AJR 2000; 175:1065-1066
© American Roentgen Ray Society
Mammographic Findings in Basal Cell Carcinoma of the Male Nipple
Richard A. Cooper1 and
David B. Eilers2
1
Department of Radiology, Loyola University Medical Center, 2160 S. First Ave.,
Maywood, IL 60153.
2
Department of Internal Medicine, Section of Dermatology, Edward Hines Jr.
Veterans Affairs Hospital, Hines, IL 60141-5000.
Received January 31, 2000;
accepted after revision March 24, 2000.
Address correspondence to R. A. Cooper.
Introduction
Basal cell carcinoma is the most common of all cancers and generally occurs
in the sun-exposed skin of individuals with fair complexions. Involvement of
the nipple, however, is a rare occurrence with only 17 cases reported in the
literature
[1,2,3,4,5].
We report the first case, to our knowledge, of basal cell carcinoma of the
nipple imaged with mammography and only the second case with calcifications
[2]. This patient was initially
thought to have male breast cancer.
Case Report
A 70-year-old white man with no previous history of skin cancer presented
to our clinic for evaluation of a mass on the right areola. The mass was
noticed 4-5 weeks earlier and was preceded by several months of localized
pruritus. Examination revealed a pink, scaly, centrally depressed, indurated
plaque involving the right superior areola. Mammography was performed (Figs.
1A and
1B) and revealed numerous
punctate calcifications in the areola. The calcifications occupied an area of
approximately 0.5 cm and were minimally pleomorphic with minimal diversity in
size. No associated mass or gynecomastia was revealed. The mammographic
calcifications were suspicious for male breast cancer, and it was thought that
the patient had Paget's disease of the nipple.
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Fig. 1A. —70-year-old man with indurated plaque of right nipple. Mammogram
reveals punctate calcifications in areola (marked with BB). Calcifications
occupy 0.5-cm area and are somewhat pleomorphic with moderate diversity in
size. Note absence of associated mass or gynecomastia.
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A biopsy of the lesion (Fig.
1C) revealed basal cell carcinoma with nodules of basaloid cells
extending into the dermis. Several of these nodules had central calcified
keratinous cysts. The patient subsequently underwent treatment with a
circumareolar excision and is currently doing well 14 months after
surgery.
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Fig. 1C. —70-year-old man with indurated plaque of right nipple.
Photomicrograph of histopathologic specimen of nipple shows nodules
(arrows) of basal cell carcinoma. Note characteristic peripheral
palisading of basal cells and central calcifications (asterisks). (H
and E, x40)
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Discussion
Basal cell carcinoma is the most common of all the cancers, with an
estimated 900,000 cases occurring annually in the United States
[6]. In contrast, basal cell
carcinoma of the nipple is a rare event, with only 17 cases previously
reported
[1,2,3,4,5].
Clinically, the presentation can vary significantly, but generally basal cell
carcinoma arises in sun-exposed skin as a slowly enlarging, shiny, somewhat
translucent-appearing papule or plaque. Of the 17 previously reported cases,
13 were reported in men
[1,2,3,4,5].
It has been speculated that this male predominance may be related to increased
sun exposure of the chest in men
[3,
4].
Our patient is unique in that, to our knowledge, he had the first case of
basal cell carcinoma of the nipple to be imaged via mammography and only the
second case to reveal calcifications
[2]. Calcification of basal
cell carcinoma itself is not a rare event, with one study showing that 21% of
200 basal cell carcinomas had calcifications
[7]. The cutaneous
calcifications in this patient do not have the appearance of the benign
sebaceous gland calcifications commonly seen on mammography, and, though they
are unusual, it is well established that calcifications may be a manifestation
of male breast cancer [8].
Thus, it was originally believed that this patient had breast cancer
presenting as Paget's disease.
Basal cell carcinoma is a locally destructive tumor that only rarely
metastasizes. Therefore, treatment consists of excision with clear surgical
margins or local destruction via curettage and desiccation, cryosurgery,
radiation, or topical 5-fluorouracil. It has been suggested that basal cell
carcinoma with calcification has a more aggressive growth pattern
[7]. Also, metastasis is
extremely rare with basal cell carcinoma but was reported by Schertz and
Balogh [3] in one previous
areolar case. These authors suggested that more aggressive treatment may be
needed for basal cell carcinoma of the nipple because these basal cell
carcinomas may be associated with increased morbidity. Because experience with
basal cell carcinoma in this location is limited, it is important for these
cases to be reported.
Basal cell carcinoma must now be included in the differential diagnosis of
pleomorphic areolar calcifications.
Acknowledgments
We thank Andre Slominski and Keith Izban for their assistance with the
photomicrographs and Linda Schomer for her assistance with preparation of the
manuscript.
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Introduction
Case Report
