Pulmonary Metastasis of Basal Cell Carcinoma

Although basal cell carcinoma is the most common skin cancer, it rarely metastasizes. Metastatic basal cell carcinoma may, therefore, initially elude diagnosis and management. We describe the case of a patient with a metastatic basal cell carcinoma present in the lungs. The differential diagnosis of suspected metastatic lesions should include metastases from a cutaneous basal cell carcinoma, in addition to those from more commonly metastasizing carcinomas, especially in patients with a history of a large basal cell carcinoma that has involved the head and neck regions, and was refractory to treatment.     

埃兹蛋白在皮肤鳞癌、基底细胞癌中的表达及相关研究

目的 探讨埃兹（Ezrin）蛋白在皮肤基底细胞癌（BCC）和鳞状细胞癌（SCC）中的表达及在肿瘤侵袭转移过程中的作用.方法 采用免疫组化SP法检测Ezrin蛋白在皮肤BCC（30例）、SCC（32例）及正常皮肤对照组（10例）中的表达情况.结果 Ezrin蛋白在BCC、SCC及正常皮肤对照组中阳性表达率分别为60.0％、84.4％和10％.Ezrin蛋白在各组之间表达差异有统计学意义（P＜0.05）.Ezrin蛋白阳性表达与SCC的分化程度和淋巴结转移密切相关,各组间表达差异有统计学意义（P＜0.05）.结论 Ezrin蛋白的检测可能成为预测皮肤恶性肿瘤转移和预后的一项指标.     

203例皮肤基底细胞癌临床与病理分析

目的研究分析基底细胞癌(Basal cell carcinoma,BCC)临床表现及组织病理特征,提高基底细胞癌的诊治水平。方法对203例基底细胞癌患者的临床表现、组织病理进行综合分析。结果所收集203例病例中,男女比例为1∶1.23,年龄50岁的病例占9.36%,其中60岁的病例中男女比例为1.37∶1。头面部BCC发生率最高占90.15%,病理分型中结节囊肿型66.7%,浅表型14.29%。在临床与病理符合率的比较中,头面部最高(86.34%)四肢最低(45.45%),色素型符合率66.7%。复发病例中以鼻部及眶周最多占56.25%,且病理分型中硬斑病样型占31.25%。结论基底细胞癌中,中青年患者占有一定比例,性别比例与老年患者不同;头面部为基底细胞癌的高发部位,病理分型中以色素型及浅表型误诊率高;临床中复发病例多发生在鼻部及眶周,硬斑病样型占较高比例;及时行病理活检对BCC的早期治疗、治疗方案的选择及预后至关重要。     

Collision Tumor Associated with Sarcomatoid Eccrine Porocarcinoma and Basal Cell Carcinoma

A ‘collision’ tumor refers to the existence of two different neoplasms within the same tumor. Sometimes, the term ‘biphasic tumor’ is also used. However, a ‘collision’ tumor is defined as the occurrence of two neoplasms within proximity of each other yet maintaining distinctly defined, separate boundaries. In contrast, a ‘biphasic’ tumor demonstrates two or more phenotypically distinct neoplastic cell populations merging within the same space. Here, we report a case of collision tumor associated with sarcomatoid eccrine porocarcinoma and basal cell carcinoma arising in a 57-year-old male patient.     

硬斑病样型基底细胞癌2例及其皮肤镜表现

例1女,38岁,因面部皮疹30余年就诊。例2女,70岁,因鼻背皮疹5年,右面部皮疹1年伴糜烂3个月就诊。例1和例2鼻背上皮损均表现为浸润性斑块,皮肤镜检查符合基底细胞癌,皮肤组织病理检查证实为硬斑病样型。例2右面部皮疹经病理证实为结节型基底细胞癌。均采用Mohs显微外科手术治疗。     

Basal Cell Carcinoma on the Pubic Area: Report of a Case and Review of 19 Korean Cases of BCC from Non-sun-exposed Areas

Basal cell carcinoma (BCC) is one of the most commonly diagnosed malignant skin tumors and develops characteristically on sun-exposed areas, such as the head and neck. Ultraviolet light exposure is an important etiologic factor in BCCs, and BCCs arising from non-sun- exposed areas are, therefore, very rare. In particular, the axilla, nipple, the genital and perianal areas are not likely to be exposed to ultraviolet light; thus, if BCC develops in these areas, other predisposing factors should be considered. Herein, we report a case of BCC arising on the pubic area in a 70-year-old man. We also performed a survey of the literature and discussed the 19 cases of BCC from non-sun-exposed areas reported to date in Korea.     

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.     

基底细胞癌72例临床特征分析

目的：探讨皮肤基底细胞癌（ BCC）临床特征及可能诱因。方法：对72例患者的临床资料进行分析。结果：72例BCC中，平均发病年龄（68.03±12.91）岁，病程2个月～60年，平均（67.64±12.98）月。按皮损类型分型，结节溃疡型51例（70.83％），色素型5例（6.94％），浅表型9例（12.50％），硬斑型2例（2.78％），纤维上皮瘤型5例（6.94％）。头面部 BCC 共60例，占83.33％；肩部 BCC 6例（8.33％），均为农民或户外工人患者；颈部2例；后背、腋窝、腹部、踝部各1例。结论：BCC好发于头面部等曝光部位，也可以好发于职业相关性紫外线暴露部位。确诊后早期采用手术切除是主要而有效的治疗方法。     

组织蛋白酶B,Ki67在皮肤鳞状细胞癌、基底细胞癌和脂溢性角化病的表达

目的观察组织蛋白酶B(CB)、细胞增殖核抗原(Ki67)在皮肤鳞状细胞癌(SCC)、基底细胞癌(BCC)和脂溢性角化病(SK)等组织中的表达,并分析其表达差异的意义。方法用免疫组化SP染色法检测CB,Ki67在15例SCC,15例BCC,14例SK及10例正常对照皮肤组织中的表达。结果 CB在正常皮肤组织表达为阴性,在SK,BCC,SCC瘤组织中表达依次升高,差异有显著性(P0.05);Ki67在SK,BCC和SCC三者表达差异亦有显著性(P0.05)。结论 CB,Ki67在SK,BCC和SCC瘤组织中的阳性表达率依次升高,可能与SCC侵袭和转移有关。     

Subclinical Infiltration of Basal Cell Carcinoma in Asian Patients: Assessment after Mohs Micrographic Surgery

Background

Several differences in basal cell carcinomas (BCCs) were found, according to the ethnic group; for example, pigmented BCCs was more common in Asian or Hispanic patients. However, there are few reports on the subclinical extension of the BCC in Asian patients.

Objective

The aim of this study was to evaluate the subclinical infiltration of the basal cell carcinoma in Asian patients.

Methods

All patients with BCC who visited the department of dermatology at Korea University Ansan Hospital were treated with Mohs micrographic surgery. In 81 patients, 83 tumors of BCC were completely eradicated by Mohs micrographic surgery (MMS) from April 2001 to August 2008, and were reviewed in this study. Information recorded included the total margin and the number of stages of Mohs micrographic surgery, anatomic location, tumor size, presence of pigmentation, clinical type, and pathological subtype. We divided the clinical types into nodular, ulcerated, and pigmented, and the pathological types into nodular, micronodular, morpheaform, and adenoid. The BCC was of pigmented type if pigmentation covered more than 25% of the tumor, regardless of whether pigmentation was distinct, or if there was apparent pigmentation that covered more than 10% of the tumor.

Results

The nose and cheek were the most common sites requiring more than one stage of surgery. In tumors smaller than 1 cm, 91.7% required only one stage of excision, compared with 60.6% in tumors larger than 1 cm. More than two Mohs stages were required in 25% of non-ulcerated BCCs and in 46.2% of ulcerated BCCs. Sixty eight percent of pigmented BCCs required only one stage of Mohs micrographic surgery. In cases of non-pigmented BCCs, only 45% required one Mohs stage. More than one Mohs stage was required in 19.2% of non-aggressive BCCs and in 42.9% of aggressive BCCs.

Conclusion

Subclinical infiltration differed between the two groups according to the size of the BCC (1 cm threshold) and most of the BCCs were located in the head and neck area. Considering this result, indication for MMS can be extended for BCCs larger than 1 cm in Asian patients. Ulcerated BCCs required more Mohs stages than non-ulcerated BCCs. Pigmented BCCs might show lesser subclinical infiltration than non-pigmented BCCs. Aggressive pathological subtypes showed more subclinical infiltration than the non-aggressive types; however, after evaluation of the border that was excised with MMS, mixed histologic types were found to be more frequent than generally accepted. Therefore, we consider that, when planning surgery, dermatologists should not place too much confidence in the pathologic subtypes identified by biopsy.     

Usefulness of Dermatoscopy for the Preoperative Assessment of the Histopathologic Aggressiveness of Basal Cell Carcinoma

BackgroundLimited information is available regarding dermatoscopic differences between non-aggressive and aggressive types of basal cell carcinoma (BCC).ObjectiveTo investigate dermatoscopic differences between non-aggressive and aggressive types.MethodsWe evaluated 145 histopathologically confirmed BCCs from 141 patients. Histopathologic types and aggressiveness from 4 mm punch biopsy and their dermatoscopic findings were evaluated. We assessed the statistical significance of dermatoscopic differences between non-aggressive and aggressive types. To objectively predict aggressiveness, we created a "dermatoscopic index of BCC aggressiveness" in which 1 point was added and subtracted for each dermatoscopic finding significantly higher in aggressive and non-aggressive types, respectively.ResultsLarge blue-gray ovoid nests were found more frequently in non-aggressive type than aggressive one (85/105 [80.9%] vs. 21/40 [52.5%], p=0.001). Compared to non-aggressive type, aggressive type had more multiple blue-gray globules (29/40 [72.5%] vs. 57/105 [54.3%], p=0.046), arborizing telangiectasia (29/40 [72.5%] vs. 48/105 [45.7%], p=0.004), and concentric structure (11/40 [27.5%] vs. 12/105 [11.4%], p=0.018). Regarding dermatoscopic index, cases of aggressive type with a score of 1 were most common (n=18, 45.0%), followed by a score of 2 (n=14, 35.0%). Limited number of aggressive type of BCCs and the effect of width on the determination of histopathologic aggressiveness.ConclusionAggressive type BCCs more often exhibited multiple blue-gray globules, arborizing telangiectasia, and concentric structure, while the non-aggressive type exhibited large blue-gray ovoid nests more frequently. Score exceeding 2 on the dermoscopic index can be screening criteria for aggressiveness. These dermatoscopic features and dermoscopic index could be useful for assessing aggressiveness of BCCs before surgery.     

Characteristics of Mixed Type Basal Cell Carcinoma in Comparison to Other BCC Subtypes

Background:

There are limited data exploring the characteristics of mixed type basal cell carcinoma (BCC).

Objectives:

To explore different characteristics of mixed type BCC.

Design:

Cross sectional study.

Materials and Methods:

825 patients with BCC enrolled in this study.

Results:

Among 825 patients, 512 (62%) were male. Three hundred and fifty five (43%) presented with nodular subtype, 267 (32.4%) with mixed subtype, 25 with superficial and the 178 remaining presented with other subtypes. Four hundred and eighty three (58.6%) of the lesions were on the face, 243 (29.5%) on scalp, 52 (6.3%) on ears, 20 (2.4%) on neck, 15 (1.8%) on trunk and 12 (1.4%) on extremities. Anatomic distribution of mixed type was as follows: 137 on face, (51.4%), 100 (37.3%) on scalp, 19 (7%) on ear, 6 (2.1%) on neck, 4 (1.5%) extremity and 1 (0.7%) on trunk, which the difference from non mixed types was statistically significant (P = 0.002). The mean diameter of the mixed types and non mixed type BCCs were significantly different (2.7 ± 2.1 cm vs. 2.2 ± 1.6 cm; P = 0.01. The prevalence of necrosis in mixed type BCC was two times higher than non mixed type BCCs (OR = 2.3, CI 95% 1.3-3.9, P = 0.001). The most frequent combined subtypes were nodular-infiltrative (P < 0.001).

Conclusion:

Mixed type BCC has differences with other BCC subtypes in anatomical distribution and tumor diameter. Indeed, mixed type BCCs are frequently composed of aggressive subtypes than nonaggressive subtypes.     

5%咪喹莫特乳膏治疗基底细胞癌Meta分析

目的以循证医学的方法对5%咪喹莫特乳膏治疗基底细胞癌的疗效与安全性进行系统评价。方法检索PubMed、Ovid、Web of Science、UMI、elsevier,以及Cochrane图书馆,纳入比较5%咪喹莫特乳膏与安慰剂的随机对照试验,由两名评价者独立提取资料并进行方法学质量评估。试验数据的统计分析采用Cochrane协作网提供的Rev Man4.2.8软件进行。结果最终纳入7个RCT,对其治疗浅表型基底细胞癌与结节型基底细胞癌进行了Meta分析,显示其与对照组相比,差异具有统计学意义,合并后前者RR=12.66(95%CI,3.56~45.06),后者RR=5.24(95%CI,2.54~10.81),没有报道与5%咪喹莫特乳膏临床应用相关的严重系统性不良反应。结论现有临床证据表明,5%咪喹莫特乳膏治疗浅表型基底细胞癌有确切的疗效与较好的安全性。疗效与剂量具有相关性,但每日2次与每日1次应用5%咪喹莫特乳膏临床疗效无差异。     

Basal Cell Carcinoma-Mimicking Lesions in Korean Clinical Settings

Background

Basal cell carcinoma (BCC) is the most common form of skin cancer and possesses various clinical features including translucency, ulceration, pigmentation, telangiectasia, and rolled borders. Accordingly, many cutaneous lesions can mimic BCCs and differential diagnosis is difficult.

Objective

To clarify the differences in clinical characteristics between BCCs and BCC-mimicking lesions (BMLs), and to determine which clinical characteristics are helpful for an accurate clinical diagnosis of BCC.

Methods

We performed clinicopathologic analysis of cutaneous lesions that received a clinical diagnosis of BCC. All lesions included in this study showed more than one of the following characteristics of BCCs: translucency, ulceration, flecked pigmentation, black or blue hue, telangiectasia, and rolled borders. We compared six clinical characteristics between the BCC group and the BML group.

Results

Among 48 lesions in the BML group, there were 15 premalignant or malignant lesions and 33 benign lesions. Various dermatoses mimicking BCC that have not been reported in the dermatological literature were identified, including angiosarcoma, vulvar intraepithelial neoplasm, foreign body granuloma, intravascular papillary endothelial hyperplasia, sarcoidosis, and others. Compared to the BML group, the BCC group had a significantly higher frequency of translucency (76.3% vs. 52.1%, p<0.001), ulceration or erosion (44.2% vs. 27.1%, p=0.022), black or blue hue (40.0% vs. 22.9%, p=0.020), and rolled borders (49.5% vs. 14.6%, p<0.001). Cutaneous lesions with two or less clinical features of BCC were significantly more likely to be BMLs.

Conclusion

The results of this study could be helpful for the differential diagnosis of BCCs and BCC-mimicking cutaneous lesions.     

Two Cases of Nevoid Basal Cell CarcinomaSyndrome in One Family

The nevoid basal cell carcinoma syndrome, or Gorlin-Goltz syndrome, is an autosomal dominant multiple system disorder with high penetrance and variable expressions, although it can also arise spontaneously. The diagnostic criteria for nevoid basal cell carcinoma syndrome include multiple basal cell carcinomas, palmoplantar pits, multiple odontogenic keratocysts, skeletal anomalies, positive family history, ectopic calcification and neurological anomalies. We report a brother and sister who were both diagnosed with nevoid basal cell carcinoma syndrome.     

基于网络药理学探索甘草治疗皮肤基底细胞癌的机制

目的利用网络药理学方法结合分子对接探讨甘草在治疗皮肤基底细胞癌(BCC)的分子机制。方法利用中医药系统药理学数据库和分析平台(TCMSP)分析甘草中的有效活性成分,并获得相应的作用靶点。筛选疾病数据库中BCC相关基因。通过Cytoscape软件构建药物与疾病交集靶点的蛋白质互相作用可视化网络,并进行拓扑学分析。利用R平台对交集靶点进行基因本体(GO)和京都基因与基因组百科全书(KEGG)通路富集分析。AutoDock软件对关键靶点与关键活性成分进行分子对接分析。结果显示甘草中81种有效活性成分的预测靶点共199个,其中189个靶点基因与BCC相关。甘草中主要发挥治疗BCC作用的活性成分包括槲皮素,山奈酚、柚皮素和甘草查尔酮甲。MAPK1,MAPK3,STAT3,CCND1,AKT1,JUN等蛋白是甘草治疗BCC的主要作用靶点。GO富集分析发现甘草可参与细胞对氧化应激、化学应激等反应的生物学过程。靶点主要为膜结构组成部分,有核受体活性配体的激活,转录分子结合,药物结合等分子功能。KEGG富集显示甘草作用靶点主要参与癌症相关信号通路和免疫调节信号通路,如化学致癌-受体通路,辅助性T细胞17(Th17)细胞分化信号通路。甘草主要活性成分与关键靶点的分子对接显示有较强的结合活性。结论甘草的多种有效活性成分可能调控多靶点基因,调控化学致癌物受体激活影响肿瘤细胞的增殖迁移和凋亡,同时发挥免疫调节功能,影响细胞炎性反应和Th17细胞分化,从而发挥治疗BCC的作用。     

IL-23/Th17相关细胞因子在基底细胞癌中的表达水平及意义

目的探讨IL-23/Th17相关细胞因子在基底细胞癌(BCC)疾病进展中的作用。方法采用免疫组织化学染色的方法检测35例BCC组织及10例正常皮肤组织中IL-17、IL-22及IL-23的表达水平。结果IL-17在基底细胞癌中的表达水平高于正常皮肤组织(P<0.05),IL-17在基底细胞癌组织细胞和肿瘤间质细胞胞质中均有表达。IL-23在基底细胞癌中的表达水平高于正常皮肤组织(P<0.05),IL-23主要在基底细胞癌组织细胞胞质表达,部分位于肿瘤间质细胞胞质中。IL-22在基底细胞癌和正常皮肤组织的表达水平差异无统计学意义(P>0.05)。基底细胞癌中IL-17和IL-23的表达水平呈正相关(P<0.05)。结论IL-23/Th17相关细胞因子可能参与基底细胞癌的发生、发展。IL-23可能通过诱导Th17细胞的发育和增殖,促进IL-17分泌并在基底细胞癌的发生、发展中发挥协同作用。     

Occult Basal Cell Carcinoma Arising in Seborrheic Keratosis

The present study reports a case of an occult basal cell carcinoma that arose in seborrheic keratosis. The patient was a fifty-six-year-old male who presented with a dark brown plaque on his back. Clinically, the lesion demonstrated no nodules or ulcerations suggesting that it was malignant. However, histopathological analysis of the lesion revealed an atypical basaloid cell mass that appeared to be a solid basal cell carcinoma beneath and surrounded by a seborrheic keratosis lesion. Thus, the coexistence of basal cell carcinoma and seborrheic keratosis is possible and should be considered when a malignant change in seborrheic keratosis is apparent.