Photodynamic therapy for the treatment of a giant superficial basal cell carcinoma

A 74-year-old man was referred to our department for the treatment of a 15 × 15 cm superficial basal cell carcinoma (BCC) on his lumbar region. As surgical excision was considered too destructive, photodynamic therapy (PDT) was proposed. Methyl 5-aminolevulinate (MAL) cream was applied under occlusion for 3 h before illumination with a light-emitting diode lamp with an emission peak of 632 nm, a fluence rate of 83.3 mW/cm, and a light dose of 37 J/cm. A second MAL-PDT session was repeated 1 week later. The neoplastic area healed in 30 days. No recurrence has occurred after a 40-month follow-up period, but clinical observation continues. Although surgery still remains the treatment of choice for giant BCC, for which the local invasiveness and metastatic potential are well known, we offered our patient the option of PDT because we believed that classical surgery could hardly provide the same satisfactory outcome. As far as we know, this is the first case of giant BCC treated with PDT.     

浅层X线放射治疗基底细胞癌和鳞状细胞癌27例疗效分析

目的：评价浅层X射线治疗皮肤基底细胞癌（BCC）和鳞状细胞癌（SCC）的疗效。方法：回顾分析2014年6月至2017年7月在我院应用浅层X射线治疗的27例原发性BCC(14例)和SCC(13例)患者,所有患者均经过组织病理学确诊,因健康状况、年龄、皮损部位等原因不适用手术而选用浅层X线治疗。结果：27例患者的31处皮损均痊愈,受照总剂量为45.6-53.2 Gy,随访 2年 仅1例患者1处皮损复发。不良反应主要为放射性皮炎及皮损处的溃烂,皮损体积较大者多伴有疼痛,一般1个月内消失。结论：浅层X射线放射治疗SCC和BCC疗效好,复发率低,对因各种原因不适合手术治疗的患者,是较为理想的方法。     

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.     

Vascular patterns in basal cell carcinoma

Background Dermoscopy has been proved to increase the diagnostic accuracy of basal cell carcinoma (BCC). Objective To characterize the type and frequency of vascular patterns in superficial and nodular BCCs. Methods We retrospectively analysed the dermoscopic images of 504 histopathologically proven BCCs. Results The most common vascular pattern was represented by arborizing vessels (306/504; 60.7%), which were significantly more frequent in nodular BCCs (nBCCs) compared with superficial BCCs (sBCCs), and in pigmented sBCCs vs. non‐pigmented sBCCs (P < 0.0001). Short fine telangectasias (SFTs) were found in 33.1% (167/504) of cases and were significantly more frequent in sBCCs compared with nBCCs (P < 0.0001). Hairpin vessels were detected in 52/504 (10.3%) BCCs. Minor vascular patterns included glomerular vessels (41/504; 8.1%), dotted (21/504; 4.2%), comma vessels (5/504; 1.0%) and polymorphous pattern (9/504; 1.8%). Conclusions Arborizing vessels are prototypic of nBCCs, whereas SFTs are characteristics of sBCCs. Differential diagnosis with squamous cell carcinoma or melanoma is mandatory when a polymorphous pattern is detected.     

Variations of basal cell carcinomas according to gender,age, location and histopathological subtype

BACKGROUND: Most published series of basal cell carcinomas (BCCs) do not take into account the histopathological subtype. Recent studies suggest that the nodular and superficial types could be induced by different causal factors. OBJECTIVES: To analyse the three major subtypes of BCC with regard to sex, age and anatomical distribution. METHODS: We retrospectively included all cases of BCC diagnosed at a single centre of dermatopathology during 1967-96. The diagnosis and subtype (nodular, superficial, morphoeiform) were confirmed by two dermatopathologists. Gender, age at excision, number of tumours and location were recorded, and analysed by histopathological subtype. RESULTS: We recorded 13 457 cases in 10 245 patients (M/F ratio 0.92) of mean age 65 years. Of the BCCs, 78.7% were nodular, 15.1% superficial and 6.2% morphoeiform. Nodular tumours occurred at a mean age of 66.3 years, whereas superficial tumours were excised earlier (63.0 years) and more frequently in women (M/F ratio 0.96). Patients with morphoeiform BCC had a mean age of 65.8 years and were predominantly women (M/F ratio 0.73). Both nodular and morphoeiform types predominated on the head (89.6% and 94.8%), whereas the trunk was the most common location for the superficial type (45.9%). Superficial carcinomas were predominantly located on the head in women (44.8% vs. 34.7% in men), whereas they predominated on the trunk in men (49.9% vs. 42% in women). Tumours of the trunk were excised earlier than those of the face, whatever their histological subtype, in both men and women. CONCLUSIONS: This is the largest series of BCCs in the literature, and shows striking differences in anatomical distribution, sex and mean age according to histological type. The results suggest that the tumours of the trunk, and not only those of the superficial type, could represent a particular subtype of BCC. The analysis also suggests that the hypothesis of chronic vs. intermittent sun exposure cannot be simply extrapolated to BCC. Other causal factors, such as a genetic predisposition, could be involved in the development of carcinomas located on the trunk.     

611例皮肤基底细胞癌的临床及病理特点

目的:分析皮肤基底细胞癌(BCC)的临床及病理特点,为早期诊断、治疗及改善预后提供依据.方法:对南方医科大学皮肤病医院2014年3月至2021年2月间611例初次活检诊断为BCC患者的临床及病理特征进行回顾性分析.结果:611例患者中,男268例,女343例,男女比例为1:1.28;发病年龄:19～92(64.18±1...     

Keratotic basal cell carcinoma of the upper eyelid

A 62 year old woman presented with two large slowly growing pedunculated tumours. These were excised from the lateral aspect of the upper eyelid and were found to be keratotic basal cell carcinomas.     

痣样基底细胞癌综合征一例

痣样基底细胞癌综合征是一种罕见的常染色体显性遗传病,以泛发性皮肤基底细胞癌和多器官发育异常为主要临床特征。本文报告1例痣样基底细胞癌综合征患者,并结合相关文献对该病的发病率、发病机制、诊断标准、治疗方法等进行讨论。     

Clinical and histopathological characteristics of basal cell carcinoma in Korean patients.

Seventy-eight Korean patients with basal cell carcinoma (BCC) between 1984 and 1998 were retrospectively examined at Ewha Womans University Tongdaemun Hospital, Seoul, Korea. We analyzed the annual incidence, age and sex distribution, site of the lesions, clinical appearance, including the proportion of clinically pigmented tumors, modalities of treatment, incidence of recurrence and metastasis of the tumors, the histopathological patterns, and whether solar elastosis, microscopic pigmentation, or adamantinoid feature were associated. The male-to-female ratio was 0.902, and the average age of the patients at first examination was 58.2 years. Eighty percent of the tumors occurred on the head and neck, most commonly on the nose (26.9%), followed by the cheek, eyelid, and upper lip. Ulcerated nodules were the most common clinical presentation. Clinically, 55% of the tumors were pigmented. Six tumors recurred; none metastasized. Surgical excision was the most common modality of treatment. The most frequent histopathological pattern was the solid type (60.3%), followed by the superficial (11.5%) and fibrosing (9.0%) types. The occurrence of the superficial type was significantly associated with truncal lesions (p < 0.001). Solar elastosis was present in 62.1% of the tumors on the head and neck, compared with 8.3% in those of the trunk and limbs (p < 0.001), indicating the significance of sun exposure in the pathogenesis of BCC on exposed areas. Microscopic pigmentation was seen in 69.2% of the tumors. The focal adamantinoid feature was found in 14.1%, which is much higher than the previously reported incidence.     

色素性基底细胞癌一例

患者女,67岁.主因左耳后皮疹20年,溃烂2年余就诊.患者自述20年前左耳后长出一绿豆大小皮肤色丘疹,无自觉症状,数年后丘疹略增大,表面变粗糙,当地医院诊断刺瘊,自行数次用头发捆勒祛除之,未见效,皮疹增长缓慢无不适感.近5年常令其子用烟头烫,2年来丘疹反复糜烂、渗液、结痂,基底渐增大,色变黑,皮疹增大至鸽卵大小,中心溃烂不愈,无痛、痒感.     

Micronodular basal cell carcinoma: A distinct subtype? Relationship with nodular and infiltrative basal cell carcinomas

Micronodular basal cell carcinoma (BCC) may be more difficult to eradicate and prone to recurrence than nodular subtype. The aim of the study was to compare anatomical and histological characteristics of the basal cell carcinomas subtypes and the relationship of the micronodular BCC with other subtypes. Primary BCCs (n = 3074) were classified as superficial, nodular, micronodular, morpheic/infiltrative. The location was head/neck, limbs, chest/abdomen, back or genitals. Fifty‐one micronodular BCCs were matched randomly with nodular and infiltrative cases, by age, sex, and tumor site. A modified Clark level was used to classify the tumor depth. Micronodular, nodular and infiltrative BCC were prevalently located in the head/neck (P < 0.0001), while superficial in the other regions (P < 0.0001). The Clark level was comparable between micronodular and infiltrative BCC, while nodular BCC showed a more superficial level than micronodular (P < 0.001) and infiltrative (P < 0.001) BCC. No nodular BCC had level IV and only 37.3% level III, while 92% of both micronodular and infiltrative BCC were level III or IV. The percentage of level IV was 11.8% and 25.5% in micronodular and infiltrative BCC, respectively. In the mid‐face/periauricular region, 95.5% of micronodular and 100% of infiltrative cases of were level III or IV, compared to 50% of nodular BCC (P < 0.001). The Clark level of nodular subtype was higher for BCC of mid‐face/periauricular than other regions (P < 0.05). It can be concluded that micronodular BCC shows intermediate characteristics compared with nodular and infiltrative subtypes but appears to have a specific individuality making it a distinct subtype.     

Treatment of basal cell carcinoma

Basal cell carcinoma is the most common tumor in Central Europe, the U.S. and Australia. The increasing incidence of basal cell carcinoma presents the health care system, especially dermatology, with great challenges. In recent years new options for treating basal cell carcinoma have become available, enriching our therapeutic options. We review the current status of each of these treatment approaches.     

息肉样基底细胞癌

报告1例息肉样基底细胞癌.患者女,77岁.右腋下赘生物25年,变红伴疼痛1年.皮肤科检查:右侧腋下可见蚕豆大暗红色息肉样半球形赘生物.皮损组织病理检查:表皮增生肥厚,部分区域向下增生,形成条索状及块状肿瘤细胞团块,肿瘤细胞团块由基底样细胞组成,细胞核大深染,可见核分裂象,部分边缘呈栅栏状排列,可见收缩间隙;真皮内可见间...     

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.