A painful lesion on the nipple: A case report of an unusual presentation of a basal cell carcinoma

Malignant tumours within the nipple-areola complex (NAC) should be considered when a non-healing, bleeding, or painful unilateral lesion persists. We report the unusual case of an 81-year-old male with prior melanoma and non-melanoma skin cancers who presented for a 1- to 2-year history of a painful lesion on the left nipple. On examination, there was a pink, crusted, tender, indurated papule within the left nipple without underlying breast masses or axillary lymphadenopathy. Histopathology revealed nodular basal cell carcinoma (BCC). The patient also had suspicious pulmonary nodules, which demonstrated metastatic melanoma. Unexpectedly, the BCC rapidly grew. It was ultimately treated with Mohs micrographic surgery. This case highlights the importance of maintaining a high index of suspicion for malignant tumours in atypical areas like the NAC, especially unexpected tumours such as BCC. Within the NAC, tumours may display more aggressive features, be misdiagnosed or undiagnosed until later stages, or inadequately treated.