Cholesterol Crystal Deposition in Basal Cell Carcinoma: An Investigation of 4 Cases

Abstract

Cholesterol crystals are a primary cause of cholesterol embolism if they appear in vessels. Various papers have reported the involvement of cholesterol crystal deposition in cutaneous diseases such as xanthoma. However, no cases of cholesterol crystal involvement in cutaneous cancer have been reported. We report four cases of basal cell carcinoma with cholesterol crystal deposition, and discuss the mechanism(s) of the condition. Disease duration, anatomical site, histopathological features, and serum lipid profiles were investigated. The median disease duration was 3.5 years, and the sites of the lesions were the scrotum (one patient) and the nose (three patients). Histopathologically, there was necrotized tissue around the clefts. In addition, we detected frequent apoptotic cells around the cholesterol clefts in two of the patients by using the terminal deoxynucleotidyl transferase dUTP nick-end labeling method. Serum lipid levels were slightly elevated in two of the patients. In conclusion, cholesterol crystal deposition in basal cell carcinoma was considered to relate to a long disease duration with a tumor in a region that was subject to external irritation. Histopathologically, apoptotic cells around the cholesterol clefts indicated that lipids from the tumor cell membranes were one of the causes of cholesterol crystal deposition.

A Case of Cholesterol Granuloma Presenting as a Cutaneous Nodule

“…Cholesterol clefts could be seen in skin biopsy specimens of xanthoma, cutaneous cholesterol embolization, necrobiosis lipoidica diabeticorum, and necrobiotic xanthogranuloma. Rarely, cholesterol clefts have also been observed in some cutaneous tumors such as epidermal cysts, trichilemmal cysts, pilomatricomas and basal cell carcinomas 3 4 . In cutaneous cholesterol embolization, livedo reticularis is the most common clinical finding, and histopathological findings of cholesterol crystals within the lumen of small arteries in the deep dermis are distinct.…”