Multiple infundibulocystic basal cell carcinomas in association with human immunodeficiency virus

Infundibulocystic basal cell carcinoma (IBCC) is a relatively recently described variant of basal cell carcinoma that is controversial and not universally accepted. Excluding cases of nevoid basal cell carcinoma syndrome, IBCC usually presents as a small, solitary, superficial lesion on the face of older persons. There have been previous reports of diffusely distributed, multiple similar lesions, but there is disagreement about the diagnosis in these cases. We present a case of a 43-year-old man with multiple papular lesions which we believe represent IBCC in the setting of infection with the human immunodeficiency virus (HIV).     

Cutaneous spindle cell carcinoma following basal cell carcinoma

A spindle cell carcinoma arose three years after the seeming excision of a so-called "infiltrative" basal cell carcinoma (IBCC) in the cheek of an 87-year-old Japanese woman. The patent had no history of irradiation. The tumor was composed of short fascicles and whorling arrangements of spindle to polygonal cells without residual IBCC. Immunohistochemically, the tumor was positive for vimentin, cytokeratin 8 & 18, epithelial membrane antigen, and alpha-smooth muscle actin. Ultrastructurally, the tumor cells had tonofilaments and desmosomes. The patient died after a local recurrence with metastatic lesions in the lung and the neck lymph nodes that were indicated by CT scanning and MRI at nine months after diagnosis. This case and others support the concept that spindle cell carcinoma can pursue an aggressive clinical course.     

Capecitabine Plus Oxaliplatin Combination Therapy for Basal Cell Carcinoma

No effective systemic chemotherapy is well-established in basal cell carcinoma. We report a case with three simultaneous malignancies: colon cancer, basal cell carcinoma, and smoldering multiple myeloma. The patient was treated with capecitabine and oxaliplatin after surgery for colon cancer. Surprisingly, he achieved a complete response for basal cell carcinoma. This is the first report of this chemotherapy regimen in basal cell carcinoma. This finding suggests that combination capecitabine and oxaliplatin can be a treatment option for patients unable to receive local therapy.     

A case of epidermotropic metastatic malignant melanoma with multiple nodular lesions of the scalp

Epidermotropic metastatic malignant melanoma (EMMM) is a form of metastatic malignant melanoma that has dermal cell nests with epidermotropism and specific histopathological features. We report a patient with eight nodular lesions of the scalp with histopathological findings compatible with EMMM. The tumors developed one year before consultation and increased in size simultaneously. The histopathological findings of all eight tumors were very similar. The tumor cells were located mainly in the dermis and partly in the basal layer of the epidermis. They contained melanin pigments and were positive for anti-HMB45 antibody. The tumors did not respond to combination chemotherapy with dacarbazine, nimustine, vincristine, and interferon-beta. Therefore, all the tumors were surgically removed. No local relapse, distant metastasis or re-elevation of plasma 5-S-cysteinyldopa was identified during nine months of follow-up. Histopathologically, all eight tumors lacked apparent vascular invasion, which may be related to a slow clinical course of the present case.     

Sarcomatoid carcinoma of the lung presenting as a cutaneous metastasis

The author reports a very rare case of cutaneous metastasis of sarcomatoid carcinoma of the lung. The skin metastasis was an initial presentation. A 67‐year‐old man consulted our hospital because of left chest skin mass. An excisional biopsy was performed, and it showed proliferation of malignant sarcomatoid spindle and polygonal cells in the deep dermis and subcutis remote from the epidermis and appendages. Immunohistochemically, the tumor cells were positive for pancytokeratins, cytokeratin (CK) 7, CK 18, vimentin, p53, Ki‐67 (95%) and PDGFRA. They were negative for high molecular weight CK, CK 5/6, CK 14, CK 19, CK 20, epithelial membrane antigen, TTF‐1, CEA, desmin, S100 protein, α‐smooth muscle actin, p63, CD34, surfactant apoprotein A, chromogranin, synaptophysin, neuron‐specific enolase, CD68, CD56, D2‐40, calretinin and KIT. A pathological diagnosis of metastatic sarcomatoid carcinoma probably originating from the lung was made. Then, the patient was admitted to our hospital, and imaging modalities including compured tomography (CT) and magnetic resonance imaging (MRI) revealed a tumor in the left lung. No other tumors were detected in the imaging techniques. Lung biopsy was planned, but the patient suddenly died; the cause of death was unclear. Autopsy was not performed. The present report suggests that sarcomatoid carcinoma of the lung should be considered in cutaneous metastatic lesions. Terada T. Sarcomatoid carcinoma of the lung presenting as a cutaneous metastasis.     

Clear cell basal cell carcinoma with pulmonary metastasis: case report and literature review

Clear cell basal cell carcinoma is a rare histological variant of basal cell carcinoma, which has been well described in the literature. We herein report a case of a 56-year-old man who developed lung metastasis from a rather aggressive tumor that grew very rapidly to involve the parotid gland, the mandibular bone, and even the petrous portion of the temporal bone, the middle ear, and the dura mater. Histological diagnosis was clear cell carcinoma, and initially a salivary origin was suspected. Only in the resection specimen, we found areas of more conventional basal cell carcinoma, and final diagnosis was clear cell basal cell carcinoma. We herein report a case of this rare variant and comment on the histopathological differential diagnosis and the possible relation between these tumors and Gorlin-Goltz syndrome.     

Neoplastic skin lesions of the scalp in children: A retrospective study of 265 cases in Taiwan

Background

The preferential occurrence of certain skin neoplasms on the scalp of children raises concerns from their parents and warrants special diagnostic and therapeutic approaches.

Objective

To explore the demographic and clinical characteristics of scalp neoplasms in the pediatric population, with attention to malignant tumors and systemic syndromes.

Methods

Scalp neoplasms in patients aged 12 years or younger were retrospectively collected in 1990–2010 from two tertiary referral centers in Taiwan.

Results

A total of 267 scalp neoplasms in 265 pediatric patients were recruited. Among the 209 neoplasms with a histopathological diagnosis, nevus sebaceus was the most common (67.9%), followed by melanocytic nevus (6.2%) and juvenile xanthogranuloma (6.2%). Most of the scalp neoplasms (77.9%) were seen at birth or before 1 month of age. Infantile hemangioma was clinically diagnosed without histology in 41.4% of cases. Malignant scalp tumors were identified in two patients (0.95%), with one basal cell carcinoma and one precursor B-cell lymphoblastic lymphoma, respectively. Scalp neoplasms in association with systemic syndromes were found in two cases. One had neurofibromatosis type I with juvenile xanthogranuloma and the other basal cell nevus syndrome with basal cell carcinoma.

Conclusions

Most pediatric scalp neoplasms in our study were hamartomas or teratomas. Malignant scalp tumors and malignant transformation of nevus sebaceus were rare. A detailed medical history taking and complete physical examinations are needed to exclude possible associations with systemic syndromes or malignancies.

     

The nevoid basal cell carcinoma syndrome

126 basal cell carcinomas from 7 patients with nevoid basal cell carcinoma syndrome were examined histologically and -using a scoring system - compared with 54 solitary basal cell carcinomas. The solid subtype formed 78.9% of all tumors in the head and neck region and 48.9% of those located elsewhere. A broader spectrum of histological subtypes was noticed in tumors from patients with the syndrome. As multiple, keratizing odontogenic and epidermal cysts are often seen in the nevoid basal cell carcinoma syndrome it was interesting to see that multiple keratinizing cysts within skin tumors were recorded more often in this group.     

Primary large cell neuroendocrine carcinoma of the skin: An under‐recognized entity and a mimic of metastatic disease

Primary large cell neuroendocrine carcinomas of the skin are exceptionally rare and can be diagnosed only when a metastasis from another organ has been excluded. We report the case of a 62‐year‐old woman with a cutaneous papule on the mid‐chest which generated a differential diagnosis of vascular lesion and basal cell carcinoma. Following excision, microscopic evaluation revealed a dermal large cell undifferentiated carcinoma, with a brisk mitotic rate and focal geographic necrosis. Mucin production was absent. On immunohistochemistry, the lesion expressed CK7, AE1AE3, CK8/18, chromogranin, synaptophysin, CD56, calcitonin (patchy) and TTF‐1 (minimal focal). Stains for neurofilament, CK20, CK5/6, p40, p63, SOX10, MART‐1, EMA, CEA, ER/PR, GATA3, GCDFP, mammoglobin, PAX‐8, CDX2, napsin, ERG and MCPyV proved negative. The histopathological diagnosis was of a large cell neuroendocrine carcinoma, probably metastatic. The patient underwent comprehensive clinical, laboratory and radiographic investigations and no underlying primary carcinoma was detected. During a 20‐month follow‐up period with an oncologist, the patient remains well and free of any apparent carcinoma. This suggests a primary large cell neuroendocrine carcinoma of skin. To date, 3 such cases have been reported in Japanese patients. This is the first in a Caucasian resident of North America.     

Basal cell carcinoma of the scalp in a black patient

Basal cell carcinoma rarely occurs in black persons. When it does occur, it most often involves the sun-exposed areas of the face. Basal cell carcinoma of the scalp often occurs after other predisposing events such as radiation damage, nevus sebaceus, or systemic conditions such as arsenic exposure or immunosuppression. We report the unusual case of a basal cell tumor arising de novo on the scalp of a black patient with none of these predisposing conditions.     

Multiple cutaneous metastases: a rare and late sequelae of lacrimal gland adenoid cystic carcinoma

Primary cutaneous adenoid cystic carcinoma (ACC) is an uncommon malignancy with approximately 60 cases reported in the literature. Metastatic ACC to the skin is even less frequent with eight previously published cases, including only one arising from the lacrimal gland. We report a case of a 61‐year‐old male, who developed multiple cutaneous metastases to the scalp and back from a lacrimal gland ACC 21 years after the initial diagnosis. Initially, in the absence of the past clinical history, the cutaneous lesions were interpreted as primary ACC of the skin. Histopathologically, the metastatic lesions were poorly circumscribed dermal and subcutaneous nodules that were composed of islands of basaloid epithelial cells with ducts and cribriform pattern, mucinous stroma and prominent perineural invasion. Histomorphologically, the cutaneous tumors were similar to the primary ACC. The cutaneous metastases were preceded by tumor dissemination to the lung and other visceral organs, and ultimately led to patient's demise. This report illustrates the importance of juditious clinico‐pathologic correlation and raises awareness regarding prolonged latency of cutaneous metastases in patients with visceral ACC.     

Image‐processing chain for a three‐dimensional reconstruction of basal cell carcinomas*†

Please cite this paper as: Image‐processing chain for a three‐dimensional reconstruction of basal cell carcinomas. Experimental Dermatology 2010; 19: 689–691. Abstract: Basal cell carcinoma (BCC) is the most common malignant skin cancer. For a deeper insight into the specific growth patterns of the tumorous tissue in BCC, we have focused on the development of a novel automated image‐processing chain for 3D reconstruction of BCC using histopathological serial sections. For fully automatic delineation of the tumor within the tissue, we apply a fuzzy c‐means segmentation method. We used a novel multi‐grid form of the non‐linear registration introduced by Braumann and Kuska in 2005 effectively suppressing registration runs into local minima (possibly caused by diffuse nature of the tumor). Our method was successfully applied in a proof‐of‐principle study for automated reconstruction.     

CD44 Expression in Normal Human Skin and Skin Tumors

CD44 is thought to be a principal cell surface receptor for hyaluronic acid. Although the distribution of hyalulonic acid has been studied, little is known about the distribution of the CD44 molecule in the human skin and skin tumors. This study was undertaken to investigate the distribution of the CD44 molecule in normal human skin as well as in benign and malignant skin tumors. In normal skin, CD44 was expressed on 1) keratinocyte cell surfaces throughout the epidermis except for the granular and horny layers, 2) hair follicular cells, 3) eccrine sweat gland cells, and 4) cell surfaces of dendritic cells in the dermis. In skin tumors, although CD44 was expressed on the tumor cell surface of seborreic keratosis, Bowen's disease, and squamous cell carcinoma as in normal skin, we could not detect any CD44 expression on the cell surface of the tumor cells of basal cell carcinoma. However, CD44 positive dendritic cells were observed in the tumor islands of basal cell carcinoma. Phenotypic analysis suggested that these CD44 positive cells were melanocytes.     

非侵袭性与侵袭性基底细胞癌的VEGF表达及微血管密度的研究

目的：研究非侵袭性基底细胞癌（non-invasive basal cell carcioma,NIBCC）与侵袭性基底细胞癌（invasive basal cell carcionma,IBCC0的血管内皮生长因子（vascular endothelial growth factor,VEGF）的表达和肿瘤微血管密度（tumoral microvascular density,TMVD），并探讨两者在BCC生物学行为中的意义。方法：应用免疫组化SP法检测34例BCC石蜡标本组织（17例非侵袭性，17例侵袭性）中的VEGF、Von-Willebrand因子表达。结果：在NIBCC与IBCC中，VEGF的表达水平中度且无明显统计学差异（P＝0.189）；IBCC的TMVD高于NIBCC（P＝0.019）；两者的TMVD、VEGF呈正相关（rsl=0.667,P=0.003;rs2=0.582,P=0.014）。结论：本实验中VEGF尚不能做为衡量BCC恶性度的指标，TMVD是衡量BCC侵袭性的较好指标之一。     

Four primary malignant tumors, including malignant melanoma and malignant lymphoma, in the same adult patient

We report an 80-year-old Japanese male with four primary malignant tumors: malignant melanoma, prostatic cancer, malignant lymphoma, and renal cell carcinoma, which occurred in that respective order. The combination of malignant melanoma and malignant lymphoma is rare. The patient was treated with BCG after an operation for malignant melanoma. He was also treated with cobalt 60 irradiation after an operation for prostatic cancer. We also discuss other reports of multiple malignant tumors and suggest some possible causes of this patient's primary malignant tumors.     

Scalp basal cell carcinoma: A different entity?

Basal cell carcinoma is the most frequent malignant neoplasm in white‐skinned individuals. It develops in different body areas, including in the scalp, which is a unique anatomical region due to the high number of pilosebaceous follicles; the scalp is protected from UV exposure, a main risk factor for basal cell carcinoma development. Moreover, scalp basal cell carcinoma has been described as more aggressive and difficult to treat than other forms of basal cell carcinoma. In this study, we reviewed the clinical and pathological characteristics, risk factors, genetics, and treatment options for scalp basal cell carcinoma to better understand this special type of cancer. Even though it is not yet clear whether scalp basal cell carcinomas represent a different entity, it seems important to give them special attention due to their potential aggressiveness, invasion capacities, tendency to relapse, and treatment difficulties.     

Dermoscopic follow‐up of therapeutic response in mantle cell lymphoma with secondary involvement of the scalp

The scalp is a potential location for both benign and malignant tumors. Lymphoproliferative diseases can involve the skin as a primary or secondary manifestation. Dermoscopy is a noninvasive diagnostic tool for rapid diagnosis, screening, and follow‐up of the majority of skin tumors. Mantle cell lymphoma (MCL), a rare type of aggressive systemic lymphoma, usually occurs as a generalized lymphadenopathy, commonly with infiltration of the bone marrow, spleen, gastrointestinal tract, and Waldeyer's ring. In rare cases, it can also involve other structures, such as the lungs, central nervous system, liver, or skin. We report the case of a 74‐year‐old male patient suffering from MCL since 2015. Complete remission was obtained after R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) treatment. During maintenance therapy with rituximab, a solitary tumor occurred on the scalp. Dermoscopy of the lesion suggested relapse because of the presence of multiple chaotically distributed short linear vessels with multiple red dots within the hair follicles. Histological examination confirmed the diagnosis of MCL. After second‐line therapy with rituximab and bendamustine (R‐B), the tumor of the scalp completely disappeared and dermoscopy showed no abnormalities.     

Erosive pustular dermatosis of the scalp: reappraisal of an underrecognized entity

Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis of unknown etiology. Herein, we present a review of the disease and report our own clinical and histopathological experience in eleven patients. EPDS tends to spontaneously affect bald areas of the scalp in elderly individuals. A history of previous surgery at the same site – as observed in four of our patients – is common. Coronary artery disease, cerebrovascular insult, arterial hypertension, diabetes mellitus, and severe cases of cancer were frequent comorbidities. Most patients show an undulating clinical course despite topical anti‐inflammatory treatment; in some individuals, the lesions heal with scarring. Histopathology reveals scaly crusts or erosions and granulation tissue‐like changes in the dermis, evolving into a scar in more advanced stages. Apart from actinic/local damage, impaired immunity and microcirculation may be predisposing factors of the disease. Similar to pyoderma gangrenosum, EPDS must be considered in the context of nonhealing wounds in the elderly after the differential diagnoses mimicking EPDS have been ruled out. Given that previous or concomitant adjacent basal cell or squamous cell carcinoma is a common finding and that infiltrative variants extending beyond the clinically visible tumor may occur, histological mapping of the surrounding skin may be advisable in doubtful cases.     

Cutaneous metastasis from anaplastic thyroid carcinoma exhibiting exclusively a spindle cell morphology. A case report and review of literature

Anaplastic thyroid carcinoma is a highly aggressive cancer accounting for 1–2% of thyroid malignancies. Cutaneous metastases from anaplastic thyroid carcinoma are exceedingly rare. We report a 65‐year‐old woman with anaplastic thyroid carcinoma (BRAF V600E mutation) who had lymph node metastases (pT4 N1b) treated by total thyroidectomy, postoperative radiotherapy, adjuvant chemotherapy (paclitaxel and pazopanib) and targeted therapy (vemurafenib). Nine months after initial diagnosis, radiographic studies revealed multiple pulmonary metastases. A dermatologic examination showed a solitary 1.2‐cm chest nodule. Skin biopsy from this nodule revealed infiltrative dermal spindle cells arranged in poorly formed fascicles. Immunohistochemical studies demonstrated the tumor cells to be PAX‐8 (+), pancytokeratin (+, focally), TTF‐1 (?) and SOX‐10 (?). Comparison with the patient's primary anaplastic thyroid carcinoma revealed focal areas of poorly differentiated spindle cells morphologically similar to the malignant spindle cells in the skin biopsy. Together, these findings confirmed the diagnosis of anaplastic thyroid carcinoma metastatic to skin. Cutaneous metastasis of anaplastic thyroid carcinoma composed exclusively of spindle cells broadens the histologic differential diagnosis of cutaneous spindle cell malignancies and presents further diagnostic challenges. PAX‐8 may be useful in discerning the spindle cell component of anaplastic thyroid carcinoma from other spindle cell malignancies in the skin.