The development of basal cell carcinoma (BCC) on the nipple-areola complex (NAC) is extremely rare. However, BCCs of the NAC have been reported to behave more aggressively than those arising from other sites of the skin. In this paper, we report a case of BCC that occurred in this unusual site. The patient was an 81-year-old man with a 15×12 mm, brown-black nodule surrounding his right nipple. Histopathological examination of the resected specimen confirmed the diagnosis of the fibroepithelioma type of BCC. The patient has remained well without signs of recurrence for two years after surgery. We reviewed the literature on BCCs of the NAC published since 1893 and summarized 57 cases. Metastatic spread to axillary lymph nodes was reported only in one patient. BCC-related death has never been recorded. Based on our literature review, there is no evidence to support the hypothesis that BCCs of the NAC have an increased potential for malignancy and should be treated more aggressively than BCCs of other sites.
We analyzed the clinical practice for dermatophytosis treatment by investigating the reimbursement data for 1.5 million individuals provided from multiple health insurance societies in Japan (Japan Medical Data Center claims database, "JMDC" ). First, we compared the data from JMDC with the large-scale epidemiological survey in Japan reported by the Japan Society of Medical Mycology, Japan Foot Week, and Japan Organization of Clinical Dermatologists ( "Survey Reports" ). This comparison revealed that the distribution of patients (by month, age and ICD-10 diagnosis codes in dermatophytosis), the rates of mycological examination and prescriptions (systemic or topical antifungal drugs) almost accorded with the data of the Survey Reports. On the other hand, there were some discords in these data with the complication rate of tinea pedis and tinea unguium. These data suggest there were some cases when either tinea pedis or tinea unguium was omitted as a diagnostic name because the antifungal drug could be prescribed for one disease (tinea pedis or tinea unguium). A further investigation was carried out by using the trace facility of JMDC. The results suggested the importance of microscopic examination. The prevalence of tinea pedis or tinea unguium in patients who were checked by microscopic examination at the first visit decreased significantly after half to one year compared to those patients who were diagnosed solely by visual inspection. These results indicate that the clinical practice for dermatophytosis treatment can be clarified in more detail by giving the JMDC analysis to the Survey Reports.