Basal Cell Carcinoma Occurring over Discoid Lupus Erythematosus: A Rare Report
Year: 2026
Type: article
Abstract: Dear Editor, Discoid lupus erythematosus (DLE) is the most predominant subset of chronic cutaneous lupus erythematosus and appears mostly in photo-distributed areas, rarely over photo-protected areas. Persistent inflammation may cause malignant conversion of the DLE plaque.[1] Associations of DLE and squamous cell carcinoma (SCC) have been reported in the literature, but coexistence with basal cell carcinoma (BCC) is infrequently described.[1,2] Here, we report a rare instance of BCC arising in the background of a long-standing DLE over a photo-protected area. A 62-year-old female presented with asymptomatic irregular hyperpigmented plaque over the left side of the abdomen for 12 years. There was a 3 cm × 4 cm plaque with central atrophy, peripheral hyperpigmentation and mild scaling over the surface of the left lumbar quadrant of the abdomen [Figure 1]. Mucosae and nails were unaffected. No other abnormalities were detected on general physical examination; routine investigations like haematological tests, chest X-ray, electrocardiograms and 2D echo were within normal limits. The antinuclear antibody test was negative. The patient was clinically diagnosed with DLE and confirmed histopathologically 4 years back. She was treated with topical steroids, intralesional steroids and tablet hydroxychloroquine on and off for the last 4 years. The disease followed a remitting and relapsing course. The lesion gradually increased since last year. Suspecting a different underlying pathology, the patient was rescheduled for another histopathology section. Histopathology showed basaloid tumours in the superficial dermis, arranged in buds and irregular nests, frequently attached to the overlying epidermis. In peripheral palisading of cells at the outer border of the nests, melanin pigments were seen within tumour cell nests and stroma [Figure 2a and b].Figure 1: Discoid lupus erythematosus plaque with central atrophy, peripheral hyperpigmentation and mild scaling over the surface of the left lumbar quadrant of the abdomenFigure 2: (a) (H and E, ×100) and (b) (H and E, ×400) showed basaloid tumours in the superficial dermis, arranged in buds and irregular nests, frequently attached to the overlying epidermis. In peripheral palisading of cells at the outer border of the nests, melanin pigments were seen within tumour cell nests and stromaThe lesion was excised with a wide local excision with a 5 mm healthy margin [Figure 3]. The final histopathology of the gross specimen disclosed tumour-free margins in all borders of the excised tissue.Figure 3: The plaque was excised with a wide local excision with a 5 mm healthy marginLocalized DLE is usually a benign skin condition commonly found on the scalp, head and neck, particularly in areas exposed to sunlight.[2] In the present case, the lesion was present over the abdomen, a relatively photo-protected part. Malignancies such as SCC and BCC are uncommon in areas with pre-existing DLE lesions. While both are serious complications, the occurrence of BCC in DLE patients is infrequent and scarcely reported in the literature.[3] DLE is usually diagnosed clinically, having an erythematous to hyperpigmented plaque with the centre showing atrophy, scaling and hyperpigmented border.[2] Patients with high-risk factors such as elderly (>60 years), exposure to ultraviolet light and long-standing trivial trauma can cause malignancy changes over the DLE lesion. Hence, the most common sites for malignancy transformation were photoexposed areas of the face, scalp and forearm, but nonphotoexposed involvement is rarely reported.[2,3] In our case, the lesion was located on the abdomen, an area more susceptible to chronic friction and trauma from wearing tight clothing, particularly in females. This constant irritation may contribute to the malignant transformation of pre-existing DLE lesions. Diagnosing BCC over DLE is often delayed due to its rarity and the variable time for malignant transformation. Thus, skin histopathology is always warranted in DLE, with high predisposing factors that do not respond to medical treatment.[3] In the current case, the plaque had been long-standing for 12 years and was refractory to the treatment for the last 1 year. DLE should be treated early with adequate medical treatment to halt disease progression and prevent complications; thus, malignancy transformations can be prevented. Although BCC’s overall outcomes are generally favourable, the disease could rarely follow an aggressive course with local spread and considerable morbidity. The primary treatment for BCC is surgical excision with histologic analysis, with a recommended margin of 3–4 mm of healthy tissue down to the subcutaneous layer.[4] This case was entirely excised with 5 mm of healthy margin without post-operative complications. To conclude, BCC rarely occurs with long-standing DLE. It is crucial to rule out malignancy in non-responsive cases. Close follow-up and incisional biopsy are needed; wide excision can cure coexisting BCC. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Indian Journal of Dermatology
Institution: Institute of Medical Sciences and Sum Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7123393721