Fibroepithelioma of Pinkus (a rare BCC variant).
Approximately 10 years ago, the patient noted a small cutaneous macule that has demonstrated slow but progressive enlargement, reaching ~2 cm at presentation & now slightly exophytic.
Dermoscopy shows features consistent w/ basal cell carcinoma, most in keeping with a fibroepithelioma of Pinkus (rare BCC variant, <2% of BCCs), a typically low-risk subtype per NCCN classification. Although biologically indolent w/ extremely low metastatic potential (<1%), the long-standing evolution allows progressive fibrotic/tumoral expansion, which can increase subclinical extension & impact both surgical field size & cosmetic outcome.
Given current size (~2 cm) on trunk/extremities, the lesion approaches higher-risk dimensional criteria, supporting standard management w/ complete surgical excision w/ 4–5 mm clinical margins & histologic margin control as appropriate. Prognosis following complete excision is excellent, w/ very low recurrence rates when adequately treated.
ALT https://www.slideshare.net/slideshow/pinkus/11352879