Cameo

Oxford, UK
International
IJD
Blackwell
0011-9059
41
Science,
Journal
Ltdof Dermatology
2002

A case of basal cell carcinoma arising in epidermal nevus

Basal cell
Ceylan
et carcinoma
al.
and epidermal nevus

Can Ceylan, MD, Fezal zdemir, MD, Gnseli ztrk, MD, and Taner Akaln, MD

From the Departments of Dermatology and

Pathology, University of Ege, Medical Faculty,
Izmir, Turkey
Correspondence
Can Ceylan, MD
Ege University Medical Faculty
Department of Dermatology
35100 Bornova / Izmir
Turkey
E-mail: canderma@yahoo.com

A 24-year-old man was admitted to our outpatient clinic with lesions in a linear configuration.
On dermatologic examination, widespread, dark brown, warty papules and plaques over an
erythematous base, following Blaschko's lines, extended from the middle of the chest to the right
arm. These lesions had been present on the chest since birth and had gradually extended
during childhood. Recently, a nodular lesion had appeared in the pre-existing epidermal nevus
in the middle part of the chest (Fig. 1). The nodular lesion was totally excised by a plastic
surgeon.
Pathologic examination of a section stained with hematoxylin and eosin revealed acanthosis
and papillomatosis, as well as numerous sebaceous glands connected to the epidermis (Fig. 2).
This histologic feature was compatible with nevus sebaceous. In addition, in the middle of the
section, there was a tumor connected to the epidermis. Histologically, the tumor islands,
composed of basaloid cells with mostly solid growth pattern, were compatible with basal
cell carcinoma. There were also some features of nevus sebaceous, characterized by
papillomatosis, and sebaceous glands attached to the epidermis were seen at the edge (Fig. 3).
On systemic examination, there was no other developmental abnormality, except that the
patient was mildly mentally retarded. There was no family history of a neurocutaneous disorder.
All laboratory analyses were within normal limits.

Discussion
Epidermal nevi are hamartomatous lesions arising from the
embryonic ectoderm. The pluripotent ectodermal cells evolve
into a variety of differentiated cell types, including keratinocytes
and the cells forming the various epidermal appendages.
Linear epidermal nevi may be either localized or systematized. In the localized type, which is present usually but not
invariably at birth, only one linear lesion is present. It consists

of closely set papillomatous hyperkeratotic papules. It may

be located anywhere on the head, trunk, or extremities. The
localized type of linear epidermal nevus resembles the inflammatory linear verrucous epidermal nevus (ILVEN) in configuration; however, the latter differs clinically by the presence
of erythema, pruritus, and crusting, and histologically by the
presence of inflammation and parakeratosis.

Figure 2 Acanthosis and papillomatosis, as well as numerous

Figure 1 Basal cell carcinoma (white arrow) appearing on the
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epidermal nevus in the middle part of the chest

International Journal of Dermatology 2002, 41, 926 927

sebaceous glands connected to the epidermis (hematoxylin and

eosin stain; original magnification, 40)
2002 The International Society of Dermatology

Ceylan et al.

Basal cell carcinoma and epidermal nevus Cameo

nevus sebaceous. This coexistence indicates that, during the

normal development of skin, pluripotent cells give rise to
keratinocytes, sebaceous glands, hair follicles, apocrine glands,
and eccrine glands. In epidermal nevi, these components
emerge in an abnormal mixture within a circumscribed site.12
In conclusion, whether the basal cell carcinoma has developed in epidermal nevus or in nevus sebaceous is controversial. Nevertheless, the coexistence of basal cell carcinoma,
epidermal nevus, and nevus sebaceous is significant, because
all may arise from the same pluripotent cells in the embryonic
ectoderm.

Figure 3 Basal cell carcinoma characterized by tumor islands

composed of basaloid cells, and a component of nevus

sebaceous, the sebaceous glands being attached to the epidermis
(hematoxylin and eosin stain; original magnification, 40)

Squamous cell carcinomas,1 verrucous2 and adnexal3 carcinomas, and Bowens disease,4 as well as basal cell carcinoma,5
have been reported within epidermal nevi. The diagnosis
of basal cell carcinoma is seldom made in patients younger
than 40 years of age; however, these malignant tumors arising
within epidermal nevi have been described in patients as
young as 17 years,6 similar to our patient.
The dermatologic conditions that predispose a patient to
the development of basal cell carcinoma include Jadassohns
sebaceous nevus, albinism, xeroderma pigmentosum, Rasmussens syndrome, Rombo syndrome, Bazexs syndrome,
and basal cell nevus syndrome, as well as linear epidermal
nevus.79
A number of different opinions have been suggested
regarding the histogenesis of basal cell carcinomas. Adamson10 stated that basal cell carcinomas are nevoid tumors
originating from latent embryonic foci aroused from their
dormant state at a later period in life. He believed that the
latent embryonic foci usually are embryonic pilosebaceous
follicles, but occasionally are embryonic sweat ducts.
On the other hand, Pinkus11 suggested that basal cell carcinomas occurring later in life do not arise from dormant
embryonic primary epithelial germ cells, but from pluripotent
cells that form continuously during life and, like embryonic
primary epithelial germ cells, have the potential to form hair,
sebaceous glands, and apocrine glands. Because epidermal
nevi also arise from the pluripotent cells in the basal layer of
the embryonic epidermis, the theories mentioned above may
explain the coexistence of epidermal nevus and basal cell
carcinoma.
In the biopsy specimen of our patient, in addition to
the histologic features of epidermal nevus, numerous mature
sebaceous glands in the upper dermis were seen, similar to

2002 The International Society of Dermatology

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