Invasive head and neck cutaneous squamous cell carcinoma: clinical and histopathological characteristics,frequency of local recurrence and metastasis

BACKGROUND

squamous cell carcinoma is the second most common type of skin malignancy and may evolve to regional lymph node and distant metastases.

OBJECTIVE

The objective of this study was to evaluate patients with head and neck cutaneous squamous cell carcinoma to identify its clinical and histopathological characteristics, as well as the frequency of local recurrence and metastasis.

METHODS

A retrospective cohort of patients with head and neck cutaneous squamous cell carcinoma. Inclusion criteria: histopathological confirmation, follow-up for longer than one year after diagnosis. Exclusion criteria: immunosuppression; lip and oral cavity squamous cell carcinoma; and non-surgical resection of the lesion. We evaluated demographic, clinical and anatomopathologic findings and explored their associations.

RESULTS

Sixty-one patients with 79 tumors and followed by 4.8±3.0 years were selected. The average age was 67.1 years, and 63% of tumors had up to two centimeters. Seven tumors (8.9%) recurred and two of them had positive margins. Recurrence was associated with higher Broders'' grade (p<0.01). Two patients (3.3%) had regional lymph node metastases. There were no distant metastases. Seventy tumors were considered to be usual tumors (89.7%), and 68 (87.2%) were classified as Broders'' grade 1 and 2. Additionally, 64.1% of tumors had a depth of invasion below four millimeters. Thirteen tumors (16.7%) had positive histological margins.

CONCLUSIONS

Most patients had good prognosis in the first year of follow-up, confirming that head and neck cutaneous squamous cell carcinoma has a better prognosis than squamous cell carcinoma of other regions such as mucosa, oral cavity, and internal organs.     

The relation between dermoscopy and histopathology of basal cell carcinoma

BACKGROUND:

Basal cell carcinoma is the most frequent cancer in fair-skinned populations and dermoscopy is an important, non-invasive technique that aids in the diagnosis of Basal cell carcinoma.

OBJECTIVES:

The aim of this study was to evaluate the relationship between histopathological subtypes and dermoscopic features of Basal cell carcinoma.

METHODS:

This study included 98 patients with clinically and histopathologically confirmed Basal cell carcinomas. The dermoscopic features of the lesions from each patient were analyzed before the histopathological findings were evaluated.

RESULTS:

Dermoscopic structures were observed in all 98 patients and irregular vascularity was identified in 78 patients (79.6%). The most common vascular pattern was the presence of arborizing vessels (42 patients, 42.9%) followed by arborizing microvessels (21 patients, 21.4%) and short fine telangiectasias (SFTs; 15 patients, 15.3%). White streaks (38 patients, 38.8%), translucency (31 patients, 31.6%), a milky-pink to red background (42 patients, 42.9%), and erosion/ulceration (29 patients, 29.6%) were also observed. Pigmented islands were seen as blue-gray globules (7 patients, 7.1%) and blue-gray ovoid nests (42 patients, 42.9%). The pigment distribution pattern was maple leaf-like areas in 9 patients (9.2 %) and spoke wheel-like areas in 6 patients (6.1%).

CONCLUSIONS:

Basal cell carcinomas show a wide spectrum of dermoscopic features. Arborizing vessels were the most common dermoscopic findings in Basal cell carcinomas, while superficial Basal cell carcinomas displayed mainly milky-pink to red areas, and arborizing microvessels. The most common dermoscopic features of pigmented types were islands of pigment (blue-gray globules, blue-gray ovoid nests). In conclusion, dermoscopy can be used as a valuable tool for the diagnosis of Basal cell carcinomas and prediction of their histopathological subtypes.     

High-frequency ultrasound associated with dermoscopy in pre-operative evaluation of basal cell carcinoma

The recent development of high-frequency ultrasound, associated with the improved sensitivity in color Doppler, enabled the identification of various skin structures and layers. In basal cell carcinoma, the 22 MHz frequency ultrasound permits the delimitation of tumor margins, while color Doppler, determines its vascularization. We present two cases in which the association of both exams allowed an in vivo analysis of the tumor''s morphology, size, thickness and vascularization, thus contributing to a better pre-operative evaluation.     

Nuclear morphometry and chromatin textural characteristics of basal cell carcinoma

Histological subtypes of basal cell carcinoma have biological, evolutionary and distinct prognostic behavior. The analysis of characteristics of the nucleus can provide data on their cellular physiology and behavior. The authors of this study evaluated nuclear morphological parameters and textural patterns of chromatin from different subtypes of basal cell carcinoma: nodular (n=37), superficial (n=28) and sclerodermiform (n=28). The parameters were compared between neoplasms'' subtypes and with unaffected adjacent basal epithelium. Nuclear area and diameter of sclerodermiform neoplasms were superior to the other subtypes. Chromatin''s color intensity and fractal dimension were less intense in superficial subtypes. Nuclear roundness and chromatin''s entropy presented lower values in tumors than in normal epithelium. There was significant correlation between morphological and textural variables of normal skin and tumors. Morphometric elements and textural chromatin''s homogeneity of basal cell carcinomas may be related to evolutionary, biological and behavior particularities related to each histotype.     

Cutaneous field cancerization: clinical,histopathological and therapeutic aspects

The concept of "field cancerization" was first introduced by Slaughter in 1953 when studying the presence of histologically abnormal tissue surrounding oral squamous cell carcinoma. It was proposed to explain the development of multiple primary tumors and locally recurrent cancer. Organ systems in which field cancerization has been described since then are: head and neck (oral cavity, oropharynx, and larynx), lung, vulva, esophagus, cervix, breast, skin, colon, and bladder. Recent molecular studies support the carcinogenesis model in which the development of a field with genetically altered cells plays a central role. An important clinical implication is that fields often remain after the surgery for the primary tumor and may lead to new cancers, designated presently as "a second primary tumor" or "local recurrence," depending on the exact site and time interval. In conclusion, the development of an expanding pre-neoplastic field appears to be a critical step in epithelial carcinogenesis with important clinical consequences. Diagnosis and treatment of epithelial cancers should not only be focused on the tumor but also on the field from which it developed. The most important etiopathogenetic, clinical, histopathological and therapeutic aspects of field cancerization are reviewed in this article.     

Multiple metastatic basal cell carcinoma with concurrent metastatic pleomorphic sarcoma in chronic lymphedema area - Case report

Chronic lymphedema presents as interstitial fluid retention due to a failure in the lymphatic system drainage. The affected region becomes more vulnerable immunologically and predisposed to the onset of neoplasms. Basal Cell Carcinoma is the most common sort of neoplasm, nevertheless it rarely metastisizes. Sarcomas are malignant mesenchymal neoplasms, locally aggressive, which can spread. Here is reported an infrequent case of multiple basal cell carcinoma, synchronous to a poorly differentiated pleomorphic sarcoma, both spreading to lymph nodes and arising from tissue compromised by chronic lymphedema.     

“改良Barsky”法在唇裂二期上唇畸形修复中的应用

目的总结应用改良Barsky法修复单侧或双侧唇裂二期畸形的经验。方法依照Barsky法根据Barsky法的基本原则设计固定方向的切口及瘢痕切除范围,所有切口均矫正为直线,切开后形成类似"Z皮瓣"的切口,美容缝合。结果应用本方法修复后的25例患者愈合良好,双侧唇峰和唇珠外观接近正常,上唇对称度增加。结论应用改良Barsky法修复唇裂修复后期上唇畸形,可以较好的延长上唇白唇长度,改善唇弓形态。由于该方法具有对称性,可以同时应用于单侧或双侧唇裂后期修复。     

Lobomycosis and squamous cell carcinoma

The occurence of squamous cell carcinoma on long-lasting ulcers is classic. Malignant transformation may occur on burn scars and chronic ulcers of varying etiology, including infectious agents. Transformation of old lobomycosis lesion scars into squamous cell carcinoma has been rarely reported. Careful and long-term follow-up of such patients is important to avoid carcinomatous transformation.     

Surgical treatment of basal cell carcinoma: an algorithm based on the literature

Although basal cell carcinoma can be effectively managed through surgical excision, the most suitable surgical margins have not yet been fully determined. Furthermore, micrographic surgery is not readily available in many places around the world. A review of the literature regarding the surgical treatment of basal cell carcinoma was conducted in order to develop an algorithm for the surgical treatment of basal cell carcinoma that could help the choice of surgical technique and safety margins, considering the major factors that affect cure rates. Through this review, it was found that surgical margins of 4mm seem to be suitable for small, primary, well-defined basal cell carcinomas, although some good results can be achieved with smaller margins and the use of margin control surgical techniques. For treatment of high-risk and recurrent tumors, margins of 5-6 mm or margin control of the surgical excision is required. Previous treatment, histological subtype, site and size of the lesion should be considered in surgical planning because these factors have been proven to affect cure rates. Thus, considering these factors, the algorithm can be a useful tool, especially for places where micrographic surgery is not widely available.     

热休克蛋白10、60在皮肤鳞状细胞癌、基底细胞癌、日光性角化病中的表达

目的 探讨热休克蛋白（HSP）10、60在皮肤鳞状细胞癌（SCC）、基底细胞癌（BCC）和日光性角化病（AK）中的表达水平。方法 采用免疫组化EnVision两步法测定HSP10、60在皮肤SCC、BCC、AK中的阳性表达水平,并与正常组对照。结果 与对照组比较,HSP10组只有BCC组的阳性表达高于正常组（Z = 3.24,P < 0.01）,AK组（Z = 0.74,P > 0.05）和SCC组（Z = 0.52,P > 0.05）与对照组比较差异无统计学意义;HSP10组中AK与BCC,AK与SCC的差异有统计学意义（P < 0.05）,但SCC与BCC组间差异无统计学意义（P > 0.05）。HSP60组三组的阳性表达均高于正常组,其中AK（Z = -2.90,P < 0.01）、BCC（Z = -2.15,P < 0.05）、SCC（Z = -2.78,P < 0.01）;三组间两两比较结果为AK = SCC > BCC（P < 0.05）。结论 HSP60的高表达可能与鳞状细胞癌、日光性角化病的生物行为有关。     

Earlobe reconstruction by the Gavello technique and bilobed flap

The earlobe is an anatomical structure that has a significant aesthetic role. Its surgical repair places a challenge due to the difficulty of obtaining a natural appearing and durable outcome. The authors present two options: the Gavello technique and the bilobed flap, after the excision of malign neoplasms of the earlobe. The Gavello technique makes use of a bilobed flap with an anterior base to mold the new earlobe. D''Hooghe''s bilobed flap with a pre and post-auricular lobe allows the reconstruction of small earlobes. Both techniques, although old, acquire an important and current interest in earlobe reconstruction, by reason of the moderate degree of difficulty, the use of a single time surgical act and under local anesthesia, with a proper aesthetic result.     

CXCR7在常见皮肤恶性肿瘤及其细胞株中的表达及意义

目的 探讨趋化因子受体CXCR7在皮肤鳞状细胞癌、基底细胞癌、侵袭性皮肤黑素瘤及其细胞株中的表达及其意义。方法 收集30例皮肤鳞状细胞癌、25例基底细胞癌、30例皮肤黑素瘤的癌组织,采用免疫组织化学方法,检测CXCR7蛋白表达水平。采用RT-PCR、细胞免疫组化方法检测CXCR7在A375、M14、A431、HaCaT细胞株中mRNA及蛋白水平。结果 CXCR7在侵袭性皮肤黑素瘤中表达明显,高表达率为80%（24/30）,皮肤鳞状细胞癌及基底细胞癌分别为26.67%（8/30）、8%（2/25）;皮肤黑素瘤CXCR7高表达率与鳞状细胞癌、基底细胞癌比较,差异均有统计学意义（χ2值分别为17.16和28.36,P值均 < 0.05）。CXCR7 mRNA在A375、M14、A431细胞株中均可检出,其中A375表达最强,而HaCaT细胞不表达;细胞免疫组化显示,仅在A375细胞见棕黄色颗粒着色。结论 皮肤黑素瘤及其细胞株A375高表达CXCR7,其可能参与了其恶性侵袭与转移。     

Jagged1蛋白在银屑病、基底细胞癌及皮肤鳞状细胞癌中的表达

目的探讨Jagged1蛋白在银屑病、基底细胞癌及皮肤鳞状细胞癌中的表达及意义。方法采用免疫组化Envision法检测Jagged1蛋白在银屑病、基底细胞癌及皮肤鳞状细胞癌皮损中的表达。结果 Jagged1蛋白在寻常性银屑病患者皮损中呈阴性表达,在基底细胞癌及皮肤鳞状细胞癌中的表达较正常人皮肤增强,差异有统计学意义(P<0.01);Jagged1蛋白在基底细胞癌及皮肤鳞状细胞癌中的表达较银屑病增强,差异有统计学意义(P<0.05)。结论 Jagged1蛋白在银屑病发病机制中与角质形成细胞异常增生及真皮乳头血管增生等组织病理变化可能不相关,提示此蛋白可能与皮肤恶性肿瘤的异常增生有关。     

基底细胞癌和鳞状细胞癌中转化生长因子βⅠ型和Ⅱ型受体表达

目的探讨转化生长因子β(TGFβ)受体在基底细胞癌和鳞状细胞癌中表达水平的变化及其意义。方法采用实时定量PCR和SP免疫组化技术分别检测基底细胞癌、鳞状细胞癌及正常人对照皮肤中Ⅰ型和Ⅱ型TGFβ受体(TGFβRⅠ,TGFβRⅡ)mRNA和蛋白的表达。结果对18例基底细胞癌、24例鳞状细胞癌患者的皮损及正常人对照皮肤的研究显示,基底细胞癌和鳞状细胞癌皮损TGFβRⅠ和TGFβRⅡ的mRNA表达水平均显著低于正常人对照皮肤。免疫组化试验结果显示;TGFβRⅠ染色强度在基底细胞癌组、鳞状细胞癌组较正常人对照皮肤组显著降低(P<0.001);TGFβRⅡ在二组表皮肿瘤与正常人对照皮肤组问表达差异也有统计学意义(P<0.01)。结论基底细胞癌和鳞状细胞癌中TGFβ受体表达下调可能有助于这些上皮细胞起源的表皮肿瘤的形成。     

皮肤恶性肿瘤microRNA的研究进展

MicroRNA(miRNA)分子广泛参与调控机体细胞的增生、分化、代谢、凋亡等生理病理活动,通过各种复杂的机制调控肿瘤的发生和发展。近来研究发现,皮肤肿瘤中存在miRNA的异常表达,提示miRNA亦参与皮肤肿瘤的发生和发展过程,同时人们对二者的关系及其具体机制进行了研究。该文对基底细胞癌(basal cell carcinoma,BCC)、鳞状细胞癌(squamous cell carcinoma,SCC)、恶性黑素瘤(malignant melanoma,MM)miRNA研究进展作一概述。     

环氧化酶-2在表皮肿瘤中的表达

目的 探讨环氧化酶-2在不同表皮肿瘤中的表达及意义。方法 选择鳞状细胞癌8例、基底细胞上皮瘤10例、Bowen病8例和脂溢性角化病12例,运用免疫组化方法观察肿瘤细胞中环氧化酶-2的表达。结果 与正常表皮相比,环氧化酶-2在鳞状细胞癌、Bowen病、基底细胞上皮瘤中的表达明显上调,尤其以鳞状细胞癌中的表达最强。而环氧化酶-2在脂溢性角化病中的表达与正常人皮肤的表达近似。结论 环氧化酶-2表达的上调可能在表皮肿瘤的发生发展中发挥一定作用。     

手术治疗162例基底细胞癌临床分析

目的 探讨基底细胞癌的一般发病规律、好发部位、常见复发部位和手术治疗的治愈率.方法 对162例基底细胞癌患者分别采用不同术式治疗的情况进行回顾性分析.结果 162例基底细胞癌中,年龄50岁以上者119例,占73.5%;肿瘤单发者156例,占96%.肿瘤好发部位依次是面颊、鼻部、头皮、躯干、口周、眼睑等.肿瘤复发率为6.3%(13/162),易复发部位依次为鼻部、口周,其次是眼睑、头皮.结论 手术治疗基底细胞癌治愈率高,复发率低,仍应作为本病首选治疗方法.手术方式与疗效、复发间无明显相关性.     

Clinical and Histological Analysis of Labial Lip Biopsy in Sjögren Syndrome

Labial lip biopsy findings from 52 patients with Sjögren syndrome (SjS) and cutaneous manifestations were clinically analyzed. Findings of the labial lip biopsy with more than one focus (a cluster of at least 50 lymphocytes) were positive in 52% (28/52). Sixteen patients who presented with oral dryness had negative labial lip biopsy findings with less than one focus score and five patients without oral dryness had positive results. Cells infiltrating into the salivary gland were categorized as plasma cell rich (Group 1), lymphocyte rich (Group 3), intermediate (Group 2), or no gland in biopsied specimens (Group 4). Sicca complaint and the grade of lip biopsy score were significantly higher in Group 3 than in Group 1; no differences were observed in laboratory findings between Groups 1 and 3. The patterns of age distribution and salivary flow rate were also not statistically significant in these two groups. The patients with plasma cell rich infiltrate presented oral dryness, although their clinical and grade of lip biopsy scores were relatively low; most of these patients have secondary SjS. Some of the patients in Group 4 showed an advanced stage of the disease though their lip biopsy score was grade 1 with atrophic or no gland. These data suggest that labial lip biopsy is a useful screening method for the diagnosis of Sjögren syndrome and that clinical manifestations may differ in parallel with the type of infiltrating cell.