Giant basal cell carcinoma surgical management and reconstructive challenges

Basal cell carcinoma is exceedingly common, but tumors >5 cm in size or giant basal cell carcinomas (GBCCs) are rare. We retrospectively review 10 GBCCs in 8 patients treated by aggressive surgical excision and reconstruction in a single operative procedure. With the exception of 1 chest lesion, all GBCCs involved the face or scalp. The 10 large defects were reconstructed with 5 free-tissue transfers, 2 pedicled musculocutaneous flaps, and 3 rotational skin flaps. There has been no evidence of local recurrence or metastasis in a mean follow-up of 29 months. Neglect has a well-established role in the presence of GBCCs, with undiagnosed preexisting medical problems also common. Surgical excision and reconstruction is the treatment of choice and can be readily accomplished in a single procedure with few complications, good oncologic control, and acceptable cosmetic results.     

The excision width in surgical treatment of basal cell carcinoma

Basal cell carcinoma originates from pluripotent cells of basal layer of epiderm, external covering of hair follicles, sebaceous glands or other skin adnexa. It is characterized by local infiltrating and sometimes destructive growth. There are several types of basal cell carcinomas that may be manifested in over 12 clinical forms. Surgical treatment depends to a large extent on the histological type, localization and its clinical manifestation. The analysis included 250 patients of both gender and different age, operated for basal cell carcinoma. Clinical characteristics of basal cell carcinoma and the width of the excision were described. It was concluded that the width of the excision of basal cell cancer was in relation to histological type.     

手术治疗鼻部基底细胞癌13例

目的探讨鼻部基底细胞癌的手术治疗及修复方法。方法我院对收治的13例鼻部基底细胞癌患者进行手术切除并根据美学原理对手术创面进行修复。结果13例患者术后切口愈合良好,均达到Ⅰ期修复。随访1～3年,无复发,术后效果满意。结论手术切除是治疗鼻部基底细胞癌的首选方法。术后采取合适的修复方式,如拉拢缝合、局部皮瓣转移及耳后皮瓣移植,可获得良好效果。     

Oncological and reconstructive management in a patient with multiple recurrences of basal cell carcinoma of the nose

Basal cell carcinoma (BCC) grows by direct extension replacing local anatomical structure; it rarely metastasizes, however may cause severe injure expanding to contiguous tissues with a biological invasive behaviour. BCC of the nose is often a highly aggressive neoplasia with infiltrative growth pattern. Fast cancer extension to the adjacent facial structures requires wide resection for oncological management. In our study we present a 69-year-old male affected by BCC of the nose back and treated by surgical radical excision with free margin disease at histological examination. Patient, subsequently, developed a local relapse. Therefore, he underwent surgical excision of the recurrence and the histological evaluation pointed out a metatypical and infiltrative BCC pattern without margins involvement. Afterwards, the patient developed another local recurrence involving the left alar nose and the omolateral cheek. Histological examination still demonstrated a metatypical and infiltrative pattern, with disease free margins, but nasal vestibule involvement. Successively the patient had another local wide resection from the nasal wing to the maxillary bone without reconstructive procedure. Three years after, the patient developed another local relapse and underwent another surgical procedure, consisting in a very wide resection with concomitant selective left laterocervical node dissection. Histological evaluation demonstrated a metatypical solid infiltrative BCC pattern with disease free margins and lymph nodes. One year after, forehead flap was made to reconstruct the nose and left cheek deficit. At 16 months follow-up the patient remains disease free.     

Use of an audit to improve surgical treatment of facial basal cell carcinoma

Background

Basal cell carcinoma (BCC) is the most prevalent form of skin cancer and the choice of current treatment strategies depends on several criteria including patient age, size of the lesion, histological subtype, and localization.

Methods

A retrospective chart review was conducted including all patients with facial BCCs, together with neck, ear, and scalp, who underwent surgical excision between January 2005 and December 2010. An audit was designed to compare the outcome of two subsequent study phases.

Results

During the first 4-year study period, a total amount of 273 tumors were excised in 251 patients (mean age, 65.6 years; 112 males, 139 females). The overall rate of positive margins was 44/273 (16.1 %). In the second study period, a total amount of 244 tumors were excised in 228 patients (mean age 63.4 years; 105 males, 123 females). In this group, 17 excisions had positive excision margins on pathohistological report (7.0 %)

Conclusions

Our findings demonstrate that performing an internal audit may improve treatment quality and therefore may be helpful in optimizing the effectiveness of present treatment modalities and their costs and the development of standards and guidelines.

Level of Evidence

Level III, risk/prognostic study.     

Clear-cell basal cell carcinoma of the upper eyelid: a case report.

A clear-cell variant of basal cell carcinoma in a previously unreported site is described. This rare variant appeared on the upper eyelid of an 81-year-old woman. Light microscopic examination showed an intradermal tumor with circumscribed lobules composed of clear cells. Histological differential diagnosis of tumors with clear-cell formation is often confusing and can have a great influence on treatment decision making, including surgical intervention.     

Massive basal cell carcinoma of the scalp: successful management by cooperation of chemosurgeon and reconstructive surgeon.

No single modality is appropriate for treatment of the huge invasive basal cell carcinoma. Mohs' chemosurgery is perhaps the most efficacious ablative method, but it must be supplemented by a reconstructive procedure in nearly all sizable lesions. A case history is presented of a patient with massive basal cell carcinoma involving the entire posterior scalp and deep tissues in which chemosurgical ablation and major staged reconstruction proceeded concurrently to a successful conclusion. The advantages of this approach are discussed.     

Evaluation of effectiveness of surgical treatment and histopathological characteristics of basal cell carcinoma in Turkish patients

Basal cell carcinoma (BCC) is the most common cancer in the white population. This study was undertaken to evaluate the effectiveness of surgical treatment and to define histological features of BCC in Turkish patients. We prospectively studied 50 patients with 57 BCCs treated surgically. The majority of the tumors occurred on the head and neck, most commonly on the nose and the cheek. The excision margin ranged between 2 and 20 mm depending on the size, anatomical location, and clinical appearance of the tumor, and 3 mm margin (35.1%) was the most common excision margin used. Defects following excision were generally closed by local flaps (57.9%). The rate of incomplete excision was 7%. The nodular type (71.9%) was the most frequent histological type. Surgical treatment is an effective and safe method for treating BCC, and histological subtypes of BCC must be recognized and reported by pathologists.     

Surgical treatment of rhinophyma associated with basal cell carcinoma: report of four cases

Rhinophyma, the end stage in the development of rosacea, is characterized by sebaceous hyperplasia, fibrosis, follicular plugging, and telangiectasis. Although it is commonly considered a cosmetic problem, it can also cause gross airway obstruction. Many patients suffer psychic trauma as a result. Basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and sebaceous carcinoma (SC) have been reported previously in association with rhinophyma. It would appear that the incidence of malignancy in rhinophyma is significantly greater than in the skin of normal noses. It is the purpose of this report to discuss and emphasize the need for histologic examination of all the surgically removed tissue in patients with rhinophyma. Early surgical treatment is advocated even in minimal rhinophyma, this can result in gratification for both the patient and the surgeon. Four illustrative cases are presented. Received: 24 March 1998 / Accepted: 19 May 1998     

Surgical treatment of an extensive basal cell carcinoma of the scalp infiltrating the superior sagittal sinus

A patient with a basal cell carcinoma infiltrating the superior sagittal sinus and involving a wide area on the scalp was successfully excised. Two lesions, one in the right frontotemporal region and the other in the temporo-parieto-occipital region, were present. Surgical resection of the two lesions was performed on two separate occasions. The tumor had invaded a wide area of the temporo-parieto-occipital region, and because of this, the scalp, skull and dura mater, together with a large part of the superior sagittal sinus, were excised. The resulting defect was reconstructed simultaneously. At one year follow-up, there was no recurrence of the lesion.     

基底细胞癌的病理生物学行为与临床治疗

目的探讨基底细胞癌的病理生物学行为与临床治疗的相关性.方法对136例基底细胞癌病例,根据其病理生物学行为及病变部位和范围,采取扩大切除后单纯缝合,局部皮瓣修复,植皮及 Mohs手术方法进行临床治疗.结果 136例病例全部Ⅰ期愈合,经2～9年随访,效果满意,无1例复发.结论认识到这类恶性肿瘤的特点是病变较为局限,恶性程度低,具有多种病理分型,极少发生转移,又多发于面中部,对人的容貌影响较大,所以基底细胞癌的治疗必须结合临床病理分型区别对待.早期手术切除,重视病变切除范围,选择适当的方法修复创面,有助于本病的彻底治疗.     

Surgical treatment of invasion of the upper aerodigestive tract by well-differentiated thyroid carcinoma

Forty-eight patients with well-differentiated thyroid carcinoma invading upper aerodigestive tract structures have been described. Age at diagnosis was found to be a negative prognostic factor, and duration of disease before invasion was found to be a positive prognostic factor. Treatment with radical surgery and adjuvant therapy provided no improvement in survival over treatment with near-total (skeletonizing) excisions combined with adjuvant therapy. All patients treated with partial debulking procedures, with or without tracheotomy, died from disease. We believe that partial resection of upper aerodigestive tract structures without sacrifice of voice, normal breathing, or swallowing should be considered in patients with well-differentiated thyroid carcinoma.     

Recognition and treatment of recurrent basal cell carcinoma

The recognition and treatment of recurrent basal cell cancer presents a diagnostic as well as a therapeutic problem. While recurrences are often masked by previous surgical efforts, there are definite clinical features that warrant suspicion and subsequent biopsy. Adequate therapy can come only with accurate recognition and aggressive treatment using microscopical control.     

输尿管软镜治疗上尿路结石的手术技巧分享(附光盘)

随着输尿管软镜硬件技术的成熟与进步,输尿管软镜治疗上尿路结石越来越受到业界的关注。输尿管软镜碎石术有其独特的安全性和有效性,本文重点阐述该技术的各项注意事项和技术要点。     

Surgical treatment of forehead and glabellar wrinkles]

Many surgeons concerned with aging in the jowl and neck often overlook more objectionable changes in the upper face. These changes produce not only an old or aged appearance but inappropriate expressions as well. This paper outlines the elements of aging in the upper face and details the planning and execution of the foreheadplasty. Topics discussed include inappropriate facial expressions, upper facial aesthetics, incisions for bald or balding men and techniques for minimizing scars. For many years the evolution and application of techniques for rejuvenation of the upper face lagged behind that of procedures used to correct aging in the cheek and neck. Men were generally overlooked as candidates for foreheadplasties by surgeons who believed these procedures not to be possible on bald or balding scalps. In addition, patients were frequently disappointed after surgery due to objectionable secondary deformities. These include bizarre expressions from over-resection of forehead muscles, contour irregularities following imprecise muscle sculpturing, inappropriate appearances due to eyebrow malpositioning and aesthetic imbalances resulting from hairline shifting. For these and other reasons some surgeons deemed the procedure to be of questionable value. The author would like to share current concepts and new techniques which have overcome these problems and delivered satisfaction and happiness to many patients.     

阴囊基底细胞癌诊治分析

目的 探讨阴囊基底细胞癌的诊断和治疗方法.方法 回顾性分析7例阴囊基底细胞癌患者的资料.患者平均年龄66(50～74)岁.主要症状为阴囊皮肤出现斑块或结节伴瘙痒,病程1～20年.肿瘤最大径1.5～4.5cm.5例曾误诊为湿疹或皮炎.7例均经活检确诊,均无远处转移.7例均行肿瘤广泛切除术治疗.结果 7例术后病理检查见肿瘤为基底样细胞和间质组成的团块,标本切缘均为阴性.1例术后21个月发生左腹股沟淋巴结转移,行双侧腹股沟淋巴结清扫术.术后随访36个月无瘤生存.1例术后48个月出现双肺转移,予环磷酰胺+表阿霉素+顺铂联合方案化疗6个疗程,获得完全缓解.化疗结束后13个月无瘤生存.其余5例术后未行辅助放、化疗,随访14～72个月均无瘤生存.结论阴囊基底细胞癌临床罕见.手术广泛切除肿瘤有可能获得治愈.部分患者在术后数年会发生转移,术后需要长期随访.     

Cryosurgical treatment of basal cell carcinoma of the skin

Cryosurgical method was used for the treatment of 102 patients with basal cell carcinoma of the skin. A portable cryosurgical apparatus with a set of applicators was used. Liquid nitrogen was used as the cold agent. The method is simple and accessible and gives good long-term results: recidivation is not more than 2%, rough cicatricial keloids are not formed.