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Basal cell carcinoma in a black woman with syringomas
Journal of the American Academy of Dermatology Volume 39, Number 6
Brief communications 1033
Basal cell carcinoma in a black woman with syringomas Leena Bhat, MD, Leonard H. Goldberg, MD, and Ted Rosen, MD Houston, Texas
Basal cell carcinoma (BCC) is the most common neoplasm in the United States but occurs infrequently in black persons. In whites, BCC predominates, whereas squamous cell carcinoma is more common in blacks.1-3 Syringoma associated with BCC has been reported twice4* and has been found in association with pruritus vulvae,5 diabetes mellitus,6 epidermal cysts,7 and intradermal nevus.8 Syringoma has not been reported in blacks and is probably rare in this population. We describe a case of syringoma on the upper and lower eyelids and cheeks in a black woman with concomitant BCC. Reprint requests: Leonard Goldberg, MD, 7515 Main, Suite 240, Houston, TX 77030. *Chui C, Goldberg LH, Pham HN. Subclinical sweat duct tumor associated with basal cell carcinoma and syringoma. Manuscript submitted for publication. J Am Acad Dermatol 1998;39:1033-4. Copyright © 1998 by the American Academy of Dermatology, Inc. 0190-9622/98/$5.00 + 0 16/54/92739
CASE REPORT A 50-year-old black woman had a BCC on her left cheek (Fig 1, A). The patient also had numerous syringomas and seborrheic keratoses on the upper and lower eyelids and cheeks (Fig 1, B). She had no known white ancestors. Mohs micrographic surgery was performed. Additional biopsy specimens from the left cheek and the left lower eyelid confirmed the diagnosis of syringoma. DISCUSSION
Skin cancer in black persons accounts for 1.2% to 2.8% of malignancies.1 BCC in blacks usually occurs in the sun-exposed areas and has a similar age distribution to whites.1-3 However, in blacks, BCC can also occur in unusual places like the anus, prepuce, nipple, and in a nephrectomy scar.3 BCC in blacks appears to occur equally in men and women, in contrast to a male predominance in whites. The histologic and clinical features are
Journal of the American Academy of Dermatology December 1998
1034 Brief communications
A
B
Fig 1. A, Pigmented BCC on left cheek in black patient. Note syringomas on eyelids. B, Left eyelid showing multiple 1 to 2 mm syringomas.
similar in both whites and blacks with the exception that pigmented BCC occurs more frequently in blacks. The pigment in dark skin and in the tumor can make the pearly, rolled border and telangiectases more difficult to detect1-3 and may lead to an erroneous diagnosis of seborrheic keratosis, dermatosis papulosa nigra,1 sebaceous adenoma, epidermal inclusion cyst,9 malignant melanoma, or nevocellular nevus.10 There are two reports on the coexistence of syringomas and BCC. Chui, Goldberg, and Pham5 described BCC, syringomas, and subclinical sweat duct proliferation in a 79-year-old white woman. Spitz, Stadecker, and Grande4 described 3 white women with syringomas or subclinical sweat duct proliferation and a BCC. Mehregan11 described a sweat duct cystic dilation that histologically resembled syringoma in association with superficial BCC. There are no reports of syringomas in blacks, and this suggests that they may be rare in this racial group. REFERENCES 1. Rosen T. Nonmelanoma skin cancer in black patients. Cancer Bull 1986;38:96-9. 2. Halder RM, Bank KM. Skin cancer in blacks in the United States. Dermatol Clin 1988;6:397-405.
3. Mora RG, Burris R. Cancer of the skin in blacks: a review of 128 patients with basal cell carcinoma. Cancer 1981;47:1436-8. 4. Spitz DF, Stadecker MJ, Grande DJ. Subclinical syringoma coexisting with basal cell carcinoma. J Dermatol Surg Oncol 1987;13:793-5. 5. Belardi MG, Maglione MA, Vighi S, Paola GR. Syringoma of the vulva: a case report. J Reprod Med 1994;39:957-9. 6. Saitoh A, Ohtake N, Fukuda S, Tamaki K. Clear cells of eccrine glands in a patient with clear cell syringoma associated with diabetes mellitus. Am J Dermatopathol 1993;15:166-8. 7. Zhu WY. Vulvar syringoma associated with epidermal cyst. Int J Dermatol 1989;28:142-3. 8. Bhawan J, Malhotra R. Simultaneous occurrence of intradermal nevus and syringoma. Cutis 1983;31:669-72. 9. Abeo F, Sanusi ID. Basal cell carcinoma in North American blacks: clinical and histopathologic study of 26 patients. J Am Acad Dermatol 1991;25:1005-11. 10. Altman A, Rosen T, Tschen JA. Basal cell epithelioma in black patients. J Am Acad Dermatol 1987;17:741-5. 11. Mehregan AH. Proliferation of sweat ducts in certain diseases of the skin. Am J Dermatopathol 1981;3:27-31.
Brief communications 1033
Basal cell carcinoma in a black woman with syringomas Leena Bhat, MD, Leonard H. Goldberg, MD, and Ted Rosen, MD Houston, Texas
Basal cell carcinoma (BCC) is the most common neoplasm in the United States but occurs infrequently in black persons. In whites, BCC predominates, whereas squamous cell carcinoma is more common in blacks.1-3 Syringoma associated with BCC has been reported twice4* and has been found in association with pruritus vulvae,5 diabetes mellitus,6 epidermal cysts,7 and intradermal nevus.8 Syringoma has not been reported in blacks and is probably rare in this population. We describe a case of syringoma on the upper and lower eyelids and cheeks in a black woman with concomitant BCC. Reprint requests: Leonard Goldberg, MD, 7515 Main, Suite 240, Houston, TX 77030. *Chui C, Goldberg LH, Pham HN. Subclinical sweat duct tumor associated with basal cell carcinoma and syringoma. Manuscript submitted for publication. J Am Acad Dermatol 1998;39:1033-4. Copyright © 1998 by the American Academy of Dermatology, Inc. 0190-9622/98/$5.00 + 0 16/54/92739
CASE REPORT A 50-year-old black woman had a BCC on her left cheek (Fig 1, A). The patient also had numerous syringomas and seborrheic keratoses on the upper and lower eyelids and cheeks (Fig 1, B). She had no known white ancestors. Mohs micrographic surgery was performed. Additional biopsy specimens from the left cheek and the left lower eyelid confirmed the diagnosis of syringoma. DISCUSSION
Skin cancer in black persons accounts for 1.2% to 2.8% of malignancies.1 BCC in blacks usually occurs in the sun-exposed areas and has a similar age distribution to whites.1-3 However, in blacks, BCC can also occur in unusual places like the anus, prepuce, nipple, and in a nephrectomy scar.3 BCC in blacks appears to occur equally in men and women, in contrast to a male predominance in whites. The histologic and clinical features are
Journal of the American Academy of Dermatology December 1998
1034 Brief communications
A
B
Fig 1. A, Pigmented BCC on left cheek in black patient. Note syringomas on eyelids. B, Left eyelid showing multiple 1 to 2 mm syringomas.
similar in both whites and blacks with the exception that pigmented BCC occurs more frequently in blacks. The pigment in dark skin and in the tumor can make the pearly, rolled border and telangiectases more difficult to detect1-3 and may lead to an erroneous diagnosis of seborrheic keratosis, dermatosis papulosa nigra,1 sebaceous adenoma, epidermal inclusion cyst,9 malignant melanoma, or nevocellular nevus.10 There are two reports on the coexistence of syringomas and BCC. Chui, Goldberg, and Pham5 described BCC, syringomas, and subclinical sweat duct proliferation in a 79-year-old white woman. Spitz, Stadecker, and Grande4 described 3 white women with syringomas or subclinical sweat duct proliferation and a BCC. Mehregan11 described a sweat duct cystic dilation that histologically resembled syringoma in association with superficial BCC. There are no reports of syringomas in blacks, and this suggests that they may be rare in this racial group. REFERENCES 1. Rosen T. Nonmelanoma skin cancer in black patients. Cancer Bull 1986;38:96-9. 2. Halder RM, Bank KM. Skin cancer in blacks in the United States. Dermatol Clin 1988;6:397-405.
3. Mora RG, Burris R. Cancer of the skin in blacks: a review of 128 patients with basal cell carcinoma. Cancer 1981;47:1436-8. 4. Spitz DF, Stadecker MJ, Grande DJ. Subclinical syringoma coexisting with basal cell carcinoma. J Dermatol Surg Oncol 1987;13:793-5. 5. Belardi MG, Maglione MA, Vighi S, Paola GR. Syringoma of the vulva: a case report. J Reprod Med 1994;39:957-9. 6. Saitoh A, Ohtake N, Fukuda S, Tamaki K. Clear cells of eccrine glands in a patient with clear cell syringoma associated with diabetes mellitus. Am J Dermatopathol 1993;15:166-8. 7. Zhu WY. Vulvar syringoma associated with epidermal cyst. Int J Dermatol 1989;28:142-3. 8. Bhawan J, Malhotra R. Simultaneous occurrence of intradermal nevus and syringoma. Cutis 1983;31:669-72. 9. Abeo F, Sanusi ID. Basal cell carcinoma in North American blacks: clinical and histopathologic study of 26 patients. J Am Acad Dermatol 1991;25:1005-11. 10. Altman A, Rosen T, Tschen JA. Basal cell epithelioma in black patients. J Am Acad Dermatol 1987;17:741-5. 11. Mehregan AH. Proliferation of sweat ducts in certain diseases of the skin. Am J Dermatopathol 1981;3:27-31.