A 63-year-old man presented with a 3-year history of a painful, progressively enlarging lesion on his right middle finger. On physical examination, there was a 12-mm erythematous plaque on the right middle finger with two 4-mm bluish-black nodules of moderate firmness and overlying crust (Fig. 1). The lesion was surgically excised. Histopathological examination of the specimen showed tumor nodules composed of basaloid cells exhibiting peripheral palisading, lacking conspicuous retraction clefts. Melanin granules were identified within the tumor nests (Fig. 2). A diagnosis of nodular basal cell carcinoma was made. Although basal cell carcinoma is the most common cutaneous malignancy, digital involvement is relatively uncommon due to the lack of sebaceous structures[
1,
2]. The differential diagnosis of digital basal cell carcinoma includes melanocytic tumors, squamous cell carcinoma, Bowen disease, and Merkel cell carcinoma; consequently, biopsy remains the gold standard when clinical diagnosis is unclear. Noninvasive imaging modalities such as dermoscopy and reflective confocal microscopy can further refine the differential diagnosis. Basal cell carcinoma should therefore be maintained in the differential diagnosis of atypical digital lesions.
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