Aggressive Basal Cell Carcinoma Research Articles

Histologically aggressive basal cell carcinoma is more common on the ear and nose

Histologically aggressive basal cell carcinoma is more common on the ear and nose

Morpheaform Basal Cell Carcinomas With Areas of Predominantly Single-Cell Pattern of Infiltration: Diagnostic Utility of p63 and Cytokeratin.

Morpheaform basal cell carcinoma (BCC) is a variant of BCC characterized by narrow strands and nests of basaloid cells with dense sclerotic stroma. The histologic extent often exceeds the clinical impression, leading to high recurrence rates after standard excision. The authors encountered a case with single-cell invasion distant from the main tumor. To date a systematic review of single-cell infiltration in morpheaform BCC has yet to be performed. Ten morpheaform BCCs, 10 nonmorpheaform aggressive BCCs, 5 desmoplastic trichoepitheliomas, and 2 microcystic adnexal carcinomas were identified by database search and confirmed on hematoxylin and eosin. Cases were evaluated by hematoxylin and eosin, immunohistochemical staining for p63, and (in a subset) broad-spectrum cytokeratin. Single-cell pattern was defined as individual cells, 2-cell clusters, or single-file invasion. Three types of single-cell pattern were identified: intratumoral (single cells within the main tumor mass), peripheral, and distant. Single cells were typically a minor component relative to larger tumor nodules and strands. Eight of the 10 cases of morpheaform BCC demonstrated areas of single-cell pattern: 3 intratumoral, 3 peripheral, and 2 with distant spread (0.75 and 1.0 mm from the main tumor). Eight of the 10 aggressive BCC demonstrated a peripheral single-cell pattern. Rare intratumoral single cells were identified in 3/5 desmoplastic trichoepitheliomas and 1/2 microcystic adnexal carcinomas. Single-cell pattern is frequently a component of morpheaform BCC. Tumor cells at a significant distance from the main component were unique to morpheaform BCC. Thus, when evaluating margins for morpheaform BCC, increased caution is recommended, and immunohistochemical stains for p63 or cytokeratins may be helpful.

Outcome of Radiation Therapy for Aggressive Basal Cell Carcinoma of the Head and Neck

Outcome of Radiation Therapy for Aggressive Basal Cell Carcinoma of the Head and Neck

Mid-face location of primary basal cell carcinoma related to cancer aggressivity

ObjectiveTo study the aggressiveness of basal cell carcinoma (BCC) on the mid-face location. MethodsA total of 30 patients were diagnosed using specimen biopsy with hematoxylin-eosin stain at Moewardi Public Hospital in Surakarta, Central Java, Indonesia. The age, gender distribution, site of the lesion, as well as clinic-pathological appearance were analyzed. ResultsThere were 30 patients consisting of 46.7% males and 53.3% females with ages ranging from 33 to 91 years old and with the most common occupation, such as farmers (53.6%) and housewives (26.7%). Morpheaform subtypes BCC were more frequent than other types. Based on the predilection, most of the BCC were found to be in the mid-face (76.7%) and using determined criteria of histopathological examination, the aggressive appearance was 77% and non-aggressive BCC was 23%. The BCC on the mid-face location was more aggressive than the other sites (P < 0.05). ConclusionsBCC is the most common skin tumor in humans with rare metastases, which might cause significant damage due to its local recurrences and aggressiveness. BCC on the mid-face is significantly more aggressive than that on the other predilection sites.

Sex hormones and the risk of keratinocyte cancers among women in the United States: A population-based case-control study.

Men are at a higher risk of developing both squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) than women, but there is emerging evidence that women may be experiencing greater increases in the incidence rates of these malignancies than men. One possible explanation is the expanding use of sex steroids among women, although only a few studies have examined this hypothesis. As part of a population-based, case-control study of women in New Hampshire, USA, we sought to evaluate the risk of SCC, BCC, and early-onset BCC in relation to exogenous and endogenous sex hormones. We found that oral contraceptive (OC) use was associated with an increased risk of SCC (OR = 1.4, 95% CI = 1.1-1.8) and BCC (OR = 1.4, 95% CI = 1.0-1.8), particularly high estrogen dose (>50 mg) OC use. Hormone replacement therapy (HRT) use also related to SCC, with an elevated OR largely for progestin use (OR = 1.4, 95% CI = 1.1-1.8). Additionally, both OC use and combination HRT use were associated with more aggressive BCC subtypes. In contrast, menstrual and reproductive history did not appear to influence keratinocyte cancer risk in our data. Our findings provide evidence that use of sex steroids may enhance risk of keratinocyte cancer.

Expression of Patched-1 Protein in Aggressive and Nonaggressive Basal Cell Carcinoma

Basal cell carcinoma (BCC) or basalioma, is a skin cancer characterized by slow-growing, minimal local invasion, rarely metastasize, but can result in extensive morbidity through local invasion and tissue destruction if the treatment was delayed. In this genomic era, aggressiveness of BCC mainly affected by intrinsic factor such as molecular biological dysregulation. The aim of this study was to assess the correlation between level of PTCH1 protein expression and aggressiveness of BCC histopathology. This study was an observational and cross-sectional study with analytical approach, conducted at Outpatient Clinic of Dermatology and Venereology Department of Dr. Wahidin Sudirohusodo Hospital Makassar, Hasanuddin University Hospital, Anatomical Pathology Laboratory of Dr. Wahidin Sudirohusodo and Hasanuddin University Hospital, and Sentra Diagnostic Patologia Laboratory, Makassar from September 2014 to January 2016. Total sample was 37 paraffin block evaluated and classified as aggressive and nonaggressive BCC by histopathological finding. Aggressive type BCCs were 34 samples (91.9%) and nonaggressive type were 3 samples (8.1%). Micronodular type was the most common histopathologic feature in 30 of 37 subjects (81.1%) and 30 of 88 histopathological finding (34.1%). Each subject can have more than one histopathologic type. Percentage of strong expression PTCH1 was found highest in pigmented type (33.4%), the percentage of moderate expression PTCH1 was found highest in infiltrating type (60.0%), and the percentage of negative/weak PTCH1 expression was found highest in the nodular type (75.0%). In this study, the correlation between the aggressiveness and PTCH 1 expression was not significant statistically (p>0.05), but it is seen that the frequency of strong PTCH1 expression was found to be higher in aggressive than nonaggressive BCC.

Accuracy of Biopsy in Subtyping Periocular Basal Cell Carcinoma.

To determine the accuracy of initial biopsy in the diagnosis of basal cell carcinoma (BCC) histologic subtype. Retrospective histopathologic review of patients with a diagnosis of primary periocular BCC from 2006 to 2013 inclusive. A total of 174 primary BCCs were identified. BCCs were classified as nodular, superficial, or aggressive (including mixed cases with an aggressive component). Punch biopsies were used in 41% of cases, while the remaining patients underwent shave or incision biopsies. The final histologic subtypes at excision were nodular (59%), superficial (7%), nodular and superficial (7%), and aggressive (51%). The overall concordance between the BCC subtype identified in the biopsy specimen and the subsequent excision specimen was 54%. In total, there were 51 cases (29%) of BCC, which included aggressive subtypes, of which 52% of initial biopsies failed to detect an aggressive component. There were 45 cases (26%) of mixed BCC, and an aggressive histologic subtype was present in 73% of these cases. The accuracy of initial biopsy for BCC histologic subtype at excision is highest for nodular BCC. For aggressive BCC, biopsy was able to detect the aggressive component in only 48% of cases. This may have implications for choice of treatment modality.

Challenges in Managing Eyelid Basal Cell Carcinoma with Mohs Surgery and Close the Large Eyelid Defect after Tumor Removal

Background: Basal cell carcinoma (BCC) is the most common skin cancer of the eyelid. The important things management we have to emphasize are to prevent recurrence rate and to get the good cosmetic result after reconstruct the large defect. The aim of this case report is to show the management of both eyelid basal cell carcinoma and large eyelid defect after tumor removal.Methods: Case Report. A Woman 40 years old was reffered from Dermatovenereology Department of Cipto Mangunkusumo Hospital with aggressive type BCC. The location of the tumor was at inferior left eyelid with size of 18 x 19 mm. They planned to perform Mohs’ surgery and consulted to Plastic and Reconstruction division of Ophthalmology Department for eyelid reconstruction. After Mohs’ surgery the horizontal length of the eyelid defect was more than 50% and vertical defect was more than 15 mm. The Mustarde cheek advancement flap were choosen.Results: Post operation necrotic tissue was noted do to ischemic problem. Oral corticosteroid was given with tapering dose for six days. One month later, the condition was improved and Dermatovenereology department performed diode laser for the necrotic tissue and further showing good result.Conclusion: The management for eyelid BCC were still challenging including the technique to reconstruct the large eyelid defect, the risk of recurrence after the tumor removal and post operative result. The dicision to choose the proper technique to reconstruct the eyelid defect and tight follow-up after surgery will give optimal functional and cosmetic result. Keywords: basal cell carcinoma; Mohs surgery; Mustarde cheek advancement flap; necrotizing flap; corticosteroid; diode laser

Management of Aggressive Basal Cell Carcinoma

Basal cell carcinoma (BCC), a malignant neoplasm derived from nonkeratinizing cells that originate in the basal layer of the epidermis, is the most common cancer in humans. Several factors such as anatomic location, histologic features, primary versus recurrent tumors, and patient characteristics influence the treatment modality for basal cell carcinoma. Mohs micrographic surgery facilitates optimal margin control and conservation of normal tissue for the management of aggressive basal cell carcinoma, basal cell carcinoma on the head, neck, or genitals, recurrent basal cell carcinoma, those with infiltrative histology or perineural invasion, and those occurring in immunosuppressed hosts; however, other treatment modalities may also be appropriately implemented for more indolent BCCs on non-high-risk sites. For the treatment of aggressive or advanced BCCs, surgical clearance with margin assessment is preferable whenever feasible, and at times, a multidisciplinary approach with adjuvant or rarely neoadjuvant therapy with targeted molecular therapeutic agents or radiation therapy when indicated.

HIPK2 expression in progression of cutaneous epithelial neoplasm.

Homeodomain-interacting protein kinase 2 (HIPK2) is responsible for a DNA damage response, centrally regulating p53. The aberrant HIPK2 expression is known to be involved in carcinogenesis in several malignancies. However, the correlation of HIPK2 expression along with progression of cutaneous epithelial neoplasm has not been investigated. Using immunohistochemistry and real-time reverse transcription-polymerase chain reaction, we examined the correlation between HIPK2 and HIPK2-related protein expressions and the progression of some cutaneous epithelial neoplasms (i.e., actinic keratosis, Bowen's disease, keratoacanthoma, squamous cell carcinoma, and basal cell carcinoma). HIPK2 expression was distinct between preinvasive and invasive lesions: the expression decreased in keratoacanthoma (none of eight) and squamous cell carcinoma (five of 35) compared to actinic keratosis (12 of 19) and Bowen's disease (10 of 23) (P<0.001). HIPK2 expression was also negatively correlated with aggressiveness of basal cell carcinoma; high-risk subtypes showed lower HIPK2 expression than did low-risk subtypes (P<0.001). HIPK2 mRNA expression of each tumor group was significantly higher than that of normal skin. HIPK2 mRNA expression of each tumor group was not correlated with the relevant HIPK2 protein expression, which was consistent with previous studies. HIPK2 expression tends to be decreased along tumor progression and may be involved with the invasive potential, suggesting a possible tumor suppressor role for HIPK2.

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.

Differential expression patterns of metastasis suppressor proteins in basal cell carcinoma.

Basal cell carcinomas (BCCs) are common malignant skin tumors. Despite having a significant invasion capacity, they metastasize only rarely. Our aim in this study was to detect the expression patterns of the NM23-H1, NDRG1, E-cadherin, RHOGDI2, CD82/KAI1, MKK4, and AKAP12 metastasis suppressor proteins in BCCs. A total of 96 BCC and 10 normal skin samples were included for the immunohistochemical study. Eleven frozen BCC samples were also studied by quantitative real time polymerase chain reaction (qRT-PCR) to detect the gene expression profile. NM23-H1 was strongly and diffusely expressed in all types of BCC. Significant cytoplasmic expression of NDRG1 and E-cadherin was also detected. However, AKAP12 and CD82/KAI1 expression was significantly decreased. The expressions of the other proteins were somewhere between the two extremes. Similarly, qRT-PCR analysis showed down-regulation of AKAP12 and up-regulation of NM23-H1 and NDRG1 in BCC. Morphologically aggressive BCCs showed significantly higher cytoplasmic NDRG1 expression scores and lower CD82/KAI1 scores than non-aggressive BCCs. The relatively preserved levels of NM23-H1, NDRG1, and E-cadherin proteins may have a positive effect on the non-metastasizing features of these tumors.

Gorlin-Goltz syndrome: Case report

Gorlin-Goltz syndrome, also known as basal cell nevus syndrome, is an uncommon, autosomal dominant inherited disorder, which is characterized by numerous basal cell carcinomas, maxillary keratocysts, and musculoskeletal malformations. Occasionally, it is associated with aggressive basal cell carcinomas and internal malignancies. Early diagnosis and treatment are essential, as well as genetic counseling. A patient with characteristic symptoms of nevoid basal cell carcinoma and a review of the literature is presented.

Two Cases of Oligometastatic Basal Cell Carcinoma: A Comparison of Pathology Characteristics and Discussion of Systemic and Radiotherapeutic Management Strategies

Metastatic basal cell carcinoma (BCC) cases are rare and clinically challenging. We are reporting two such cases, which were seen at a short interval from one another, in order to outline and compare case features indicative of an aggressive BCC. Furthermore, we wish to discuss the role and delivery of radiation therapy in the treatment of this disease in the metastatic setting, including the use of stereotactic ablative radiotherapy. Finally, we address the use of vismodegib as it was made in these cases.

Gorlin syndrome: case reports with extremely large odontogenic keratocysts

Background and objectives: Gorlin syndrome is an autosomal dominant, inherited cancer disease with a rare incidence. Diagnostic features are frequently missing in young patients, making the recognition difficult. The presence of two major and one minor criteria or one major and three minor criteria are necessary to establish a diagnosis. The odontogenic keratocyst is frequently the presenting manifestation of this syndrome. This condition may be associated with aggressive basal cell carcinomas and malignant neoplasias in 10% of the patients.

Skin Retraction As a Marker for Aggressive Basal Cell Carcinoma

Skin Retraction As a Marker for Aggressive Basal Cell Carcinoma

Dermatopathology Update

This past year has seen a wealth of new developments in dermatopathology that appear to herald the dawning of a new era. Advances in molecular biology and the simplification of techniques have put molecular tests within reach of routine clinical practice and led to a radical change in our approach to lesions such as melanoma; in the future, the genetic characterization of these lesions will be an essential requirement for establishing diagnosis, prognosis, and therapy. Technological innovations have also reached dermatology departments: the introduction of ultrasound scans has propitiated the use of fine-needle aspiration cytology, which allows samples to be stained and studied immediately, thereby facilitating diagnosis of superficial and lymph-node lesions, and allowing staging of tumors such as melanoma. Targeted cancer therapies have led to the introduction of more sensitive and specific systems for identifying new targets, have reawakened interest in forgotten diseases such as aggressive basal cell carcinoma, and have led to dermatological reactions that, together with those caused by biologic drugs, we are just beginning to recognize. Consolidated techniques such as immunohistochemistry continue to advance with the addition of new antibodies that contribute considerably to improved diagnosis. New clinicopathologic diseases have also been described or characterized this year, including 2 new types of melanoma, and progress has been made in our knowledge of other diseases, such as primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma. These topics, together with new developments in adnexal tumors, alopecia, and other lesions, will be discussed in this review.

Recurrence Rates of Aggressive Histologic Types of Basal Cell Carcinoma After Treatment with Electrodesiccation and Curettage Alone

Basal cell carcinoma (BCC) is the most common cancer in Caucasians. Treatment options include electrodesiccation and curettage (EDC), surgical excision, and Mohs micrographic surgery (MMS). EDC is standard for smaller BCCs in low-risk locations with nonaggressive histologic subtypes. Larger BCCs in higher-risk locations and aggressive histologic subtypes are treated using surgical excision or MMS. We found no studies reporting recurrence rates for aggressive BCC subtypes treated using EDC alone. To determine recurrence rates of histologically aggressive BCC treated using EDC. This population-based, retrospective case study reviewed 37 primary infiltrative, desmoplastic, morpheaform, or micronodular BCCs in 34 patients treated with EDC. Recurrence was defined as reappearance of BCC within the boundaries of or contiguous to the scar resulting from initial treatment. Of 37 primary aggressive BCCs, 10 recurred within 3.3 years. Average primary tumor diameter was 0.69 cm. Average primary tumor diameter was 0.73 cm for those that recurred and 0.67 cm for those that did not recur. Six recurrences were in high-risk areas, three in moderate-risk areas, and one in a low-risk area. We report a 27% recurrence rate for histologically aggressive BCCs treated using EDC alone with median 6.5 years follow-up.

初回術後，20年経過し根治手術不能となった破壊型基底細胞癌の1例

78歳，男性。右頬の潰瘍を主訴に，2011年3月に東邦大学大森病院を受診。20年前に同部位の基底細胞癌で切除術を受け，以後通院を自己中断していた。初診時の顔面MRIにて上顎洞内に，右眼窩，鼻腔内へ浸潤する腫瘍塊を認めた。手術目的で他科へコンサルトするも，手術適応なしと判断されたため，放射線治療を施行したが，腫瘍の縮小は得られなかった。その後，潰瘍の増大と，壊死による悪臭のため社会生活が困難となり，同年11月に東京労災病院を受診した。根治手術は困難と考えたが，全身麻酔下に悪臭を伴う壊死組織の除去と，可能な限りの腫瘍切除を行った。一般的に予後良好とされる基底細胞癌であるが，長期間の放置や，再発により自験例のような破壊型の基底細胞癌に進展し，治療困難となる例も存在し，患者教育も含め様々な課題を含んでいると考え，報告する。

Vismodegib: The first drug approved for advanced and metastatic basal cell carcinoma

Treatment of basal cell carcinoma (BCC) usually involves surgical interventions and laser ablation, but in locally advanced BCC, which arise either from earlier untreated lesions or from recurrence of aggressive BCC, surgery and radiotherapy are not helpful. Vismodegib, the first oral-targeted therapy for locally advanced and metastatic BCC, unsuitable for surgery or radiotherapy, was recently approved by US Food and Drug Administration (FDA). The drug was under the priority review program of FDA and was approved on the basis of promising results of phase II trial. Vismodegib acts by targeting the hedgehog pathway, which is activated abnormally in most BCCs. Approval of vismodegib is a big step ahead in the treatment of advanced BCC, where there was no other effective drug therapy till now.