical presentation was variable and commonly included scaly or ulcerated plaques and nodules. This tumor was typically associated with the nodular (42.9%) or superficial (30.9%) subtype of BCC. The most common treatment was excision. There were three reported patients who had metastatic disease to their lymph nodes; one of the patients died from his tumor.ConclusionThe nipple and areola are uncommon sites of BCC. BCC of the nipple-areola complex is less frequently observed in females (36.4%), as this is more commonly a photo-protected site. BCC of the NAC has been considered to behave more aggressively than BCCs at other anatomical sites; however, the BCCs are frequently associated with a non-aggressive histologic subtype. Treatment usually involves complete excision of the BCC. Tumor recurrence was uncommon following successful treatment of the primary neoplasm.

Cytokeratin Profile of Basal Cell Carcinomas According to the Degree of Sun Exposure and to the Anatomical Localization

“…2 ), but no studies evaluating the CK profile in such tumors have been reported. A similar situation could be postulated for the rare observation of BCC developing on the nipple, 30 an apocrine-rich area, devoid of hair follicles, 31 in which we have also observed an intense CK7 expression (Figs. 3 B, D).…”

Basal Cell Carcinoma: A Patient and Physician’s Experience

“…Indeed, similar to her tumor, most basal cell carcinomas occur on skin that has been directly exposed to the sun. However, albeit less common, basal cell carcinomas can occur at usual sites, at locations that have been shielded from the sun, or both; these include the axilla [ 6 , 16 ], breast and nipple [ 20 ], buttock and perianal area [ 21 ], foot, groin, penis and scrotum, periungual and subungual area (adjacent and beneath the nail) [ 22 , 23 ], umbilicus [ 24 ], and vulva.…”

An unusual localised pigmented skin lesion on the nipple-areola complex

“…Superficial spreading melanoma frequently exhibits as a slightly raised macule or plaque in the non-exposed areas characterised by asymmetry, border irregularity, and colour variegation 5. Superficial pigmented BCC-NAC usually presents as irregular pigmented macula with erythema and scale on the NAC 678…”