Case Report: Nodular basal cell carcinoma of the palm initially suspected to be a hemangioma

Basal cell carcinoma (BCC) rarely involves the palm and may be difficult to recognize preoperatively. An 81-year-old woman presented with a 6-month history of a gradually enlarging left palmar mass. Examination revealed a nodule approximately 1 cm in diameter with hemorrhagic crusting. The initial clinical impression was a hemangioma. Ultrasonography showed a heterogeneous hypoechoic lesion extending from the dermis into the subcutaneous tissue, with abundant Doppler flow within its solid component, reinforcing the suspicion of a vascular lesion. The lesion was excised under local anesthesia, and the defect was reconstructed using a pedicled flap. Histopathological examination of the excised specimen, supported by immunohistochemistry, confirmed nodular BCC. No tumor was identified at the examined lateral or deep margins. At the 9-month postoperative follow-up, the surgical site had healed well, and there was no clinical evidence of local recurrence. BCC should be considered in the differential diagnosis of persistent, enlarging palmar masses, even when clinical and ultrasonographic findings suggest a vascular lesion. Histopathological examination is essential for definitive diagnosis.