Basal cell carcinoma superimposed on a cutaneous leishmaniasis lesion in an immunocompromised patient
In 2009, a 52-year-old woman presented with a single lesion on her nose, which started as a papule, referred to Sedighe Tahereh Clinic, Isfahan, Iran. The lesion had existed for a period of 14 months and was slowly increasing in size, enlarging to a plaque. The diagnosis of leishmaniasis was confirmed with a positive smear of the lesion showing leishmania bodies about 1 year before. All five members of her family had had a history of proven leishmaniasis. In the past medical history, the patient was a renal failure case since 11 years before and received a renal transplant 4 years after the diagnosis of renal failure. She was also suffering from hypertension and hyperlipidemia. She was receiving oral mycophenolate mofetil (2 g daily) and cyclosporine (100 mg daily). Her skin type was determined as IV in the skin examination. No actinic keratosis was present. A 3×3 cm indurated ulcer with elevated borders was present on the tip of her nose (). Her therapeutic plan was intralesional glucantime injection (approximately 1 ml of 1.5 g vial per week, intralesional injection). After completing a therapeutic course of 20 sessions receiving intralesional glucantime injections, she was considered as glucantime therapy resistant. Therefore, surgical excision was advised and performed under local anesthesia. The histopathology was that of a BCC.