Abstract

The presence of pigmented and partially pigmented skin lesions of non-univocal interpretation should always trigger a cautious approach. Albeit the diagnosis of malignant melanoma should remain our main concern, other more common skin conditions, namely basal cells carcinoma, should be taken into consideration in the diagnostic process and management plan. The following case highlights how, sometimes, the diagnosis of partially pigmented basal cells carcinoma may not appear to be immediately evident and the opportunity to deal with non-surgical approach missed. Case report 50-year-old man of Caucasian origin, phototype III in Fitzpatrick scale, initially presenting with a 6-month history of pigmented, inflamed, flat skin lesion at the base of the neck. The lesion had been noticed in the summer months due to the itching and occasional burning it caused (figure 1). Physical examination revealed a 7 mm x 8 mm superficial skin lesion, partially pigmented, not well defined, slightly hyperkeratotic, against a background with several lentigo and nevi. No particular concerns were raised by dermoscopy, or dermatoscopy, and the patient was reassured, even though a small white clod was noted.