Basal Cell Carcinoma Group Research Articles

Histological and Clinical Features of Primary and Recurrent Periocular Basal Cell Carcinoma

Background. Basal cell carcinoma (BCC) is the most common malignancy of the eyelids. Medial canthal BCCs tends to recur more often. Purpose. To evaluate the clinical and histological features of primary and recurrent periocular BCC, in order to identify any existing associations. Methods. Data from 87 patients (71 primary and 16 recurrent) were analyzed in this study. All patients underwent tumor excision with frozen section margin control at the Goldschleger Eye Institute between 1/1995 to 12/1997. Statistical analysis was performed to identify possible associations between histological and clinical characteristics of primary and recurrent BCC. Main Outcome Measures. Anatomical location, clinical presentation, and histology of peri-ocular BCC. Results. No association was found between histopathological and clinical characteristics of BCC. Similar features with regard to eyelid location and histology were found in primary and recurrent peri-ocular BCCs, whereas recurrent BCCs tended to involve a greater eyelid extent with a longer duration of symptoms. Medial canthal BCCs, morpheaform, or sclerosing histology were not more common in the recurrent BCC group. Conclusions. Similar clinical and histological characteristics were noted in primary and recurrent periocular BCC, implying that incomplete surgical excision rather than anatomical location or histological features is the main cause for recurrence.

Clinical and Histopathological Features of Aggressive Basal Cell Carcinoma

Background: Basal cell carcinoma (BCC) is the most frequent type of skin cancer in humans. A minority of BCCs have an aggressive biological behavior, causing extensive deep tissue invasion, metastasis and recurrence. The object of this study was to evaluate clinical and histopathological features of aggressive BCC. Material and Methods: The study group was consisted of 19 recurrent and/or invasive BCC and control group was consisted of 19 nonaggressive BCC patients. Results: At the aggressive group 3 had only recurrent tumor, 6 were recurrent and invasive and 10 had only invasive tumor. Localization of the lesions was at periorbital site most frequently. Histopathologically, at the aggressive group, the loss of regularity in palizading was revealed at 16 cases, morpheiphorm or sclerozing stroma at 14 cases, infiltrative tumor type at 15 cases, squamous differentiation at 15 patients and increase in tumor cells nuclear pleomorphism at 14 cases. Conclusion: There is no any standardized certain diagnostic criterias of aggressive BCC. Therefore, by the evaluation of the histopathological criterias of scalp and neck sited BCCs according to the features that were above mentioned, can supply the estimation of the biological behaviors of BCCs.

Recurrent basal cell carcinoma following ablative laser procedures

In Korea, many patients diagnosed with basal cell carcinoma (BCC) have a history of laser ablations of undiagnosed lesions. To evaluate the clinical/pathological and surgical features of BCC developing from undiagnosed lesions following laser ablations (not full-face cosmetic ablations) and to compare them with primary BCCs. This study enrolled 359 patients with 373 biopsy-proven BCC lesions. All of the patients were treated by Mohs micrographic surgery (MMS) at the Department of Dermatology, Pusan National University Hospital from 1998 to 2008. BCC was classified by previous treatment history of lesion ablative laser: post-laser BCC vs primary BCC. We conducted a retrospective study through clinical photographs, pathology slides, and MMS sheets. Among 373 BCCs, 58 lesions (15.5%) were post-laser BCCs. The post-laser BCC group was younger (59.9 vs 65.4 years, P = .001), but had a longer disease interval until pathologic diagnosis (7.18 vs 3.33 years, P < .0001) than the primary BCC group. The post-laser BCC group had a greater frequency of the micronodular pattern (22.4% vs 10.8%, P = .01), required more stages of excision (2.69 ± 1.63 vs 2.15 ± 1.05, P < .001), and had fewer cases with one Mohs stage excision (10.3% vs 27%, P = .006) than the primary BCC group. We could not identify the type of laser used in all 58 cases; instead, we supposed that most of the patients were likely treated with the carbon dioxide laser. The results demonstrated that the post-laser BCC group had a longer disease interval to diagnosis, a more aggressive histologic pattern, and required more stages of excision in MMS than the primary BCC group.

Expression of P27kip1 and Skp2 in basal cell carcinoma and its clinical pathological characters

Objective To investigate the expression of Skp2 and P27kip1 and their relationship with the clinicopathologic characters in basal cell carcinoma(BCC). To explore their expression between with the types of BCC of skin, especially in morpheaform BCC group. Methods Immunohistochemical SP technique was used to examine the expression of Skp2 and P27kip1 in 50 cases of BCC and 30 cases of normal tissues of skin.The expression level was analyzed combined with clinicopathological features of age, sex and types of tumor.Results Skp2 positive products located in cytoplasm or nucleus. P27kip1 positive products located in nucleus.The high expression of Skp2 and the low expression of P27kip1 were observed in BCC, there was statistical significance between the tumor group and the control group (P ＜ 0. 05 ) . The expression of Skp2 and P27kip1 were correlated with clinical types of BCC ( P ＜ 0. 05 ), while which were not correlated with age and sex ( P ＞0.05 ). In BCC tissue, Skp2 expression was negatively correlated with P27kip1 ( - 0.624; P ＜ 0.05), there was no correlated with each other in morpheaform BCC group ( P ＞ 0. 05 ). Conclusion The expression of Skp2 and P27kip1 in BCC are significant differences to normal skin tissues, and they are correlated with each other.They may play an important role in carcinogenesis and the development of BCC, and also make targets to treat it. Compared to nodular and superficial BCC group, the expression of Skp2 are higher in morpheaform BCC group, and the expression of P27kip1 is lower. They may play an important role in the types of the BCC and useful factors to predict the types of the tumor, also determine surgical margin for BCC cases. Key words: Neoplasms, basal cell; S-phase kinase-associated proteins; Cyclin-dependent kinase inhibitor p27

Increased expression of COX-2 in recurrent basal cell carcinoma of the skin: A pilot study

Basal cell carcinoma (BCC) is the most frequent malignant skin tumor. BCC rarely metastasizes, but it is often locally aggressive. Cyclooxygenase-2 (COX-2) is critical for tumor formation, angiogenesis and metastasis. Matrix metalloproteinases (MMPs) are the members of the family of zinc (Zn)- and calcium-dependent endopeptidases that degrade the extracellular matrix. In our study, we used immunohistochemical methods for the evaluation of COX-2, MMP-2 and MMP-9 expression in tissue samples of 30 primary and 10 recurrent skin BCC cases. Immunohistochemical COX-2 expression was significantly higher in the infiltrating pattern of BCC compared with the nodular (P = 0.005) and superficial (P = 0.041) subtypes in the primary BCC group. There was not a significant difference between nodular and superficial BCCs for COX-2 expression. In addition, COX-2 expression was significantly higher in the recurrent BCC group than in the primary BCC group (P = 0.030). There was no statistically significant difference between the histological subtypes of primary BCCs and between primary and recurrent BCCs for MMP-2 and MMP-9 expressions. Our data confirm previous findings that COX-2 and MMP-9 expressions are increased in BCC. Our results revealed an elevated COX-2 expression in recurrent BCCs. We suggest that COX-2 inhibition might have beneficial effects in BCCs, especially for the tumors with a higher level of COX-2 expression or aggressive phenotype.

The incidence of Demodex species in skin biopsy specimens diagnosed as actinic keratosis and nonmelanoma skin cancer.

Background: The most common types of skin cancers include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), which are grouped as non-melanoma skin cancers. Actinic keratosis (AK) is a precancerous lesion that may develop into SCC. The pilosebaceous follicle mites, Demodex folliculorum and Demodex brevis, inhabit most commonly and densely certain facial skin areas where BCC and SCC also develops most frequently. Objective: Determine the prevalence of Demodex species in skin biopsy specimens diagnosed as SCC, BCC, and AK. Method: Specimens of the patients whose reports were available were studied in terms of Demodex. The specimens were stained using Hematoxylin and Eosin, and evaluated for Demodex species positivity. Results: There were Demodex species in seven (38.9%) out of 18 AK cases, 12 (31.6%) out of 38 SCC cases, and 26 (44.8%) out of 58 BCC cases of this study. The rate of Demodex species in patients diagnosed SCC, BCC, and AK was found to be rather high. Conclusion: Demodex species should also be evaluated in the follow-up of the treatment of patients in SCC, BCC, and AK group.

Polymorphisms of 5,10-methylenetetrahydrofolate reductase and thymidylate synthase in squamous cell carcinoma and basal cell carcinoma of the skin

Genetic instability resulting from mutations in repair genes, defects in folic acid metabolism or DNA synthesis has been reported to contribute significantly to the development of skin cancer. The enzymes 5,10-methylenetetrahydrofolate reductase (MTHFR) and thymidylate synthase (TS) are essential participants in folic acid metabolism and DNA synthesis. Thus, the present case-control study was conducted to determine whether an association exists between the MTHFR/TS polymorphisms and squamous cell carcinoma (SCC) and/or basal cell carcinoma (BCC) among Korean individuals. The study subjects comprised 95 patients with SCC, 100 patients with BCC and 207 controls with no evidence of malignancy or pre-malignant lesions. Patients with skin cancer and control samples were analyzed for polymorphisms of the MTHFR or TS genes by means of polymerase chain reaction-restriction fragment length polymorphism. The MTHFR 677C>T and MTHFR 1298A>C polymorphisms showed no significance with regard to the development of SCC and BCC. However, within the 6bp insertion (ins)/deletion (del) polymorphism in the 3'-untranslated region (3'-UTR) of the TS gene, the BCC group showed statistical significance with a 2.8-fold increased risk of cancer development [adjusted odds ratio (AOR)=2.821] in heterozygous mutations (0bp/6bp), 7.5-fold (AOR=7.539) in homozygous mutations (6bp/6bp) and 3-fold (AOR=3.079) upon combination of heterozygous mutations and homozygous mutations (0bp/6bp + 6bp/6bp). We thus conclude that the 6bp ins/del polymorphism in the 3'-UTR is associated with increased risk of the development of skin cancer among Korean individuals with BCC.

Difference between Pigmented and Nonpigmented Basal Cell Carcinoma Treated with Mohs Micrographic Surgery

There have been several articles characterizing cases of pigmented basal cell carcinomas (PBCC). Previous studies have also evaluated the relationship between histologic pattern and frequency of basal cell carcinoma (BCC) associated with pigment formation. No specific studies, however, have examined the subclinical extension and surgical margins of PBCC tumors. A prospective study of 345 Mohs micrographic BCC surgical cases revealed 67 PBCC cases. Analysis of patient details included patient age and sex, the lesional site, histologic subtype, tumor size, final surgical margin, and the number of stages required to achieve tumor-free margins together with the presence or absence of pigment. This study was performed between May 2004 and January 2005 at the Department of Dermatology and Cutaneous Surgery, University of Miami, Mohs Surgery Center. Total mean surgical margin was smaller in the PBCC than the nonpigmented BCC (NPBCC) group (3.89 mm vs. 5.85 mm; p<0.05). In lesions less than 2 cm in size, there were even more significant differences between the two groups (3.32 mm vs. 5.33 mm; p<0.05), and also between the aggressive and nonaggressive histologically diagnosed groups (3.13 mm vs. 5.01 mm; p<0.05). We have demonstrated that PBCC requires a smaller surgical margin for complete tumor excision than NPBCC, especially in smaller tumors and in the nonaggressive histologic subtype group. Treatment within the early growth stages also involves less subclinical microscopic invasion and a smaller surgical margin in PBCC.

Plasma antioxidant defense in actinic keratosis and basal cell carcinoma

Reactive oxygen species and lipid peroxides have been implicated in the pathogenesis of a variety of diseases, particularly cancer. There may be an inverse correlation between lipid peroxidation and antioxidant defense mechanisms. The aim of this study was to investigate whether certain plasma antioxidants (ascorbic acid, alpha-tocopherol, total thiol groups, ceruloplasmin, urate, albumin and erythrocyte glutathione) are altered in actinic keratosis (AK) and basal cell carcinoma (BCC). Plasma samples and red blood cells (RBC) of 13 patients with AK, 12 with BCC and 16 healthy controls were investigated. Data analysis indicates significant decrease of ascorbic acid (P < 0.001), alpha-tocopherol (P < 0.05 and P < 0.001), total thiol groups (P < 0.001), ceruloplasmin (P < 0.001 and P < 0.05), and RBC glutathione (P < 0.05) values in both AK and BCC groups compared to controls. Comparison of AK and BCC groups evidenced a significant decrease of alpha-tocopherol and RBC glutathione (P < 0.05) in BCC patient. Plasma antioxidants are decreased in the AK and BCC, probably due to the long exposure to UV irradiation which is one of the most important factors in the etiology of AK and BCC and alpha-tocopherol and RBC glutathione (P < 0.05) are most altered in BCC.

Plasma antioxidant defense in actinic keratosis and basal cell carcinoma

Background Reactive oxygen species and lipid peroxides have been implicated in the pathogenesis of a variety of diseases, particularly cancer. There may be an inverse correlation between lipid peroxidation and antioxidant defense mechanisms. The aim of this study was to investigate whether certain plasma antioxidants (ascorbic acid, α-tocopherol, total thiol groups, ceruloplasmin, urate, albumin and erythrocyte glutathione) are altered in actinic keratosis (AK) and basal cell carcinoma (BCC).Methods Plasma samples and red blood cells (RBC) of 13 patients with AK, 12 with BCC and 16 healthy controls were investigated.Results Data analysis indicates significant decrease of ascorbic acid (P<0.001), α-tocopherol (P<0.05 and P<0.001), total thiol groups (P<0.001), ceruloplasmin (P<0.001 and P<0.05), and RBC glutathione (P<0.05) values in both AK and BCC groups compared to controls. Comparison of AK and BCC groups evidenced a significant decrease of α-tocopherol and RBC glutathione (P<0.05) in BCC patient.Conclusion Plasma antioxidants are decreased in the AK and BCC, probably due to the long exposure to UV irradiation which is one of the most important factors in the etiology of AK and BCC and α-tocopherol and RBC glutathione (P<0.05) are most altered in BCC.

Can ultraviolet erythema be used to identify the basal cell carcinoma phenotype?

Since a prolonged duration of a strong UVB erythema has been suggested as a marker for propensity to develop skin cancer, we objectively followed the duration and intensity of erythemas induced by UVB and UVA radiation for 28 days in 18 patients with basal cell carcinoma (BCC), and in 15 healthy controls using reflectance spectrophotometry. The erythema index, defined as the difference in redness between UV-exposed skin and normal, adjacent skin on the lower abdomen, did not differ significantly between the two groups at 24 h, when the reaction was maximal, following a dose of 6 MED of UVB. Erythema values after 7 and 14 days were slightly higher in the BCC group, but this difference did not reach statistical significance. At day 7 some patients in the BCC group showed very strong erythemas. At days 21 and 28 the two groups had almost identical erythemal reactions. Following a standard dose of UVA of 100 J/cm2, patients with BCC and healthy controls both showed weak erythemal reactions, which declined somewhat over the study period. No significant differences in pigmentary response were noted between the BCC and the control group, neither following UVB nor UVA. Although individual patients with BCC deviate from the normal erythemal curve for UVB, the UVB response is not a suitable predictive instrument in screening patients with the basal cell carcinoma phenotype.