Surgical options for treatment of lip and perioral tumors: report of 5 cases

Basal cell and squamous cell carcinomas are the main neoplasms of lip andperioral location. We describe different techniques of successful surgicalreconstruction, including flaps or simple incision and suture. Using the lattertechnique satisfactory results were demonstrated, although the incision maderemoved more than a third of the lip, contrary to the literature. Our goal is toemphasize that the common sense and experience of the surgeon should prevail inthe choice of reconstructive method. Moreover, even if the priority is completeexcision of the lesion, we cannot ignore the aesthetic and functional recoveryobjective.     

Modified Tripier flap in reconstruction of the lower eyelid

We describe the use of modified Tripier flap for reconstruction of a surgicaldefect in the lower eyelid region, after excision of nodular basal cellcarcinoma.     

The relation between dermoscopy and histopathology of basal cell carcinoma

BACKGROUND:

Basal cell carcinoma is the most frequent cancer in fair-skinned populations and dermoscopy is an important, non-invasive technique that aids in the diagnosis of Basal cell carcinoma.

OBJECTIVES:

The aim of this study was to evaluate the relationship between histopathological subtypes and dermoscopic features of Basal cell carcinoma.

METHODS:

This study included 98 patients with clinically and histopathologically confirmed Basal cell carcinomas. The dermoscopic features of the lesions from each patient were analyzed before the histopathological findings were evaluated.

RESULTS:

Dermoscopic structures were observed in all 98 patients and irregular vascularity was identified in 78 patients (79.6%). The most common vascular pattern was the presence of arborizing vessels (42 patients, 42.9%) followed by arborizing microvessels (21 patients, 21.4%) and short fine telangiectasias (SFTs; 15 patients, 15.3%). White streaks (38 patients, 38.8%), translucency (31 patients, 31.6%), a milky-pink to red background (42 patients, 42.9%), and erosion/ulceration (29 patients, 29.6%) were also observed. Pigmented islands were seen as blue-gray globules (7 patients, 7.1%) and blue-gray ovoid nests (42 patients, 42.9%). The pigment distribution pattern was maple leaf-like areas in 9 patients (9.2 %) and spoke wheel-like areas in 6 patients (6.1%).

CONCLUSIONS:

Basal cell carcinomas show a wide spectrum of dermoscopic features. Arborizing vessels were the most common dermoscopic findings in Basal cell carcinomas, while superficial Basal cell carcinomas displayed mainly milky-pink to red areas, and arborizing microvessels. The most common dermoscopic features of pigmented types were islands of pigment (blue-gray globules, blue-gray ovoid nests). In conclusion, dermoscopy can be used as a valuable tool for the diagnosis of Basal cell carcinomas and prediction of their histopathological subtypes.     

双叶皮瓣修复面中部基底细胞癌切除后皮肤缺损19例

目的探讨面中部皮肤肿瘤手术切除后缺损修复的有效方法,分析双叶皮瓣修复皮肤缺损的设计模式。方法面中部皮肤肿瘤手术切除后,根据皮损位置和大小,在皮损外侧规范设计双叶皮瓣,充分皮下游离,转移皮瓣,分层间断缝合。结果19例患者,4例第二叶皮瓣远端皮肤术后发生0．1cm×0．2cm范嗣内的皮瓣血运障碍、坏死,后经积极换药后愈合;15例第二叶皮瓣、19例第一叶皮瓣术后全部成活。全部病例手术后眼、鼻、口外观均未见明显畸形。结论皮肤缺损外侧模式设计的双叶皮瓣,是一种能够修复面中部皮肤缺损的成形方法。     

High-frequency ultrasound associated with dermoscopy in pre-operative evaluation of basal cell carcinoma

The recent development of high-frequency ultrasound, associated with the improvedsensitivity in color Doppler, enabled the identification of various skin structuresand layers. In basal cell carcinoma, the 22 MHz frequency ultrasound permits thedelimitation of tumor margins, while color Doppler, determines its vascularization.We present two cases in which the association of both exams allowed an in vivoanalysis of the tumor''s morphology, size, thickness and vascularization, thuscontributing to a better pre-operative evaluation.     

Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases

BackgroundThe ear is a region that has a high prevalence of cutaneous carcinomas and several guidelines indicate Mohs micrographic surgery as the first-choice treatment in such cases. Although the technique allows maximum preservation of healthy tissue, many auricular surgical wounds constitute a challenge due to the peculiar local anatomy, with evident curves and reliefs. Auricular reconstruction should prioritize function before aesthetics, but without leaving the latter aside, since postoperative distortions can have a significant psychological impact.ObjectiveTo describe the authors’ experience in auricular reconstruction after Mohs surgery and to evaluate the most frequently used repair methods.MethodsRetrospective study of consecutive cases submitted to Mohs surgery and auricular reconstruction, over a period of 3 years.ResultsOne hundred and one cases were included and the most common repair method was primary closure (n = 35), followed by full-thickness skin graft (n = 30) and flaps (n = 24). In thirty cases, reconstruction methods were associated. Seven patients had complications (partial graft necrosis, postoperative bleeding or infection).Study limitationsRetrospective design and the absence of long-term follow-up of some cases.ConclusionsThe dermatologic surgeon should be familiarized with different options for auricular reconstruction. Primary closure and skin grafts were the most frequently used repair methods.     

Lepromatous leprosy,melanoma, and basal cell carcinoma: clinical-histopathologic association

Cutaneous neoplasms frequently occur in leprosy, but there are few reports of the coexistence of leprosy and basal cell carcinoma in the same lesion. This case reports a 49-year-old male with an ulcerated plaque on the right lateral nasal wall, bright papules on the sternal region, and a blackened plaque on the right temporal region. The nasal and temporal lesions were diagnosed by histopathology as basal cell carcinoma and melanoma, respectively. The sternal lesions were excised with the repair of the “dog ear” which histopathological examination showed macrophages in the dermis parasitized with acid-fast bacilli, confirming the diagnosis of lepromatous leprosy with Fite-Faraco staining. This case report highlights the importance of referring the dog-ear specimen for histopathologic analysis.     

Nuclear morphometry and chromatin textural characteristics of basal cell carcinoma

Histological subtypes of basal cell carcinoma have biological, evolutionary and distinct prognostic behavior. The analysis of characteristics of the nucleus can provide data on their cellular physiology and behavior. The authors of this study evaluated nuclear morphological parameters and textural patterns of chromatin from different subtypes of basal cell carcinoma: nodular (n=37), superficial (n=28) and sclerodermiform (n=28). The parameters were compared between neoplasms'' subtypes and with unaffected adjacent basal epithelium. Nuclear area and diameter of sclerodermiform neoplasms were superior to the other subtypes. Chromatin''s color intensity and fractal dimension were less intense in superficial subtypes. Nuclear roundness and chromatin''s entropy presented lower values in tumors than in normal epithelium. There was significant correlation between morphological and textural variables of normal skin and tumors. Morphometric elements and textural chromatin''s homogeneity of basal cell carcinomas may be related to evolutionary, biological and behavior particularities related to each histotype.     

Multiple metastatic basal cell carcinoma with concurrent metastatic pleomorphic sarcoma in chronic lymphedema area - Case report

Chronic lymphedema presents as interstitial fluid retention due to a failure in thelymphatic system drainage. The affected region becomes more vulnerableimmunologically and predisposed to the onset of neoplasms. Basal Cell Carcinoma isthe most common sort of neoplasm, nevertheless it rarely metastisizes. Sarcomas aremalignant mesenchymal neoplasms, locally aggressive, which can spread. Here isreported an infrequent case of multiple basal cell carcinoma, synchronous to a poorlydifferentiated pleomorphic sarcoma, both spreading to lymph nodes and arising fromtissue compromised by chronic lymphedema.     

CXCR7在常见皮肤恶性肿瘤及其细胞株中的表达及意义

目的 探讨趋化因子受体CXCR7在皮肤鳞状细胞癌、基底细胞癌、侵袭性皮肤黑素瘤及其细胞株中的表达及其意义。方法 收集30例皮肤鳞状细胞癌、25例基底细胞癌、30例皮肤黑素瘤的癌组织,采用免疫组织化学方法,检测CXCR7蛋白表达水平。采用RT-PCR、细胞免疫组化方法检测CXCR7在A375、M14、A431、HaCaT细胞株中mRNA及蛋白水平。结果 CXCR7在侵袭性皮肤黑素瘤中表达明显,高表达率为80%（24/30）,皮肤鳞状细胞癌及基底细胞癌分别为26.67%（8/30）、8%（2/25）;皮肤黑素瘤CXCR7高表达率与鳞状细胞癌、基底细胞癌比较,差异均有统计学意义（χ2值分别为17.16和28.36,P值均 < 0.05）。CXCR7 mRNA在A375、M14、A431细胞株中均可检出,其中A375表达最强,而HaCaT细胞不表达;细胞免疫组化显示,仅在A375细胞见棕黄色颗粒着色。结论 皮肤黑素瘤及其细胞株A375高表达CXCR7,其可能参与了其恶性侵袭与转移。     

Keep it simple. A ten-year experience in reconstructions after Mohs micrographic surgery

BackgroundMohs micrographic surgery is worldwide used for treating skin cancers. After obtaining tumor-free margins, choosing the most appropriate type of closure can be challenging.ObjectivesOur aim was to associate type of surgical reconstructions after Mohs micrographic surgery with the characteristics of the tumors as histological subtype, anatomical localization and especially number of surgical stages to achieve complete excision of the tumour.MethodsTransversal, retrospective analyses of medical records. Compilation of data such as gender, age, tumor location, histological subtype, number of stages to achieve clear margins and type of repair used.ResultsA total of 975 of facial and extra-facial cases were analyzed. Linear closure was the most common repair by far (39%) and was associated with the smallest number of Mohs micrographic surgery stages. This type of closure was also more common in most histological subtypes and anatomical locations studied. Using Poisson regression model, nose defects presented 39% higher frequency of other closure types than the frequency of primary repairs, when compared to defects in other anatomic sites (p < 0.05). Tumors with two or more stages had a 28.6% higher frequency of other closure types than those operated in a single stage (p < 0.05).Study limitationsRetrospective study with limitations in obtaining information from medical records. The choice of closure type can be a personal choice.ConclusionsPrimary closure should not be forgotten especially in surgical defects with fewer stages and in non-aggressive histological subtypes in main anatomic sites where Mohs micrographic surgery is performed.     

Vismodegib for treatment of periocular basal cell carcinoma – 6-year experience from a tertiary cancer center

BackgroundThe treatment of advanced periocular basal cell carcinomas becomes a challenge as surgery may involve highly mutilating procedures. Vismodegib is the first selective hedgehog inhibitor approved for the treatment of locally advanced tumors or metastatic disease.ObjectiveAnalyze the results of treatment with vismodegib for advanced periocular basal cell carcinomas in a real-life setting of a reference center between 2014 and 2020.MethodsRetrospective longitudinal study. The patient's demographic profile, comorbidities, tumor characteristics, and treatment outcomes were analyzed.ResultsA total of 13 patients were included. Median follow-up and treatment duration were 15.9 and 10.5 months, respectively. Objective clinical response rate was 76.9%: 30.8% had a complete response and 46.2% a partial response. The median duration of response was 13 months. Progressive disease was observed in 38.5% of cases, with a median of 19 months after the beginning of treatment. Eighty-four percent of the patients had at least one adverse event, and 61.54% needed to interrupt treatment temporarily or permanently to increase tolerability.Study limitationsBeing a retrospective study in a real-life setting, the evaluation of objective clinical response was subjective to physician appreciation.ConclusionVismodegib is a safe and effective treatment for locally advanced basal cell carcinoma. To prevent recurrences, the drug should be used continually when tolerated. The role of neoadjuvant vismodegib before surgery is being investigated and might add an important step in searching for a definitive treatment for these cases.     

Recurrence rate of basal cell carcinoma in patients submitted to skin flaps or grafts

BackgroundBasal cell carcinoma is the most common type of skin cancer. Although the literature provides a great deal of information on the recurrences of basal cell carcinoma, studies about these indices addressing only the cases in which flaps and/or grafts have been performed for surgical reconstruction of the excision of this tumor are still lacking.ObjectivesTo evaluate rates of recurrence of basal cell carcinoma submitted to conventional surgery with pre-established margins and reconstruction by flaps or grafts.MethodsA retrospective and observational study was performed through the analysis of 109 patients, who met inclusion criteria with 116 basal cell carcinomas submitted to conventional surgery and pre-established safety margins, requiring reconstruction through a graft or cutaneous flap. This work was performed the small surgeries sector of Dermatology of the Specialty Outpatient Clinic of the University Hospital of the State University of Londrina, between January 1, 2011 and December 31, 2015. The following data were collected and inserted in an Excel worksheet: name, registration number of the hospital patient, sex, age, tumor location, histopathological type of BCC, procedure performed (type of flap and/or graft), follow-up time, recurrence.ResultsOf the 116 procedures, there were recurrences in 3 cases (2.6%) that were located in the nasal region and related to sclerodermiform or micronodular histological types.Study limitationsRetrospective nature of the study.ConclusionThe present study of the dermatology department of this university hospital showed a low rate of recurrence of basal cell carcinoma in cases where flaps and/or grafts were used in the surgical reconstruction.     

Polypoid melanoma and superficial spreading melanoma different subtypes in the same lesion

Melanoma is a malignant melanocytic neoplasm with high mortality rate, andsteadily and universally increasing incidence rates. Polypoid melanoma isconsidered an exophytic variant of the nodular subtype. The incidence ofpolypoid melanoma is extremely variable, most likely because of the differentcriteria used for its characterization. We presented a rare case of polypoidmelanoma and superficial spreading melanoma in the same lesion.     

Study of skin neoplasms in a university hospital: integration of anatomopathological records and its interface with the literature

BackgroundSkin cancer is a highly prevalent condition with a multifactorial etiology resulting from genetic alterations, environmental and lifestyle factors. In Brazil, among all malignant tumors, skin cancers have the highest incidences.ObjectiveTo retrospectively evaluate the incidence, prevalence and profile of basal cell carcinoma, squamous cell carcinoma and cutaneous melanoma in Campos dos Goytacazes and region.Methods:In total, 2,207 histopathological reports of a local reference hospital were analyzed between January 2013 and December 2015, of which 306 corresponded to the neoplasms studied.Results:Of the 306 reports evaluated, 232 basal cell carcinomas (75.9%), 55 squamous cell carcinomas (18%) and 19 cutaneous melanomas (6.5%) were identified. The face was the most involved anatomical site (58.8%) and women (51%) were the most affected gender. The temporal analysis revealed a decrease in the overall incidence of 3.4% from 2013 to 2014 and 5.4% from 2014 to 2015. There was a 10.1% increase in basal cell carcinomas and 38% in melanomas in this period; however, there was a decrease in the number of squamous cell carcinomas of 14.8% during the studied years.Study limitations:Some samples of cutaneous fragments had no identification of the anatomical site of origin.Conclusion:Research that generates statistical data on cutaneous tumors produces epidemiological tools useful in the identification of risk groups and allows the adoption of more targeted and efficient future prevention measures.     

热休克蛋白10、60在皮肤鳞状细胞癌、基底细胞癌、日光性角化病中的表达

目的 探讨热休克蛋白（HSP）10、60在皮肤鳞状细胞癌（SCC）、基底细胞癌（BCC）和日光性角化病（AK）中的表达水平。方法 采用免疫组化EnVision两步法测定HSP10、60在皮肤SCC、BCC、AK中的阳性表达水平,并与正常组对照。结果 与对照组比较,HSP10组只有BCC组的阳性表达高于正常组（Z = 3.24,P < 0.01）,AK组（Z = 0.74,P > 0.05）和SCC组（Z = 0.52,P > 0.05）与对照组比较差异无统计学意义;HSP10组中AK与BCC,AK与SCC的差异有统计学意义（P < 0.05）,但SCC与BCC组间差异无统计学意义（P > 0.05）。HSP60组三组的阳性表达均高于正常组,其中AK（Z = -2.90,P < 0.01）、BCC（Z = -2.15,P < 0.05）、SCC（Z = -2.78,P < 0.01）;三组间两两比较结果为AK = SCC > BCC（P < 0.05）。结论 HSP60的高表达可能与鳞状细胞癌、日光性角化病的生物行为有关。     

Surgical treatment of basal cell carcinoma: an algorithm based on the literature

Although basal cell carcinoma can be effectively managed through surgical excision,the most suitable surgical margins have not yet been fully determined. Furthermore,micrographic surgery is not readily available in many places around the world. Areview of the literature regarding the surgical treatment of basal cell carcinoma wasconducted in order to develop an algorithm for the surgical treatment of basal cellcarcinoma that could help the choice of surgical technique and safety margins,considering the major factors that affect cure rates. Through this review, it wasfound that surgical margins of 4mm seem to be suitable for small, primary,well-defined basal cell carcinomas, although some good results can be achieved withsmaller margins and the use of margin control surgical techniques. For treatment ofhigh-risk and recurrent tumors, margins of 5-6 mm or margin control of the surgicalexcision is required. Previous treatment, histological subtype, site and size of thelesion should be considered in surgical planning because these factors have beenproven to affect cure rates. Thus, considering these factors, the algorithm can be auseful tool, especially for places where micrographic surgery is not widelyavailable.     

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。     

皮肤镜在微小色素型基底细胞癌诊断中的初步研究

目的 评价皮肤镜在微小色素型基底细胞癌诊断中的价值.方法 体表疑似微小(皮损直径＜5 mm)色素型基底细胞癌患者58例,男19例,女39例;年龄16～82岁;病程3个月至25年.对每例皮损进行皮肤镜检查,留皮肤镜照片.由两名医生参照色素型基底细胞癌皮肤镜特点,仅根据照片盲法独立进行诊断.以病理诊断为金标准,通过诊断性试验的研究方法,研究皮肤镜在微小色素型基底细胞癌诊断中的敏感度、特异度及一致性.结果 58例患者中36例经组织病理学诊断为基底细胞癌,医生A皮肤镜诊断为色素型基底细胞癌41例,不是色素型基底细胞癌17例;医生B皮肤镜诊断为色素型基底细胞癌40例,不是色素型基底细胞癌18例.与病理诊断相比,两名医生皮肤镜诊断色素型基底细胞癌的灵敏度、特异度、Youden指数及Kappa值分别为97.22％、72.73％、69.95％、0.732 (P＞ 0.05)和97.22％、77.27％、74.49％、0.772(P＞0.05).结论 皮肤镜对微小色素型基底细胞癌诊断与组织病理学检查结果有较好的一致性.