Several theories explaining why BCC occurs at sun-protected sites have been proposed. Gibson and Ahmed reported 51 cases of perianal and genital BCC. They reported no association with human papillomavirus and suggested that local trauma and advancing age may contribute to the development of BCC at these sites. In this case, given the fact that the size of the lesion increased after the patient gave stimulus to it, it is thought that the development of BCC can be associated with trauma. Heckmann et al proposed that areas with high facial BCC frequency despite low UV exposure, such as the medial quadrant of the orbit, are characterized by a concave shape, a reduced skin tension, and the presence of marked skin folds. They suggest that the disturbed cell matrix interactions found at these sites may be a cofactor for developing BCCs. LeSueur et al. proposed that non-sun-exposed sites, including the axilla, might share these same characteristics.
Location, size, histologic tumor type and treatment strategies are important factors in the recurrence of BCC. Lesions that developed a long time ago, that occur in the center of the face or the ear, that exceed 2 cm in size, that have a historyof therapeutic management and that are histologi- cally infiltrative, micronodular and morpheaform have a high risk of recurrence. As a therapeutic method, Mohs micrographic surgery is known to be most effective. However surgical excision is preferred because of the good prognosis of the disease and the fact that Mohs micrographic surgery is complicated and time-consuming. In this case, the lesion was removed by surgical excision, and no evidence of recurrence has been found during the follow-up visits until now.
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Because the axilla is a site that is less likely to be monitored by the patient, there is the potential for delay in diagnosis and treatment, increasing the possibility of more extensive surgery and recurrence. This report highlights the importance of performing a complete cutaneous examination including sun- protected sites. This is especially important for patients with a history of skin cancer or those with other potential risk factors.