The epidermal basement membrane in basal cell carcinoma: an immunohistochemical study

An immunohistochemical study of basal cell carcinomas of varying histological type, using a panel of antibodies to constituents of the epidermal basement membrane, showed marked deficiencies in the expression of the antigens identified by the antibodies LH7.2, GB3 and G71. There was no correlation between loss of immunoreactivity to these antibodies and the histological features of the tumour.     

The immunobiology of basal cell carcinoma: an in situ monoclonal antibody study

A semi-quantitative, immunoperoxidase monoclonal antibody technique was used to study the mononuclear cells surrounding 32 basal cell carcinoma specimens from 30 patients. Tumours were analysed in subgroups based on recurrence, size and ulceration. T cell counts were high (greater than 3 out of 4) for all groups while T helper/inducer and T suppressor/cytotoxic cell counts were equal (approx. 2). Macrophage counts were low for all groups, about I X 2, while B cell and Ia positive cell counts were high (greater than 3). T/B cell and T helper/suppressor cell ratios approached one for the tumours as a whole as well as the sub-groups. The relative importance and contribution of cell mediated vs. humoral immunity in keeping basal cell carcinomas in check is discussed.     

Risk factors for basal cell carcinoma in a southern Brazilian population: a case-control study

Background Basal cell carcinoma (BCC) is the most common cancer to occur in Caucasian populations, and its incidence is increasing. Despite its frequency, there is a paucity of data on risk factors for BCC in some regions. Objectives This study investigated the association between pigmentary characteristics, distinctive patterns of solar exposure, habits and lifestyle, and risk for BCC among patients attending a dermatology center in a region in southern Brazil. Methods We conducted a hospital‐based, case–control study that included 127 case patients with histologically confirmed BCC and 280 cancer‐free control subjects with other dermatologic conditions, observed between January 2006 and December 2007. The study was conducted using a questionnaire and physical examination by a dermatologist. Relative risks were estimated using exposure odds ratios generated by cross‐tabulation and logistic regression models. Results Risk for BCC was associated with family history of skin cancer, Fitzpatrick skin type I, and the presence of actinic keratoses, solar lentigines, leukoderma, and elastosis romboidalis nuchae. No effect was found for different patterns of solar exposure, eye, hair or skin color, exposure to non‐solar ultraviolet radiation (UVR), or lifestyle‐related habits such as sunscreen use and cigarette smoking. Conclusions The results of this study suggest that skin type and family history of skin cancer may be important in establishing risk for developing BCC. Additionally, the detection by clinical examination of skin markers related to UVR action is important in establishing which patients are more likely to develop BCC.     

Superoxide dismutase in psoriasis, squamous cell carcinoma and basal cell epithelioma: an immunohistochemical study

Monoclonal antibodies against human Cu,Zn-superoxide dismutase (SOD) and Mn-SOD were used to stain frozen sections of normal and abnormal human skin. In normal human epidermis, the Cu,Zn-SOD antibody almost exclusively stained the basal cells. Mn-SOD antibody weakly stained the whole of the epidermis but more predominantly the basal cell layer. In psoriasis, Cu,Zn-SOD antibody mainly stained the basal cells of the lowest parts of the elongated rete ridges. Basal cells corresponding to the tip of the dermal papillae were weakly stained. Mn-SOD staining was considerably decreased in the psoriatic epidermis. In squamous cell carcinoma, staining with both Cu,Zn-SOD and Mn-SOD antibodies was decreased, and single cells positive for Cu,Zn-SOD were scattered throughout the tumour nests. In basal cell epithelioma, Cu,Zn-SOD staining was intense and diffusely distributed throughout the tumour nests, while Mn-SOD staining was absent.     

Incidence of cancer in first-degree relatives of basal cell carcinoma patients

There is evidence to suggest that genetic factors play an important role in the development of basal cell carcinomas (BCCs), and that skin neoplasms might be a sign for a genetic predisposition to cancer. We investigated whether the incidence of visceral and skin malignancies among first-degree relatives of BCC-patients was increased. Postal questionnaires were sent to 249 BCC-patients, who were divided into two groups (young = BCC under the age of 51 years and older = BCC over the age of 50 years), and asked them about cancer in their first-degree relatives. The reported numbers of cancer among the relatives were compared with the expected numbers based on sex and age-specific population-based incidence rates. The accuracy of the reported diagnoses was verified. A total of 157 BCC-patients reported 277 malignancies in 1,272 relatives. The incidence of the following cancers was higher than expected in relatives from young BCC-patients: bone and soft tissue (O/E = 3.91; 95% CI: 1.43–8.66), skin (O/E = 2.13; 95% CI: 1.30–3.29) and digestive tract (O/E = 1.59; 95% CI: 1.10–2.23). In relatives of older BCC-patients, only the incidence of digestive tract cancer was higher than expected (O/E = 1.44; 95% CI: 1.08–1.89). Diagnoses that were verified turned out to be accurate in 87% of the cases. This study suggests that the risk of certain cancers, particularly that of the digestive tract, in first-degree relatives of BCC-patients is increased. These findings may indicate a genetic predisposition to both skin and visceral malignancies in this patient group.     

Facial site distribution of basal cell carcinoma in Japanese

Basal cell carcinoma (BCC) occurs preferentially on the face. We retrospectively analyzed 200 cases of BCC treated at Nagoya City University Hospital from April 2004 to October 2015 and examined regional features based on modified facial aesthetic units. BCC occurred more frequently on the cheek, nasal and orbital areas. There was no significant difference between sides, and age was the only factor affecting tumor size.     

Regression in basal cell carcinoma: an immunohistochemical analysis

Summary Spontaneous regression of some cutaneous tumours is well recognized, and is thought to result from an immunological response to the tumour, Regression has previously been noted in basal cell carcinomas, but no studies defining the role of the immune response in the regression of this malignancy have been performed. We have examined 45 primary basal cell carcinomas (BCCs) (20 nodular, 25 superficial) and identified the cellular phenotypes and activation states of the cells infiltrating primary regressing and non-regressing BCCs, by immunocytochemistry. We have found a significantly increased number of CD3⁺ and CD4⁺ T cells infiltrating regressing compared with non-regressing tumours, and the expression of interleukin-2 receptor (an early activation marker for T cells) was also increased. There were no significant differences in class II major histocompatibility complex (MHC), CD1, or macrophage antigen expression in these groups. These findings suggest that activated CD4⁺ cytokine-secreting cells are important in the regression of BCCs.     

Incidence of perineural invasion in histologically aggressive types of basal cell carcinoma

Basal cell carcinoma is generally an indolent form of skin cancer. Morpheaform, infiltrative, and sclerosing types are more aggressive tumors. The incidence of perineural invasion in aggressive types of basal cell carcinoma has not been previously described. We studied aggressive basal cell carcinomas for the presence of perineural invasion. Between 1995 and 1998, the histopathologic diagnosis of basal cell carcinoma was made on 5,097 specimens at Dartmouth-Hitchcock Medical Center. Of this total, 507 were classified as sclerosing, infiltrative, or morpheaform. Perineural invasion was found in 15 of the 507 cases. Of these 15 cases, 12 were from the face, and 3 from the back; 13 were recurrent, and 2 were primary lesions. The mean age of patients at diagnosis was 71 years. We found 9.9% of all basal cell carcinomas at our institution to be aggressive types. We found an incidence of perineural invasion of 3% in the aggressive basal cell carcinoma types. This incidence approaches that reported by others for cutaneous squamous cell carcinomas.     

Signet ring cell basal cell carcinoma: a basal cell carcinoma with myoepithelial differentiation.

Basal cell carcinoma (BCC) can show a variety of routes of differentiation, but myoepithelial differentiation has rarely been described. We describe a case of BCC showing histologic and immunohistochemical features of myoepithelial differentiation. Histologically, the lesion showed well-demarcated tumor nodules composed of two different components. One component was typical of BCC, and the other component was composed of tumor cells containing abundant cytoplasm, eccentric nuclei, and no peripheral palisading, with scattered signet ring-shaped cells. Immunohistochemically, the tumor cells in the typical BCC component stained with CKAE1/AE3 and smooth muscle actin (SMA), but not with S-100 protein. They stained weakly with CAM5.2, epithelial membrane antigen, and glial fibrillary acidic protein (GFAP). The tumor cells in the other component stained strongly with CKAE1/AE3 and SMA, moderately with epithelial membrane antigen and GFAP, and weakly with CAM5.2. In a small area, the tumor cells stained with S-100 protein.     

Cryosurgery of basal cell carcinoma: a study of 358 patients

INTRODUCTION: Cryosurgery is a well-established therapeutic modality for basal cell carcinoma. We report herein an important series of basal cell carcinoma treated by cryosurgery, with a five year cure rate evaluation. PATIENTS AND METHOD: Retrospective study with 395 basal cell carcinomas (over 358 patients - sex ratio H/F: 0.85) treated by cryosurgery between 1981 and 1992. For each patient the data were: age, sex, size of the lesion, location, clinical sub-type, tissue-temperature monitoring, recurrence date and esthetic outcome. RESULT: The lesions were located on the face (93 p. 100) and back (7 p. 100). Mean size was 17 mm. Clinical sub-types were known for 178 lesions; 11 p. 100 of BCC were morpheaform. Tissue-temperature monitoring was performed for 55 p. 100 of cases. 111 tumors were observed for more than 5 years. The 5-year actuarial failure rate was 9 p. 100. The 5-year cure rate was not significantly altered by sex, size of lesions, location and clinical sub-type. No frequent recurrences were observed when tissue-temperature monitoring had not been performed. Complications were rare and esthetic outcome was good. DISCUSSION: The 5-year actuarial recurrence rate with cryosurgery is similar to conventional surgery. It is not essential to control tissue-temperature for preventing recurrences. Cryosurgery is a reliable treatment and outcome depends on surgeon experience. Quickness and low cost of this procedure argue for choosing cryosurgery when treating elderly patients.     

Cytokeratins as markers of follicular differentiation: an immunohistochemical study of trichoblastoma and basal cell carcinoma.

Trichoblastoma(s) (TB) are benign neoplasms of follicular differentiation frequently found in nevus sebaceus. Many morphologic features are shared with nodular basal cell carcinoma(s) (BCC), sometimes rendering the differential diagnosis difficult. Because both neoplasms can simulate components of mature hair follicles histologically, we attempted to corroborate this by immunohistochemical examination of cytokeratins and hair keratins differentially expressed in the hair follicle. Trichoblastoma(s) and BCC showed homogenous expression of CK14 and CK17. The innermost cells of the tumor nodules in all TB and in 72% of BCC were positive for CK6hf. Using a specific CK15 antibody, 38% of TB showed a focal labeling and all BCC remained negative; 70% of TB and 22% of BCC expressed CK19. CK8 was expressed by numerous Merkel cells present in all TB but in none of the BCC examined. All type I and II hair keratins tested, (especially hHa1, hHa5, and hHa8) remained negative in all tumors examined. Trichoblastoma(s) and BCC show consistent expression of CK6hf, CK14, and CK17; variable expression of CK15 and CK19; and absence of hair keratins. This indicates a differentiation toward the outer root sheath epithelium or the companion layer and not toward the inner root sheath, matrix, or cortex.     

Incidence, prevalence and future trends of primary basal cell carcinoma in the Netherlands

Basal cell carcinoma (BCC) incidence rates are increasing worldwide. This study's objective was to estimate the occurrence of BCC in the Netherlands in terms of incidence and prevalence. Data on first primary carcinomas were retrieved from the Eindhoven Cancer Registry and extrapolated to the Dutch population. Extrapolated data showed a total of 444,131, histologically confirmed cases in the Netherlands between 1973 and 2008. During this period, age-adjusted incidence rates (European Standard Population) increased approximately three-fold from 40 to 148 per 100,000 in males and from 34 to 141 in females. Lifetime risk of BCC was 1 in 5-6 for Dutch citizens. Disease prevalence in the Netherlands was 1.4% and almost four times higher than this (5.4%) in the oldest age group (age 65 years or more). Predictions of future trends showed no signs of a plateau in the number of cases. These estimates should urge Dutch policymakers to provide solutions for the growing group of patients with BCC.     

Melanocytic naevi and basal cell carcinoma: is there an association?

Background Melanoma and basal cell carcinoma (BCC) affect similar body sites and share a complex relationship with sun exposure. Objective To establish the existence and magnitude of association between melanocytic naevi, the strongest predictors of melanoma, and BCC to give possible insights into shared pathways of solar ultraviolet tumourigenesis. Methods In a community‐based longitudinal Australian study, detailed information was collected about sun sensitivity, and dermatologists assessed skin colour and counted naevi on the forearms (1986) and back (1992). The BCC frequency and sites were prospectively monitored until 2007. Multivariate logistic regression was used to assess the association of naevi on the forearms or on the back with the development of BCC, adjusting for other risk factors. Results Of 1621 study participants in 1992, 1339 (average age 49) had complete follow‐up and 401 (30%) of these had 1202 histologically confirmed BCCs until 2007. After adjustment for age, gender, skin colour, naevi on the back and sun exposure, overall BCC risk increased significantly in those with forearm naevi (odds ratio: 1.5; 95% confidence intervals: 1.1–1.9). Risk of BCC specifically on the back was doubled in those with many (11 or more) forearm naevi compared with no forearm naevi (odds ratio: 2.4; 95% confidence interval: 1.1–4.8). Naevi on the back were not associated with subsequent basal cell carcinoma. Conclusions High naevus prevalence on the arms is associated with future BCC development.