Pigmented speckling as a sign of basal cell carcinoma

BACKGROUND. Basal cell carcinoma may present as a discrete skin-colored papule, which may mimic other common skin tumors. OBJECTIVES. We present pigmented speckling as a clinical sign for basal cell carcinoma. METHODS. Twenty cases of basal cell carcinoma with pigmented speckling were collected and their clinical and histologic features were reviewed. RESULTS. There were 12 men and 5 women. The patients' average age was 70.5 years (range 33-90 years). Fifteen of the 17 tumors were on the head and neck, and 2 tumors were on the shoulders and back. Clinical examination revealed a "speckled appearance" of brown-black pigmentation within and/or at the border of the tumors. Histopathology showed basal cell carcinoma with melanin pigment (positive for Fontana-Masson stain and negative for Perl's stain) within nests of tumor cells. CONCLUSION. The speckled pigmentation of a basal cell carcinoma is a distinguishing feature, which may be useful in the differential diagnosis of this tumor from other discrete skin tumors.