Keratotic Basal Cell Carcinoma of the Scalp: A Case Report of a Rare Histopathological Variant

Basal cell carcinoma (BCC) is the most common cutaneous malignancy and demonstrates considerable histopathological diversity.Keratotic BCC is an uncommon variant characterized by prominent keratinization within otherwise typical BCC architecture, which may create diagnostic overlap with other keratinizing and follicular neoplasms.We report a 51-year-old man with a longstanding scalp lesion and a history of prolonged occupational sun exposure.Histopathological examination demonstrated characteristic features of BCC with prominent keratinization and squamous differentiation.Given the follicular association and keratin-filled spaces, a trichilemmal neoplasm was considered; however, the overall morphology and supportive immunohistochemical findings established the diagnosis of keratotic BCC.This case highlights an uncommon morphological variant of BCC and emphasizes the importance of recognizing keratotic differentiation within its histopathological spectrum.Increased awareness of this variant may facilitate accurate distinction from other keratinizing and follicular cutaneous neoplasms.