皮肤鳞状细胞癌临床和病理分析

目的探讨皮肤鳞状细胞癌的临床和病理特点。方法收集2009--2012年经组织病理诊断为皮肤鳞状细胞癌的58例患者的临床及病理资料,对临床和组织病理学特征进行回顾分析。结果皮肤鳞状细胞癌高峰发病年龄为70～89岁,皮损见于头面部27例（46．55％）,外生殖器部位20例（34．48％）,四肢9例（15．52％）,躯干2例（3．45％）。临床上表现为结节隆起型27例,占46．55％,深在浸润型19例,占32．76％,溃疡型12例,占20．69％。组织病理表现为经典型51例,特殊类型7例（疣状型5例、腺性鳞癌1例、透明细胞型1例）。结论皮肤鳞状细胞癌好发于老年人曝光部位,应及早进行组织病理学检查以明确诊断,提高患者生存率。     

1333例皮肤恶性肿瘤回顾性分析

目的了解重庆地区皮肤恶性肿瘤的发病情况及特点。方法收集和回顾性分析第三军医大学西南医院皮肤科1991年～2010年经组织病理确诊的皮肤恶性肿瘤患者临床资料。结果共统计1333例皮肤恶性肿瘤患者,男女之比为1．26：1,其中基底细胞癌454例（占34．06％）、鳞状细胞癌235例（占17．63％）、鲍恩病136例（占10．20％）、恶性黑素瘤133例（占9．98％）、乳房及乳房外Paget病104例（占7．80％）。临床诊断与组织病理诊断符合率为72．4％,符合率最高的是乳房及乳房外Paget病（93．27％）。基底细胞癌主要发生于头面部和颈部,鲍恩病多见于躯干部位,恶性黑素瘤的主要发病部位在足跖。结论相对于国内外其他研究资料,重庆地区的皮肤恶性肿瘤发病情况具有一定的自身特点。     

80例基底细胞癌误诊病人情况及组织病理研究

目的 探讨基底细胞癌患者的临床情况及组织病理特点,探寻误诊原因,为临床提升其检出率、诊断率提供一定支持。方法 收集某人民医院2018年6月至2020年1月收治的80例皮肤基底细胞癌误诊患者作为研究对象,所有研究对象最终经手术切除及组织病理学检查证实为基底细胞癌。结果 80例误诊患者误诊为脂溢性角化病26例、色素痣15例、鳞状细胞癌12例、日光性角化病7例、化脓性肉芽肿3例、血管瘤5例、毛母细胞瘤5例、皮肤溃疡1例、增生性瘢痕2例、皮肤纤维瘤2例、表皮囊肿2例。最终诊断结果显示患者中组织学分型以结节型为主,共46例,占比为57.50%。其他病例分别有腺样型7例,占比为8.75%;中浅表型5例,占比为6.25%;微结节型5例,占比为6.25%;浸润型4例,占比为5.00%;色素型4例,占比为5.00%;角化型2例,占比为2.50%;基底细胞癌伴附属器分化4例,占比为5.00%;鳞状细胞基底细胞癌3例,占比为3.75%。结论 皮肤基底细胞癌的组织分型较多,形态也呈现明显的差异,易与其他疾病混淆、误诊。皮肤基底细胞癌相较于其他皮肤疾病在组织病理中大多有明显差异,因此组织病理诊断是鉴别基底细胞癌的理想方式。     

皮肤镜在微小色素型基底细胞癌诊断中的初步研究

目的 评价皮肤镜在微小色素型基底细胞癌诊断中的价值.方法 体表疑似微小(皮损直径＜5 mm)色素型基底细胞癌患者58例,男19例,女39例;年龄16～82岁;病程3个月至25年.对每例皮损进行皮肤镜检查,留皮肤镜照片.由两名医生参照色素型基底细胞癌皮肤镜特点,仅根据照片盲法独立进行诊断.以病理诊断为金标准,通过诊断性试验的研究方法,研究皮肤镜在微小色素型基底细胞癌诊断中的敏感度、特异度及一致性.结果 58例患者中36例经组织病理学诊断为基底细胞癌,医生A皮肤镜诊断为色素型基底细胞癌41例,不是色素型基底细胞癌17例;医生B皮肤镜诊断为色素型基底细胞癌40例,不是色素型基底细胞癌18例.与病理诊断相比,两名医生皮肤镜诊断色素型基底细胞癌的灵敏度、特异度、Youden指数及Kappa值分别为97.22％、72.73％、69.95％、0.732 (P＞ 0.05)和97.22％、77.27％、74.49％、0.772(P＞0.05).结论 皮肤镜对微小色素型基底细胞癌诊断与组织病理学检查结果有较好的一致性.     

多发性浅表型基底细胞癌1例

报告1例多发性浅表型基底细胞癌。患者男,52岁,皮疹表现为全身多发黑褐色丘疹、斑块,多处组织病理检查均确诊为基底细胞癌。多发性浅表型基底细胞癌临床表现多样,应注意与其他疾病相鉴别,应加强组织病理、免疫组化等检查,避免误诊。     

211例基底细胞癌分析

回顾性分析本院2013年1月-2017年12月211例皮肤基底细胞癌临床表现及误诊情况。211例皮肤基底细胞癌中,男80例,女131例,发病年龄在50～80岁共178例,占84.4%;皮损发生于头面部者最多,共159例,占75.4%;临床首诊与病理诊断相符合共141例,占66.8%;其中临床误诊为鳞状细胞癌15例,占7.1%,误诊为脂溢性角化12例,占5.6%,误诊为恶性黑色素瘤9例,占4.3%,误诊为色痣7例,占3.3%,误诊为Bowen病5例,占2.4%,误诊为化脓性肉芽肿4例,占1.9%。     

临床误诊为黑素瘤的其他疾病141例分析

【摘要】 目的 分析141例临床误诊为黑素瘤的病例,提高疾病认识及诊断水平。方法 回顾分析第四军医大学西京皮肤医院2001年11月至2019年9月病理数据库中141例临床初诊为黑素瘤但经组织病理检查排除黑素瘤诊断的患者临床及组织病理资料。结果 误诊为皮肤黑素瘤141例,男64例,女77例,误诊时中位年龄51岁,平均病期103.4个月。皮损主要表现为斑片、丘疹,颜色以黑色为主,组织病理诊断包括色素痣35例,基底细胞癌 29例,脂溢性角化病15例,鲍恩病 7例,甲黑素斑6例,表皮囊肿5例,汗孔瘤、出血及皮肤纤维瘤各4例,其他32例。结论 临床部分疾病表现有黑素瘤特征,容易误诊,需掌握其临床特征,积极进行皮肤镜、皮肤组织病理等辅助检查明确诊断,降低误诊率。     

71例基底细胞癌皮肤镜下特征分析

目的：明确基底细胞癌在皮肤镜下的特征,为临床皮肤镜鉴别色素性皮损提供参考。方法：分析71例（71 lesions)经组织病理确诊为基底细胞癌的皮损皮肤镜图像。结果：最主要的皮肤镜指征按出现频率由高到低分别为：蓝灰色卵圆形巢（78.9%）、血管模式（74.6%）、多发性蓝灰色小球（60.6%）、溃疡（57.7%）、叶状结构（21.1%）。单纯临床诊断符合率为55%,加用皮肤镜后临床准断符合率为95%,提高了40%。结论：皮肤镜可提高临床诊断基底细胞癌的符合率。     

皮肤镜对基底细胞癌鉴别诊断价值的初步研究北大核心CSCD

目的探讨皮肤镜在基底细胞癌鉴别诊断中的应用价值。方法选取北京大学第一医院行皮肤镜检查并经病理确诊的基底细胞癌皮损为病例组,并随机选取色素程度和部位与基底细胞癌相似的其他色素性皮损作为对照组。以病理检查结果为金标准,用诊断试验方法评价皮肤镜诊断基底细胞癌的能力,计算提示黑素细胞性皮损的指征在基底细胞癌中的出现情况,并比较不同色素程度的基底细胞癌在皮肤镜下的差异。结果病例组86例,对照组68例。基底细胞癌皮肤镜经典诊断模式的灵敏度、特异度、阳性预测值、阴性预测值分别为98．84％、89．71％、92．39％、98．39％,Youden指数为0．88,与病理诊断的符合率94．81％。色素网、多发褐色至黑色小球或小点、毛囊口周围色素在黑素细胞性皮损中的比例显著高于基底细胞癌（P〈0．05）,蓝白幕样结构见于61．63％的基底细胞癌。蓝黑色斑片和蓝白幕样结构在重色素组基底细胞癌中出现频率显著高于低色素组（P〈0．01）。结论皮肤镜诊断色素性基底细胞癌的经典模式在中国人群也显示出良好的诊断能力,研究提出的几个指征如周边色素栅状排列、周边色素加深、毛囊口周围色素加深或减退,在鉴别诊断中的价值尚需大样本研究证实。     

皮肤基底鳞状细胞癌1例

报道1例皮肤基底鳞状细胞癌。52岁女性，反复左鼻唇泡溃疡结痂11年，近3月余来，溃疡加深，血性分泌物增多，上唇挛缩明显。病理诊断为基底鳞状细胞癌。免疫组化染色显示：瘤细胞人上皮抗原（Ber EP4)阳性而上皮细胞膜抗原（EMA）阴性。     

Expression of vascular endothelial growth factor in basal cell carcinoma and cutaneous squamous cell carcinoma of the head and neck

BACKGROUND: Basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) can both arise from any cutaneous epithelial surface. BCC are slow growing and rarely metastasise, whereas SCC are usually more aggressive. It is likely that the angiogenic process plays a key role in determining rate of growth and propensity for dissemination. Angiogenesis is a complex process requiring many factors and a pivotal group of proteins involved in this process is vascular endothelial growth factor (VEGF). METHODS: Immunohistochemical expression of VEGF was assessed in 44 cases of BCC and 41 cases of cutaneous SCC from the head and neck region. RESULTS: VEGF was expressed by blood vessel endothelial cells in both adjacent skin and tumour, and in the basal keratinocyte layer of epidermis. In BCC, VEGF was expressed by tumour epithelial cells, predominantly at the invasive tumour front, in 24/44 cases and its expression was significantly greater than in adjacent skin (p = 0.038). More widespread VEGF expression was found in 32/41 cases of SCC, and it was significantly associated with the degree of tumour differentiation (p < 0.001). CONCLUSIONS: The patterns of VEGF expression in BCC and SCC may help to explain the different behaviour that is usually seen with these tumours.     

基底细胞癌组织病理类型与性别、年龄及部位的相关性分析

目的 分析基底细胞癌(BCC)组织病理类型与性别、年龄及部位的相关性.方法 回顾性分析2000年1月到2009年4月共243例BCC的临床病理资料,应用SPSS 13.0软件对资料进行分析.结果 243例BCC中,男118例,女125例,男女比例为0.94:1;平均年龄(65.16±12.62)岁;好发于头颈部,占77.4%;结节型是最常见的病理类型,占53.9%,其次为浅表型和浸润-硬化型,分别占18.9%和18.5%.女性患者就诊年龄早于男性(P＜0.05).不同组织病理类型BCC的性别构成差异无统计学意义(P＞0.05).浅表型BCC好发于躯干部位,就诊年龄早于非浅表型,女性就诊年龄早于男性,差异均有统计学意义(P＜0.05).结节型、浸润-硬化型及微小结节型BCC好发于头颈部,就诊年龄较晚,男女患者就诊年龄无差异(P＞0.05).结论 不同组织病理类型BCC的临床特征不同,可能存在不同的发病机制.

Abstract：

Objective To analyze the relationship of histopathological subtypes of basal cell carcinoma (BCC) with gender,age and anatomical location of skin lesions.Methods The clinical and histopathological data on 243 cases of BCC collected from Jan 2000 to Apr 2009 were reviewed retrospectively.Data analysis was carried out by using SPSS 13.0 software.Results A total of 243 patients were included in this study,including 118 males and 125 females with the male/female ratio being 0.94:1.The average age of patients was 65.16 ± 12.62 years.Head and neck were the predilection (77.4%) sites of BCC in these patients.Nodular type (53.9%) was the most common type,followed by the superficial type (18.9%) and infiltrative-morphoeic (sclerosing) type (18.5%).The age at visit was younger in female patients than in male patients(P ＜ 0.05),no significant difference was observed in the gender composition among patients with different subtypes of BCC (P ＞ 0.05).Superficial BCC was more common on the trunk; the age at visit was younger in patients with superficial BCC than in those with other subtypes of BCC,and younger in female patients than in male patients (all P ＜ 0.05).Nodular,infiltrative-morphoeic and micronodular subtypes of BCC showed a predilection for the head and neck with an old age at visit,and no differences were observed in the age at visit between female and male patients with these subtypes of BCC (au P ＞ 0.05).Conclusions Different subtypes of BCC show different clinical features,which may be attributed to their different pathogenesis.     

Basal cell carcinoma of the vulva: 21 cases

INTRODUCTION: Basal cell carcinoma (BCC) accounts for 2 to 3 p. 100 of all vulvar malignancies. PATIENTS AND METHODS: We report a retrospective study of 21 cases treated from 1937 to 1999. RESULTS: Vulvar BCC's occurred in elderly patients (average age: 66 years), with mean delay to diagnosis of 5.5 years. Five patients were referred for recurrence. Lesions were located on the external hairy side of the labia majus, except one located on the internal side. In 4 cases a preexisting risk factor was identified: 2 patients had previously received radiation therapy and 2 other patients had multiple disseminated BCC. Mean BCC diameter was 2 cm. Pathological data were similar to skin BCC, with one case of mixed tumor (BCC and squamous cell carcinoma). The treatment was surgical excision for 19 BCCs. Local recurrence risk was high. Only one patient died of visceral dissemination of the disease. DISCUSSION: More than 250 cases of vulvar BCC have been reported in the literature. Clinical, pathological and follow up data are similar to results in the present series. Treatment of choice consists of surgical excision with tumor-free margins. Because of local recurrence risk and possible association with other primary cancers in this age group, long term follow-up is necessary.     

High recurrence rates of Basal cell carcinoma after mohs surgery in patients with chronic lymphocytic leukemia

OBJECTIVES: To estimate and compare the recurrence rates of basal cell carcinoma (BCC) after Mohs surgery in patients with chronic lymphocytic leukemia (CLL) and controls and to evaluate differences among histologic subtypes of BCC. DESIGN: Retrospective assessment of clinical histories, postoperative notes, and surgical photographs. SETTING: Tertiary-care institution (Mayo Clinic, Rochester, Minn). PATIENTS: Twenty-four patients with CLL who underwent Mohs surgery for 33 BCCs and 66 controls matched for sex, age, and surgical year who underwent Mohs surgery for BCC of the head and neck from May 1988 through September 1998. RESULTS: Among the 24 patients with CLL who underwent Mohs surgery for 33 BCCs, there were 4 recurrences. The cumulative incidence of recurrence on a per-tumor basis was 3% at 1 year, 12% at 3 years, and 22% at 5 years. Basal cell carcinoma was 14 times more likely to recur in patients with CLL than in controls (P =.02). Overall, there were no significant differences between patients with CLL and controls in preoperative tumor size (median, 1.6 cm vs 1.4 cm; P =.18) and proportion of aggressive histologic subtypes of BCC (58% vs 41%; P =.12). CONCLUSIONS: Recurrence rates of BCC are significantly higher after Mohs surgery in patients with CLL. Overall, patients with CLL do not appear to have significantly larger BCCs or more aggressive histologic subtypes of BCC. In patients with CLL, close surveillance is warranted for recurrence of BCC and a decreased threshold is indicated for subsequent biopsies.     

基底细胞上皮瘤56例分析

本文对皮肤科门诊1981-1986年6年间的56例基底细胞上皮瘤进行了回顾性的研究,其中男性33例,女性23例,男女之比为1.43:1,发病年龄最小的5岁,最大的33岁,平均年龄53,3岁,其中40岁以上者45例,占80.4%.本文结合文献复习,对基底细胞上皮瘤的组织发生,病因学、临床表现及组织病理学分类进行了讨论.从组织病理学和心理学角度,我们同意本病命名为基底细胞上皮瘤.     

Basaloid neoplasms in nevus sebaceus

BACKGROUND: Nevus sebaceus (NS) (organoider nevus) may frequently be associated with the development of a number of benign and malignant neoplasms among which basaloid neoplasms are the most common. Histopathologic criteria for diagnosis and classification of basaloid proliferations arising in NS are still debated. Most previous investigators have considered them to represent mainly basal cell carcinomas (BCCs). On the contrary, a number of recent authors have proposed that most basaloid neoplasms in NS exhibit predominantly morphologic features implying benignancy, thus representing trichoblastomas (TBs). In this study, we attempted to characterize better the histopathologic features of basaloid neoplasms in NS in a large series based on current morphologic criteria. METHODS: Three-hundred and sixteen cases of NS seen over 19 years were consecutively sampled and reviewed for basaloid neoplasms. Twenty-four cases of basaloid neoplasms in NS were identified and categorized based on current histopathologic criteria either as TB or BCC. For comparison of histopathologic features, 37 solitary TB were also studied. RESULTS: Following histopathologic analysis, 22 cases were categorized as TB (91.6%, 10 males, 12 females; mean age 40.8 years, range 19-78 years) and 2 cases as BCC (8.4%, 1 male, 1 female; 32 years and 40 years). Clinical features in both groups were generally similar. The lesions presented exclusively on the head and neck as skin colored to pigmented papules or nodules within NS (scalp in 19 TB cases and 1 BCC case; face in 2 TB cases and 1 BCC case; neck in 1 TB case). Histopathologically, TB in NS were characterized by smooth-bordered basaloid aggregations with either a nodular and/or a superficial pattern, abundant fibrous stroma with focal clefts within the stroma, and prominent features of limited follicular differentiation (rudimentary follicular germs in concert with papillae). In contrast, BCC in NS showed basaloid aggregations that vary markedly in size and shape, scant fibrous stroma, focal mucinous clefts between basaloid aggregations and surrounding stroma, and lack of prominent rudimentary follicular germs in concert with papillae. Remarkably, sections in a few cases of TB showed features occasionally found in BCCs but presently widely considered to be unspecific (e.g., ulceration, cystic degeneration, and focal clefts between basaloid aggregations and surrounding stroma). Two cases of TB in NS were associated with a sebaceoma and 1 case with a desmoplastic trichilemmoma. Follow-up data in 14 TB cases and 2 BCC cases (mean follow-up 28.8 months; range 1 to 160 months) revealed no local recurrences or distant metastases. CONCLUSION: Our study confirms that the vast majority of the basaloid neoplasms arising in NS show clear-cut morphologic criteria for TB, whereas only a few cases display histopathologic features consistent with BCC. In a minority of cases, basaloid neoplasms with overall morphologic features of TB may present problems in diagnosis when they exhibit a few histopathologic features traditionally associated with BCC or when they occur in combination with other adnexal neoplasms.     

5-氨基酮戊酸光动力治疗基底细胞癌疗效评价

目的：评价5-氨基酮戊酸光动力(ALA-PDT) 治疗基底细胞癌的疗效及安全性。方法：回顾2016-2019年我院进行ALA-PDT治疗的17例基底细胞癌患者（浅表型14例,结节型3例）的临床资料。结果：14例浅表型基底细胞癌患者中13例患者皮损消退,仅留轻微色素沉着或色素减退,2例复发,1例于治疗后6个月后复发,1例于治疗后10个月后复发。3例结节型患者皮损面积缩小>50％。所有患者均未发生严重不良反应。结论：光动力治疗浅表型基底细胞癌临床效果好,复发率低,较为安全,对于结节型基底细胞癌治疗效果较差。     

Continuous-wave Nd:Yag laser hyperthermia: a successful modality in treatment of basal cell carcinoma

It was observed that malignant tumor cells are more sensitive than normal cells to heat. Hyperthermia is known to be cytotoxic at temperatures above 41 degrees C and selectively lethal to cancer cells. The aim of the present study was to evaluate the therapeutic efficacy of continuous wave Nd:Yag laser-induced hyperthermia in treatment of basal cell carcinoma (BCC). The study was performed between April 1995 and August 2000 on 37 patients with BCC selected from of the outpatients of the dermatology clinic of al-Minya University Hospital. Patients were treated with continuous-wave Nd:Yag laser hyperthermia at 6-week intervals (laser output power was 10 W, spot size 8 mm, and irradiation time up to 1 minute). Following this treatment, 36 patients (97.3 %) were completely cured. Within a follow-up period of 3-5 years only one recurrence was encountered (2.7 %). Continuous wave Nd:Yag laser-induced hyperthermia should be considered as an alternative treatment for BCC. This simple, bloodless, outpatient procedure showed excellent efficacy and cosmetic result with minimal complication.     

Basal cell carcinoma of the sole

Basal cell carcinoma (BCC) of the plantar surface of the foot is rare, with only 22 previously reported cases. This clinico-pathologic study is based on 20 cases pf BCC of the plantar surface and plantar-like surfaces from adjacent lower lateral and medial aspects of the foot, submitted to a large podiatric laboratory from 1986 through June 1992 (total specimens for this period = 518,624; total BCC of lower extremities, below knee = 53). There were 15 women and 5 men. The average patient age was 73 years, with a range from 52 to 92 years. The duration of the lesion before diagnosis was 2 months to 12 years, with an average of 2 years. Three patients had a history of trauma. Podiatric clinical diagnoses included BCC (4), SCC (3), soft tissue tumor (2), nevus (1), granuloma (1), keratosis (2), verucca (1), and psoriasis (1). Follow-up information was available on 10 patients; all were free of disease up to 64 months, with an average follow-up of 15.7 months. Three of 20 BCC showed predominant histologic patterns characteristic of fibroepithelioma of Pinkus (FEP). An additional three BCC showed focal or suggestive patterns of FEP. Fourteen tumors showed ordinary BCC histologic patterns. No multicentric-superficial or morphea like BCC were observed. The relatively high incidence of FEP in BCC of the sole correlates with abundant sweat glands and lack of hair follicles on the plantar surface, in accordance with the recent proposal that FEP derives its histologic pattern from the spread of BCC down eccrine ducts, eventually replacing them with solid strands of tumor.     

Risk Factors for Basal Cell Carcinoma

Completed questionnaires regarding suspected risk factors for basal cell carcinoma (BCC) were completed by 538 basal cell carcinoma patients and 738 age-, sex-, and location-matched controls in Saskatchewan. Significant risk (actors were identified using chi² analyses. Relative risks were subsequently computed. The following relative risks were identified: occupation of farming, 1.29; prominent freckles in childhood, 1.23; family history of skin cancer, 1.22; sunburn, 1.19; Irish, Scottish, Welsh mother, 1.19; light skin color, 1.18; red/blond hair color, 1.16; and working outdoors more than 3 hours/day in winter, 1.13: The average age of cases of BCC with a family history of skin cancer was significantly lower than cases of BCC with no family history of skin cancer (63.86 vs. 67.02 years, p = 0.018). No association was noted between BCC and psoriasis.