Basal-Cell Carcinoma

To the Editor: The excellent review by Rubin et al. of basal-cell carcinoma (Nov. 24 issue) 1 considers the genital area an unusual site for basal-cell carcinomas. In our view, this site, especially the vulva, is neither unusual nor random. Like melanoma, 2 even basal-cell carcinomas appear in sun-shielded areas such as the vulva, challenging the conventional knowledge that associates these cancers with ultraviolet radiation. Vulvar basal-cell carcinoma typically includes poor pigmentation and, often, a clinical appearance that mimics eczema or psoriasis. 3 The dominant symptom, itching, often induces both patients and doctors to dismiss the condition as a simple irritation or intertrigo. . . .