Abstract: Basal cell carcinomas (BCCs) are one of the most frequent cutaneous malignancies. The majority of BCCs are reported to occur on the auricular helix and periauricular region due to ultraviolet light exposure. Despite the frequency of BCCs, those that develop within scar tissue are rare, and the phenomenon of keloid BCCs has rarely been reported in the literature. Keloid collagen within BCCs is associated with morphoeiform characteristics, ulceration, or necrosis. Extensive keloid collagen is often seen in BCCs of the ear region, a site prone to keloid scarring. This article presents a rare case of a secondary tumor (BCC) which arose on top of a primary tumor (keloid scar) on the right auricle region in a healthy 23-year-old female after an ear piercing 2 years prior. To our knowledge, the tumor described in this case, in contrast to keloidal BCCs, has never been reported in the literature.


Keywords: basal cell carcinoma, BCC, keloid scar, auricle, methylprednisolone acetate 


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INTRODUCTION

Basal cell carcinomas (BCCs) develop within the basal cell layer of the epidermis.1 They are one of the most frequent skin malignancies2,3 accounting for 75%–80% of all skin cancers, with 70%–80% of all BCCs occurring in the head and neck region.1 Furthermore, they are the most common type of malignancy of the ear.4 The majority of BCCs are reported to occur on the auricular helix and periauricular region due to exposure to ultraviolet light4 and may infiltrate the cartilage.4 Reports of an etiological relationship between prior trauma/scar tissue and the development of a BCC have been reported within the literature.3 To date, only five case reports of keloidal BCCs have been discussed in the literature.5–9 Keloid collagen within BCCs is reported to be associated with morphoeiform characteristics, ulceration, or necrosis, with extensive keloid collagen seen in BCCs of the ear region, a site prone to keloid scarring.10 However, presented here, to our knowledge, is the first reported case of a secondary tumor (BCC) which arose on top of a primary tumor (keloid scar) on the right auricle region in a healthy 23-year-old female after an ear piercing 2 years prior.