Abstract
Simple SummaryBasosquamous carcinoma is a rare, aggressive non-melanoma skin cancer with features that lie between those of basal cell carcinoma and squamous cell carcinoma. A lot of controversy has been raised around the classification, pathogenesis, histologic morphology, biologic behavior, prognosis and management of this tumor. This is a narrative review based on articles published on PubMed in English language which had in their title the terms “basosquamous carcinoma” and/or “metatypical carcinoma of the skin”. The aim of this review was to summarize and evaluate the latest data of the English literature regarding epidemiology, clinical presentation, dermoscopic and histopathologic characteristics, as well as the genetics and management of BSC to better characterize basosquamous skin lesions.Basosquamous carcinoma is a rare, aggressive non-melanoma skin cancer with features that lie between those of basal cell carcinoma and squamous cell carcinoma. A lot of controversy has been raised around the classification, pathogenesis, histologic morphology, biologic behavior, prognosis and management of this tumor. This is a narrative review based on an electronic search of articles published in PubMed in English language which had in their title the terms “basosquamous carcinoma” and/or “metatypical carcinoma of the skin”. The aim of this review was to summarize and evaluate current data regarding epidemiology, clinical presentation, dermoscopic and histopathologic characteristics, as well as the genetics and management of BSC, in order to shed some more light onto this intriguing entity. As a conclusion, dermoscopy, deep incisional biopsies and immunohistologic techniques (Ber-EP4) should be applied in clinically suspicious lesions in order to achieve an early diagnosis and better prognosis of this tumor. Surgical treatments, including wide excision and Mohs’ micrographic surgery, remain the treatment of choice. Finally, vismodegib, a Hedgehog pathway inhibitor, must be thoroughly investigated, with large controlled trials, since it may offer an alternative solution to irresectable or difficult-to-treat, locally advanced cases of basosquamous carcinoma.
Highlights
Basosquamous carcinoma (BSC) is a rare, relatively aggressive non-melanoma skin tumor which has raised a lot of controversy regarding its classification, its pathogenesis and its management since it was first described in the early 20th century
In 1928, the term BSC was used by Montgomery in order to describe 17 out of 119 carcinomas which he believed were transitional between basal and squamous cell carcinomas [4,5]
Other treatments options such as the PD-L1 inhibitors pebrolizumab and cepilumab have been used for the treatment of advanced-metastatic basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) but still there are no literature data for their use in advanced BSC [56]
Summary
Basosquamous carcinoma (BSC) is a rare, relatively aggressive non-melanoma skin tumor which has raised a lot of controversy regarding its classification, its pathogenesis and its management since it was first described in the early 20th century. Multiple diagnostic and treatment challenges arise from the fact that BSC has a variable and non-characteristic clinical and histologic morphology seated between that of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) that is followed by a rather unpredictable biologic behavior. This article aimed to summarize and evaluate all the latest data of the English language literature regarding epidemiology, clinical presentation, dermoscopic and histopathologic characteristics, as well as the genetics and management of BSC, in order to shed some more light to this intriguing entity
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