Large facial basal cell carcinoma treated with multimodal combination therapy

Large basal cell carcinomas (BCCs) with mixed intratumoral histology can present treatment challenges. Although a single treatment modality may be appropriate for some portions of the tumor, it may prove to be inadequate or overly aggressive for others. We describe a patient with a large facial BCC who was referred to our clinic for Mohs micrographic surgery. Biopsies revealed both noduloinfiltrative and superficial patterns. To excise the tumor completely would have been disfiguring, and topical therapy alone would have been inadequate. A multimodal approach using Mohs micrographic surgery to excise the central nodular portion and topical imiquimod to treat the surrounding superficial portion resulted in an excellent clinical outcome. This approach, which minimizes morbidity by capitalizing on the benefits of various techniques, can be applied to any BCC demonstrating distinct nodular and superficial portions.     

Perceptions of facial aesthetics in surgical patients with basal cell carcinoma

BACKGROUND: Basal cell carcinoma (BCC) is a non-melanoma form of skin cancer that is frequently localized within the cervicofacial area. So far, little research is available on how patients perceive their facial aesthetics after surgical treatment for BCC. OBJECTIVES: To analyse (i) if there was a statistically significant improvement over time with regard to the perceived facial aesthetics of surgical patients; (ii) if there was a significant difference between primary and recurrent BCC patients; and (iii) between patients who had Mohs micrographic surgery (MMS) or surgical excision (SE). To assess (iv) which baseline perceptions and/or clinical parameters may predict the evaluation of facial aesthetics at 6 months after surgery. METHODS: Parallel to a clinical trial, a survey was carried out in which patients were asked, by means of a newly developed disease-specific questionnaire, about perceptions with regard to their facial aesthetics before and after surgery. RESULTS: Aesthetic perceptions of all surgical patients improved over time. There was no statistically significant difference on facial aesthetics between the group with a primary or recurrent BCC and patients treated with MMS or SE. Results also showed that the evaluation of postsurgical facial aesthetics can be predicted by both visibility of the tumour and preoperative perceptions. CONCLUSION: It is recommended to administer preoperatively a short questionnaire in which perceptions related to facial aesthetics are included. In doing so, physicians will become more familiar with the aesthetic problems patients might have regarding their afflicted facial site. Ultimately, it may help physicians in deciding whether patients will benefit from additional cosmetic procedures after surgery.     

Correlations between the Sonic Hedgehog pathway and basal cell carcinoma

The Hedgehog (HH) family of intercellular signaling proteins has some essential functions in patterning both invertebrate and vertebrate embryos. Identified as an important regulator of segment polarity and tissue organization in flies, the HH pathway can also play a significant role in human development and in cutaneous carcinogenesis. The family received their name because when the D. melanogaster HH protein malfunctions the mutant fly ends up looking like a small prickly ball, similar to a curled up hedgehog. The Sonic hedgehog (SHH) pathway is implicated in the etiology of the most common human cancer, the basal cell carcinoma (BCC). Mutations in the receptor of SHH, the patched gene (PTCH), have been characterized in sporadic BCCs as well as those from patients with the rare genetic syndrome nevoid BCC. Human PTCH is mutated in sporadic as well as hereditary BCCs, and inactivation of this gene is probably a necessary if not sufficient step for tumorigenesis. Delineation of the biochemical pathway in which PTCH functions may lead to rational medical therapy for skin cancer and possibly other tumors.     

局部组织瓣即刻修复面部基底细胞癌术后效果及瘢痕形成观察

目的观察158例面部基底细胞癌(BCC)手术切除后即刻进行局部组织瓣修复的临床效果及瘢痕增生情况。方法收集、整理和统计2011年1月—2015年1月就诊于我院皮肤科、整形外科门诊的158例面部BCC患者的临床资料、组织病理资料,观察患者治疗的复发率、局部组织瓣治疗后局部形态的恢复及瘢痕形成情况。结果除5例未进行手术治疗的患者外,153例手术治疗患者随访时间0.5~5年,仅有3例复发,复发率为2%;除3例患者对术后局部形态稍有不满意外,其他患者对局部组织瓣修复后形态均较满意,满意率为98%;仅有10例患者在术后3个月内出现轻度的瘢痕增生,半年后消失。结论 BCC手术切除后即刻进行局部组织瓣修复具有较好的临床效果,瘢痕形成少,美观效果好。     

Cost comparisons of managing complex facial basal cell carcinoma: Canadian study

BACKGROUND: Basal cell carcinoma (BCC) is the most common human malignancy and accounts for over 60,000 new cases of cancer in Canada annually. Although expensive to the health care system, no Canadian studies have reported the costs involved in management. This study calculated the costs of managing high-risk BCCs using radiotherapy (RT) and Mohs micrographic surgery (MMS). METHODS: Forty-nine consecutive complex BCC cases presenting to a skin cancer referral center were collected prospectively. All were located on the head and neck and were either recurrent disease or located in "at risk" sites such as the eye, ear, lip, or nose. All patients underwent MMS. A radiation oncologist reviewed each case retrospectively. The costs of MMS were the actual costs of the procedure, with an additional amount added to account for the technical costs of the surgery. The costs of RT included physician fees and technical fees. A sensitivity analysis was performed using known recurrence rates from the medical literature. RESULTS: Five patients were excluded from the comparative analysis because radiation was not recommended (age < 50 years or radiation would overlap with a previous radiation field). The direct cost of treating a patient with a single BCC was $871 (range $630-1,159) using MMS and $3,625 (range $3,430-3,971) using RT. The costs were significantly higher for patients with multiple tumors with both modalities (p = .02 for both). The direct costs of a "5-year cure" were $952 (range $644-1,647) for MMS and $3,758 (range $3,564-4,675) for RT. CONCLUSIONS: This study attempted to document the costs associated with two well-recognized and effective methods of treating complex BCC in Ontario. Subgroup analysis revealed independent associations between aggressive histology, larger size, and complexity of surgical closure with higher costs. Although we did notice a trend toward greater costs in patients with recurrent disease, in males, younger patients, and tumors present for > 1 year, these did not reach significance within our sample size. Despite the limitation that treatment costs may be center and provincially dependent, we hope this preliminary report will initiate further study into comparing Canadian costs of managing skin cancer.     

SUFU-associated Gorlin syndrome: Expanding the spectrum between classic nevoid basal cell carcinoma syndrome and multiple hereditary infundibulocystic basal cell carcinoma

Basal cell nevus syndrome (BCNS), also known as Gorlin syndrome, is characterized by an aberrant activation of the hedgehog (Hh) pathway, most cases being caused by PTCH1 mutations. However, certain features such as multiple hereditary infundibulocystic basal cell carcinomas (MHIBCC), sclerotic fibromas, childhood medulloblastoma or meningioma may be relatively specific to a SUFU mutation. We present two patients with MHIBCC, along with a more complex cutaneous and extracutaneous phenotype. MHIBCC syndrome and BCNS may share clinical features and, indeed, both syndromes probably represent different degrees of upregulation in the Hh pathway.     

改良菱形皮瓣在面部基底细胞癌手术缺损修复中的应用

目的：分析改良菱形皮瓣在面部基底细胞癌手术缺损修复中的应用。方法：选取2012年2月至2016年5月在我院就诊的面部基底细胞癌患者为研究对象，采用常规肿瘤切除术及改良菱形皮瓣修复术对患者进行治疗，对患者的术后不良反应、瘢痕恢复情况等进行总结分析。结果：本研究共纳入41例患者，术后所有患者皮瓣均I期成活，创面平整，未见皮下血肿及感染，周围器官未发生明显位移或畸形；其中2例患者眼部略有牵拉变形，随访1年后变形情况逐渐改善，双眼基本对称；术后瘢痕评估结果显示，患者瘢痕颜色评分为0.61±0.08、平整度评分为0.40±0.06、弹性评分为0.72±0.15、宽度评分为0.86±0.10。结论：改良菱形皮瓣在面部基底细胞癌手术缺损的修复中有较好的疗效。     

Frequency of facial basal cell carcinoma does not correlate with site-specific UV exposure

BACKGROUND: Basal cell carcinoma (BCC) is the most common type of skin cancer in whites. Long-term exposure to UV radiation is considered a major risk factor. We decided to investigate whether maximally exposed areas of the body are also the most frequent sites where BCCs develop. DESIGN: Retrospective analysis of distribution and histopathologic features of 3065 facial BCCs. SETTING: University hospital. PATIENTS: Patients with primary or recurrent BCC of the face. INTERVENTION: Exact topographic documentation followed by removal of BCC with Mohs prcedure and analysis of tumor extension. MAIN OUTCOME MEASURE: To test the hypothesis that site-specific UV exposure correlates with site-specific BCC frequency. RESULTS: The most frequent sites of BCC were the nose (n = 1373), orbital area (n = 386), and ears (n = 269). Subdivision of these anatomical units showed that most nasal BCCs are located at the base of the nose (n = 851), while the apex (n = 292) and the dorsum of the nose (n = 230) were less frequent sites despite their prominent sun exposure. The shaded retroauricular fold (n = 99) and the sun-exposed preauricular crest (n = 105) were similar in frequency of BCCs; fewer BCCs were located on the helix of the ears (n = 65). Finally, almost 10 times more BCCs were found in the medial quadrant of the orbit (n = 225) than in the lateral quadrant (n=24). No correlation between prominent UV-exposed facial contours and particular histologic features, such as solid, morpheaform, or adenoid-cystic, could be established. CONCLUSIONS: Site-specific cumulative UV exposure alone is a poor predictor of frequency or histologic features of BCC. Additional site-specific textural qualities of facial skin may be considered as potential cofactors for the development of BCC.     

局部皮瓣修复面部基底细胞癌术后皮肤缺损

目的探讨局部皮瓣修复面部基底细胞癌(basal cell carcinoma,BCC)切除后皮肤缺损的临床效果。方法 62例基底细胞癌患者在全麻或局麻下,行皮损扩大切除,根据缺损的大小、部位、深度采取各种局部皮瓣修复创面,术后观察皮瓣成活及外观。结果 62例面部皮肤缺损,皮瓣修复成活良好、美观,达到了较理想的效果。结论通过局部皮瓣修复面部基底细胞癌术后皮肤缺损,结果满意,瘢痕不明显。     

Correlation between the dermatoscopic and histopathological features of pigmented basal cell carcinoma

Background Dermatoscopy has a great value in the diagnosis of pigmented basal cell carcinoma (BCC), which is a clinical variant of BCC. The precise definitions of histopathological correlates of dermatoscopic features observed in pigmented BCC have not been established yet. Objective The present study aimed to investigate the correlation between the dermatoscopic features of pigmented BCC and their histopathological counterparts to provide clear histopathological definitions of each dermatoscopic feature. Methods In this case series that comprised a methodological component, after the orientation of dermatoscopic features was determined by placing sutures in the lesions, the histopathological counterparts of each were examined and definitions were made accordingly. Results Although the most common histopathological subtype of BCC is the solid type, the most common histopathological subtype observed in the pigmented BCC lesions in the present study was the superficial multifocal type (72.5%). Blue‐whitish veil was observed in 57.5% (n = 23) of the lesions, a percentage higher than that reported in the literature. In addition to confirming the previously histopathologically defined dermatoscopic features of pigmented BCC, we identified three histopathologically undefined features of pigmented BCC that are spoke‐wheel areas, large blue‐grey ovoid nests and multiple blue‐grey globules. Conclusion Dermatoscopy facilitates prediction of the corresponding histopathological findings in pigmented BCC, based on specific dermatoscopic features.     

Granular cell basal cell carcinoma

Granular cell basal cell carcinoma (BCC) is a rare histologic variant of BCC. In this, the third reported case, the tumor consisted almost entirely of granular cells. By electron microscopy, these cells were filled with pleomorphic lysosome-like granules lined by unit membranes and containing homogeneous or granular electron-dense bodies, membranous debris and amorphous material. The epithelial origin of the tumor was suggested by the characteristic light microscopic appearance of tumor cell islands with some areas of peripheral palisading, and was confirmed by electron microscopic features of numerous well-formed pentalaminate desmosome junctions and sparse cytoplasmic tonofilament bundles, some of which showed attachments to the desmosomes. Histochemical immunoperoxidase stains for lysozyme showed no cytoplasmic lysozyme activity, in common with other granular cell tumors, but ultrastructural examination did not reveal angulate bodies, in contrast to findings in non-epithelial granular cell tumors.     

面部巨大基底细胞癌致残1例

临床资料患者,男,53岁。主因面部溃疡4年于2008年12月6日来我科就诊。患者4年前无明显诱因左面部鼻唇沟处起一粉刺样丘疹,微痛,偶痒,自行挤破,形成溃疡,逐渐增大,波及左眼内眦、右眼     

Granular cell basal cell carcinoma

A 69-year-old woman presented with a 2-year history of a slowly growing tumour on the nose. The clinical diagnosis was basal cell carcinoma (BCC) and a complete excision was performed. Histologically, the tumour had the general features of a BCC but with sheets and nests of cells with granular cytoplasmic changes in the centre of the lesion. A pathological diagnosis of granular cell BCC was made. On immunohistochemical examination, the tumour cells were Ber-EP4, cytokeratin AE1/AE3 and cytokeratin CAM 5.2 positive but S100 protein negative. Only the granular cells were CD68 antigen (monoclonal antibody KP1) positive.     

Giant basal cell carcinoma

The basal cell carcinoma is the most common skin cancer but the giant vegetating basal cell carcinoma reaches less than 0.5 % of all basal cell carcinoma types. The Giant BCC, defined as a lesion with more than 5 cm at its largest diameter, is a rare form of BCC and commonly occurs on the trunk. This patient, male, 42 years old presents a Giant Basal Cell Carcinoma which reaches 180 cm(2) on the right shoulder and was negligent in looking for treatment. Surgical treatment was performed and no signs of dissemination or local recurrence have been detected after follow up of five years.