Types Of Basal Cell Carcinoma Research Articles

Basal cell carcinoma on the eyelids: own experience.

Basal cell carcinoma (BCC) is the most common skin malignancy. Eyelids constitute a special location of BCC because of the proximity of the eyeball. This study was undertaken to evaluate the incidence of BCC located on the eyelids, to examine the clinical and histologic types of BCCs in this location, and to present some reconstructive techniques used in the treatment of BCC in palpebral region. There were 330 patients with BCC retrospectively included in the study. The comparison was performed between clinical and histologic features of BCCs located on eyelids and in other locations. Approximately 16% of all tumors were located on the eyelids. The majority of tumors were situated on the lower eyelid. Noduloulcerative clinical type was observed in 96.3% of tumors. This type was significantly more frequently found on eyelids than on trunk and extremities (p<0.00001). The histologic nodular type was the most common found on eyelids. It was significantly more common on eyelids than on trunk and extremities (p=0.002). The superficial type was significantly less frequently found on the eyelids (p<0.00001). The infiltrative type was significantly more seldom observed on the eyelids compared with other locations of head and neck region (p=0.048). Some technical aspects of reconstructive surgery of the eyelids are presented.

Carcinoma basocelular múltiple tratado con imiquimod

Superficial basal cell carcinoma (BCC) account for 15% of all BCC. Treatment of superficial BCC with surgery, cryosurgery and electrodessication often produce anaesthetic scars. We present a case of a 58 year-old male, with multiple superficial BCC, who was treated with imiquimod 5% cream, in a schedule of one application daily three times per week, with a very good response after 12 applications. Imiquimod is an immune response modifier which induces cytokines and interferon, and is effective for the treatment of different types of BCC.

Demarcation of nonmelanoma skin cancer margins in thick excisions using multispectral polarized light imaging.

More than a million cases of nonmelanoma skin cancers are diagnosed every year. Treatment of cancer patients could benefit greatly if a real-time, noninvasive, reliable, and cost-effective technique for delineating tumor margins were available. A novel multispectral dye-enhanced polarized light imaging technique that enables rapid imaging of large tumor fields is described. A tunable monochromatic light source and a CCD camera were employed as the imaging device. Linear polarizers were introduced into both the incident and collected light pathways in order to limit the measurement volume to the superficial tissue layers. To enhance the tumor contrast in the image, aqueous solutions of toluidine blue or methylene blue were topically applied to fresh thick skin excisions for several minutes. Then the specimens were rinsed in saline solution. Images were acquired before and after staining at the selected wavelengths. The two sets of wavelengths corresponding to the hemoglobin Soret absorption band and to the absorption bands of the dyes were used to demarcate the areas of enhanced hemoglobin and dye absorption, respectively. The resulting images demonstrate that staining significantly enhances contrast of the tumor in the image and enables reliable delineation of cancer. Locations and shapes of tumor lobules revealed by polarized light images closely correspond to those found in Mohs frozen sections for 41 specimens out of 45. The study demonstrates that the suggested technique has significant potential as a guidance tool in tumor excision surgery.

The Influence of Painful Sunburns and Lifetime Sun Exposure on the Risk of Actinic Keratoses, Seborrheic Warts, Melanocytic Nevi, Atypical Nevi, and Skin Cancer

Painful sunburns are implicated in the pathogenesis of squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. Chronic exposure to ultraviolet radiation is known as the most important risk factor for the development of actinic keratoses and squamous cell carcinoma. The purpose of the study was to assess the effect of painful sunburns and lifetime sun exposure on the development of actinic keratoses and seborrheic warts in relation to the development of squamous cell carcinoma and basal cell carcinoma, and on the development of melanocytic nevi and atypical nevi in relation to the development of malignant melanoma. We made use of a cohort of 966 individuals who participated in a case-control study to investigate environmental and genetic risk factors for skin cancer. Exposure measurements for sunlight were collected and actinic keratoses, seborrheic warts, melanocytic nevi, and atypical nevi were counted. Relative risks were estimated using exposure odds ratios from cross-tabulation. Multivariate logistic regression was used to adjust for potential confounders. The recall of painful sunburns before the age of 20 y was associated with an increased risk of squamous cell carcinoma, nodular basal cell carcinoma, and multifocal superficial basal cell carcinoma as well as actinic keratoses. Odds ratios with 95% confidence intervals adjusted for age, sex, and skin type were 1.5 (0.97; 2.3); 1.6 (1.1; 2.2); 2.6 (1.7; 3.8); and 1.9 (1.4; 2.6) for the three types of nonmelanoma skin cancer and actinic keratoses, respectively. Painful sunburns before the age of 20 y were also associated with an increased risk of malignant melanoma and the development of its precursors, melanocytic nevi and atypical nevi. Odds ratios with 95% confidence intervals adjusted for age, sex, and skin type were 1.4 (0.86; 2.1); 1.5 (1.1; 2.0); and 1.4 (0.88; 2.3) for malignant melanoma and the two types of precursors, respectively. Lifetime sun exposure was predominantly associated with an increased risk of squamous cell carcinoma (p-value for trend=0.03) and actinic keratoses (p-value for trend <0.0001) and to a lesser degree with the two types of basal cell carcinoma. By contrast, lifetime sun exposure appeared to be associated with a lower risk of malignant melanoma, despite the fact that lifetime sun exposure did not diminish the number of melanocytic nevi or atypical nevi. Neither painful sunburns nor lifetime sun exposure were associated with an increased risk of seborrheic warts.

Expression of beta-catenin in basal cell carcinoma.

Background beta-Catenin is a crucial member of the E-cadherin/catenin complex, which plays a major role in cell-cell adhesion. beta-Catenin is also known to be involved in signal transduction pathways. Many studies have demonstrated changes in the expression of beta-catenin in colorectal carcinomas, suggesting a role for beta-catenin in neoplastic development. Objectives Basal cell carcinoma (BCC) is a locally invasive tumour. The various subtypes show differences in biological behaviour. This study aimed to investigate the presence of differences in the immunoprofile of beta-catenin among histological variants of BCC. Methods Eighty BCCs were studied (32 nodular, 7 micronodular, 24 superficial and 17 infiltrative and morphoeic). Formalin-fixed, paraffin-embedded tissue sections were stained for beta-catenin using the avidin/biotin immunodetection technique. Results All the nodular BCCs showed membranous and weak cytoplasmic staining. Nuclear staining was seen in 15 of 32 (47%) cases, being stronger at the periphery of the nodules in 11 of 15 (73%) of these cases. In superficial BCCs the membranous staining was variable and cytoplasmic staining was increased. Nuclear staining was seen in 16 of 24 (67%) cases, being more notable at the periphery in 8 of 16 (50%) of these cases. All micronodular BCCs showed strong membranous staining, weak cytoplasmic and no nuclear staining. In the infiltrative and morphoeic BCCs membranous staining was completely lost at the advancing margins of the invading cell strands, with a marked increase in cytoplasmic staining; nuclear staining was observed in all these tumours. Conclusions The expression of beta-catenin varied between different types of BCC. Nuclear localization was most notable in the infiltrative and morphoeic variants, followed by the superficial variant, and seen least in nodular BCC. Its prominence at tumour margins suggests that this may be associated with more aggressive types of invasion.

Expression of basic fibroblast growth factor, vascular endothelial growth factor, and thrombospondin-1 related to microvessel density in nonaggressive and aggressive basal cell carcinomas.

The aggressive forms of basal cell carcinoma (BCC) are biologically different in a number of features from their nonaggressive counterparts. The expression of basic Fibroblast Growth Factor (bFGF), Vascular Endothelial Growth Factor (VEGF), and Thrombospondin-1 (TSP-1) was examined in primary culture samples of nonaggressive and aggressive BCCs. We studied the relationship between neoangiogenesis by counting microvessels, tumor aggressiveness, and the expression of three different angiogenic factors. bFGF mRNA was detectable in all BCC samples, but there was no significant difference in the levels of expression between the two types. VEGF mRNA was also detectable in all BCC samples. VEGF expression in the aggressive type was approximately 3.5-fold higher than in the nonaggressive type. TSP-1 expression was variable and not related to the type of BCC. The mean value of microvessel density (MVD) was significantly higher for the aggressive type than for the nonaggressive type. There was a significant correlation between VEGF levels and MVD. No significant relationships were found between bFGF, TSP-1 mRNA expression, and MVD. In conclusion, the results of present study suggest that VEGF expression and angiogenesis might play important roles in the progression to aggressive BCC.

Changing demographics and pathology of nonmelanoma skin cancer in the last 30 years.

Nonmelanoma skin cancer is a common and important public health concern. Few long-term demographic studies to evaluate potential changes in the clinical or pathologic attributes of theses lesions have been initiated. A computer-based archival search of nonmelanoma skin cancer (NMSC) diagnosed in 1972 and 2001 at a large VA medical center was examined with accompanying glass slides. The NMSC consisted of basal cell carcinoma (BCC), invasive squamous cell carcinoma (SCC) and squamous cell carcinoma in situ (SIS). Pathologic attributes examined included the histologic type of BCC (nodular, superficial, infiltrating), and histologic grade of SCC. Demographic features included age, and location. As the majority of patients were men, women were excluded from the study. The results were tabulated and statistically evaluated by the Students' t-test. A total of 831 cases of NMSC diagnosed in 809 patients in 1972 compared to 1,712 cases in 1,011 patients in 2001. BCC accounted for 45%, SIS 23%, and SCC 32% in 1972 compared to 34% BCC (P = .04), 38% SIS (P = .01), and 28% SCC (P > .05) in 2001. Histologic subtypes of BCC included nodular accounted for 45%, superficial 37% and infiltrating 7% in 1972 compared to 35% (P = .05), 46% (P > .05) and 19% (P = .01) in 2001. Among SCC, 79% were well differentiated with 13% moderate and 7% poorly differentiated in 1972 compared with 82% (P > .05), 10% (P >.05), and 8% (P > .05)in 2001. The average age of patients in 1972 was 76.2 and 64.1 in 2001 (P = .02). The most common locations in 1972 are head and neck (H&N) (54%), extremities (24%); 2001 H&N (50%) and extremities (32%, P = .05). The data would suggest that NMSC is being diagnosed at a younger age and more commonly on the extremities in Veteran's than in the past. The relative proportion of SIS and of superficial and infiltrating BCC is also increasing.

Ｂａｓａｌ Ｃｅｌｌ Ｃａｒｃｉｎｏｍａ ｏｎ ｔｈｅ Ｓｃｒｏｔｕｍ 陰嚢に生じた基底細胞癌の１例

We reported a case of basal cell carcinoma (BCC) on the scrotum. The patient was a 59-year-old man who presented with an approximate 10-year history of an asymptomatic nodule on the scrotum. Histopathology revealed a solid type of BCC and the lesion was subsequently excised. We surveyed the literature and found 52 cases of BCC arising on the scrotum in the Japanese literature. [Skin Cancer (Japan) 2003; 18: 80-82]

Downregulation of expression of a novel cadherin molecule, T-cadherin, in basal cell carcinoma of the skin.

T-cadherin appears to act as a tumor-suppressor factor in various cancers. Downregulation of T-cadherin is caused by a combination of allelic loss and hypermethylation of the T-cadherin promoter region and is related to cancer invasion. To elucidate the molecular mechanism of invasiveness of basal cell carcinoma of the skin, T-cadherin expression was investigated in archival pathological tissue sections made up of normal counterparts of skin and various types of basal cell carcinoma. Immunohistochemical staining showed that T-cadherin was not expressed in 38 of 51 (75%) basal cell carcinoma specimens, whereas normal counterparts of the skin appeared to express abundant T-cadherin. Loss of heterozygosity in intron 1 of the T-cadherin gene was found in four of 20 informative cases that did not express T-cadherin. Aberrant methylation of the T-cadherin promoter region also was found in six of 25 basal cell carcinomas by methylation-specific polymerase chain reaction. In contrast, no structural alternations were found in two loss of heterozygosity-positive basal cell carcinomas on sequence analysis. These findings indicated that T-cadherin expression was downregulated by a combination of allelic loss and aberrant methylation in basal cell carcinoma of the skin. Loss of T-cadherin expression might be related to the biological behavior of basal cell carcinoma. In addition, results of the present study suggested that downregulation of T-cadherin in various cancers might be related to tumor invasiveness rather than metastasis, because basal cell carcinoma of the skin principally lacks metastatic activity.

Investigation of basal cell carcinoma [correction of carcionoma] by confocal laser scanning microscopy in vivo.

In vivo confocal laser scanning microscopy (CLSM) allows to study human skin up to 200 micro m deep non-invasively. Aim of this study was to investigate basal cell carcinoma (BCC) using in vivo CLSM, and to compare the micromorphologic features of BCC with uninvolved skin. Twelve patients with histological diagnosis of BCC referred to our department for tumor excision were investigated on the lesion(s) and on clinically uninvolved sites preoperatively by in vivo CLSM using the Vivascope 1000 (Lucid Inc., Rochester, USA). The images were compared to histological examinations of the excised tissue. Typical changes in vasculature such as increase in number and diameter of the blood vessels, loss of the vascular architecture, parallelly and horizontally orientated vessels, and accumulation and rolling phenomena of bright reflecting cells of 11.88 +/- 1.75 micro m in diameter along the vessel wall were observed in all BCCs. The tumor stroma of the BCCs showed a strong reflectance mainly due to numerous bundles of collagen fibers encoating dark, cell-rich areas of tumor parenchym. In five patients, slim basaloid cells with relatively large, elongated dark nuclei were observed in the periphery of the tumor parenchym. In the fibrosing type of BCC, curled bundles of collagen with large cells represented the tumor stroma. BCC can be investigated by CLSM and provide typical features. Besides the tumor parenchym and stroma, typical changes in vasculature seem to be a sensitive criteria for BCC and may in future help in diagnosing BCC by CLSM as well as in assessing the margins of large tumors. We suggest that CLSM is a promising non-invasive tool for the diagnostics of BCC and the assessment of tumor margins prior to surgery.

Can smoking and/or occupational UV exposure have any role in the development of the morpheaform basal cell carcinoma? A critical role for peritumoral mast cells.

The stroma of basal cell carcinoma (BCC) is rich in mast cells. Morpheaform BCC has been reported to contain many more mast cells than the other types of BCC. However, pathogenesis and clinical relevance of this observation are currently unclear. Smoking and ultraviolet (UV) exposure have recently been suggested to be related to the development of morpheaform BCC. With a retrospective study, we aimed to investigate the possible roles of smoking and occupational UV exposure in the development of morpheaform BCC through the quantification of peritumoral mast cells. Our case population consisted of 34 patients with morpheaform BCC and 50 patients with solid BCC. After identification of mast cells with toluidine blue stain, a mast cell index was determined in each case. Mean mast cell index of morpheaform BCCs was significantly higher than that of solid BCCs (P < 0.02). Increased mast cell indices were associated with smoking (P = 0.003), but not with UV exposure (P > 0.05), irrespective of the tumor type. Morpheaform BCC was significantly more frequent in smokers compared to solid BCC (P < 0.05). In the cases with morpheaform BCC, mean mast cell index of smokers was significantly higher than that of nonsmokers (P = 0.02). Mean mast cell index of smokers with morpheaform BCC was also significantly higher than that of the smokers with solid BCC (P = 0.04). Ultraviolet exposure alone had no significant influence on mast cell indices, nor on the frequency of morpheaform BCC. We suggest that smoking can play a key role in the differentiation of BCC toward its sclerosing form, through the increased peritumoral mast cell numbers.

Anaplastic neoplasms arising from basal cellcarcinoma xenotransplants into SCID-beige mice.

An animal model for the study of basal cell carcinoma (BCC) is required to better understand its biology. Several attempts to grow BCC in immuno-incompetent animals have been only modestly successful. To test the ability of BCC to grow in a mouse with complete and severe immuno-incompetence, 14 individual BCC were transplanted into the subcutaneous tissue of 18 SCID-beige mice (T, B and natural killer cell deficient). Light microscopy and immunophenotypic analyses were performed on primary BCC and first and seventh passage tumors. Transplantation of three BCC yielded rapidly growing anaplastic tumors for a tumor take of 18% (3/18). SCID-beige mice without tumor growth had mostly scars or epidermoid cysts at the transplant sites. The three patients whose BCC gave rise to the anaplastic tumors were significantly older than those without tumor growth (87 vs. 64, p = 0.001), but they did not differ with respect to BCC type or general health. These three anaplastic tumors were histologically and immunophenotypically similar, being composed of dyscohesive, pleomorphic cells that expressed vimentin and smooth muscle actin. In the first passage mice these tumors were locally invasive, tumor-forming nodules associated with an expansion of donor inflammatory cells (T and B lymphocytes and plasma cells), rare remnants of BCC epithelium and epidermoid cysts. By the seventh passage, the tumors were homogenous and metastasized widely throughout the mice. Changing transplantation location to the dermis to wound environment or supplementing the tumor with BCC-derived fibroblasts did not alter the phenotype or growth rate in SCID-beige mice. Anaplastic tumors also grew easily in SCID mice (T and B cell deficient). However, transplantation of the anaplastic tumors into normal mice (CB-17) or less severely immunodeficient mice (NCr and Balb/c: T and natural killer cell deficient) did not allow for growth. Furthermore, tumor growth could not be maintained in vitro. Empirically, these data suggest that BCC has the potential to become an aggressive metastatic neoplasm, given the right immune and stromal environment. Moreover, a functional B lymphocyte system appears to prevent this growth. As human lymphocytes also engraft in SCID-beige mice, the original host immune response could be responsible for the lack of tumor growth in the majority of xenografts. Furthermore, the anaplastic and metastatic phenotype of these BCC derived neoplasms may be the experimental equivalent of metastatic BCC and BCC associated with carcinosarcoma.

下顎部に生じたＡｄａｍａｎｔｉｎｏｉｄ Ｂａｓａｌ Ｃｅｌｌ Ｃａｒｃｉｎｏｍａの１例

We report a rare case of adamantinoid basal cell carcinoma (BCC). A 75-year-old woman presented with a 7×7mm black nodule with bloody crust on her right jaw. The tumor was totally excised. Histopathological examination revealed that the tumor mass was mainly situated in the upper to deep dermis and in contact with the epidermis. At the periphery of the tumor, there were typical solid BCC nests, but within the majority of lobules, intercellular spaces were widened and cells were connected by stellate stretched thin cytoplasm. From these findings, this tumor was diagnosed as an adamantinoid BCC. [Skin Cancer (Japan) 2002; 17 : 221-224]

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Circulating anti-p53 antibodies have been described and used as tumoural markers in patients with various cancers and strongly correlate with the p53 mutated status of the tumours. No study has yet looked at the prevalence of such antibodies in skin carcinoma patients although these tumours have been shown to be frequently p53 mutated. Most skin carcinoma can be diagnosed by examination or biopsy, but aggressive, recurrent and/or non-surgical cases’ follow up would be helped by a biological marker of residual disease. We performed a prospective study looking at the prevalence of anti-p53 antibodies using an ELISA technique in a series of 105 skin carcinoma patients in comparison with a sex- and age-matched control skin carcinoma-free group (n = 130). Additionally, p53 accumulation was studied by immunohistochemistry to confirm p53 protein altered expression in a sample of tumours. Anti-p53 antibodies were detected in 2.9% of the cases, with a higher prevalence in patients suffering from the more aggressive squamous cell type (SCC) of skin carcinoma (8%) than for the more common and slowly growing basal cell carcinoma type or BCC (1.5%). p53 protein stabilization could be confirmed in 80% of tumours studied by IHC. This low level of anti-p53 antibody detection contrasts with the high rate of p53 mutations reported in these tumours. This observation shows that the anti-p53 humoral response is a complex and tissue-specific mechanism. © 2001 Cancer Research Campaign http://www.bjcancer.com

A comparison of touch imprint cytology and Mohs frozen-section histology in the evaluation of Mohs micrographic surgical margins

Background: Touch imprint cytology (TIC) is commonly used in the diagnosis of tumors and has been applied to margin analysis of breast lumpectomy specimens with good success.Objective: Our purpose was to determine the diagnostic adequacy of TIC for identifying positive and negative Mohs surgical margins for basal cell carcinoma (BCC) excisions, compared with the “gold” standard, Mohs tangential sectioning.Methods: Fifty-eight patients undergoing 69 Mohs micrographic surgical procedures for biopsy-proven BCC were included in this study between October 1998 and January 1999. Patients were excluded if the neoplasms were of another histologic type, including BCCs with squamous features. One hundred sixty-six touch imprint slides were prepared from 166 fragments of skin tissue excised during MMS. Touch imprint slides were evaluated blindly and independently by two pathologists, one of whom was also a cytopathologist. The slides were diagnosed as positive for tumor, negative for tumor, or, rarely, atypical but suspect for tumor. Discrepancies between the pathologists' interpretations were re-evaluated with the use of a two-headed microscope and a consensus was reached. After all cytologic interpretation was completed, the results were compared with the histologic diagnosis rendered for each fragment of tissue by the Mohs surgeon.Results: The prevalence of a positive margin by histologic confirmation was 55% overall, 60% for recurrent or sclerosing lesions, and 51% for nonsclerosing or recurrent lesions. The overall accuracy of this technique in identifying true positive and true negative margins was 71%. The sensitivity of TIC for identifying a positive margin was approximately 50% for all BCC types. The specificity was approximately 90% for all BCC types.Conclusion: TIC is inadequate for identifying positive margins compared with the “gold” standard, MMS. (J Am Acad Dermatol 2001;44:660-4.)

Aggressive basal cell carcinoma in young patients: fact or fiction?

It has been suggested that basal cell carcinomas (BCC) arising in younger patients may be of a more aggressive phenotype than those that present in the older population. The purpose of this study was to investigate this hypothesis by comparing the histological types of BCC in a large cohort of young and old patients.A total of 271 histological specimens and clinical records were evaluated. A consecutive series of 120 patients under 50 years old were compared with a consecutive series of 151 patients over 50 years of age. Tumours were classified according to the accepted definition of aggressive (morphoeic, infiltrative and micronodular) and less aggressive (nodular and superficial) histological growth patterns. Aggressive growth types were found in 35% of patients over 50 and 33% of patients under 50. There was a higher rate of incomplete excision in younger patients but this did not reach significance (16% compared to 9%, P = 0.1). This study found that BCC arising in young patients are not histologically different to those found in the older population. Clinically observed aggressive behaviour of BCC in young patients may result from inadequate surgical excision due to cosmesis and diagnostic doubt.

Incidence of perineural invasion in histologically aggressive types of basal cell carcinoma.

Basal cell carcinoma is generally an indolent form of skin cancer. Morpheaform, infiltrative, and sclerosing types are more aggressive tumors. The incidence of perineural invasion in aggressive types of basal cell carcinoma has not been previously described. We studied aggressive basal cell carcinomas for the presence of perineural invasion. Between 1995 and 1998, the histopathologic diagnosis of basal cell carcinoma was made on 5,097 specimens at Dartmouth-Hitchcock Medical Center. Of this total, 507 were classified as sclerosing, infiltrative, or morpheaform. Perineural invasion was found in 15 of the 507 cases. Of these 15 cases, 12 were from the face, and 3 from the back; 13 were recurrent, and 2 were primary lesions. The mean age of patients at diagnosis was 71 years. We found 9.9% of all basal cell carcinomas at our institution to be aggressive types. We found an incidence of perineural invasion of 3% in the aggressive basal cell carcinoma types. This incidence approaches that reported by others for cutaneous squamous cell carcinomas.

Photodynamic Therapy of Residual or Recurrent Basal Cell Carcinoma after Radiotherapy using Topical 5-Aminolevulinic Acid or Methylester Aminolevulinic Acid

This study was conducted to assess the efficacy of aminolevulinic acid-based photodynamic treatment for residual or recurrent basal cell carcinomas after radiotherapy. Photodynamic therapy with either topical 5-aminolevulinic acid 20% and dimethylsulfoxide 99% pretreatment or topical methylester aminolevulinic acid 20% w/w in cream and subsequent light illumination of 50-200 J/cm2 was performed after an initial skin shaving procedure in 20 patients with 22 residual or recurrent basal cell carcinomas. Three lesions were treated once, while twelve, three, one and two lesions received two, three, four and five treatment sessions respectively. At examination, 6-40 months (mean 22 months) after the last treatment, 18 lesions were in complete remission. All lesions were considered excellent or good with regard to cosmetic outcome. Three lesions responded only partially to photodynamic therapy and a fourth lesion recurred 21 months after photodynamic treatment. Two of these four lesions were confirmed as the morpheaform type of basal cell carcinoma.

でん部に生じた基底細胞癌の１例

We present a case of basal cell carcinoma on the buttock. The patient was a 30-year-old man who noticed a gradually enlarging asymptomatic dark reddish nodule of one year duration on his right buttock.Histopathology showed solid type basal cell carcinoma with markedly pigmentladen tumor cells. Surveillance of the literature disclosed 25 Japanese basal cell carcinoma cases of gluteal - perianal location, among which our case was the youngest one. [Skin Cancer (Japan) 2000; 15: 85-87]

Mixed type basal cell carcinoma of the eyelids.

A retrospective histopathologic review of 97 patients with basal cell carcinoma of the eyelid was performed to determine the prevalence and behavior of tumors with a mixed pattern of growth. A mixed type basal cell carcinoma was defined as a tumor having a significant nodular or ulcerative component combined with an infiltrative component. Histologic classification of the 97 tumors yielded four (4.1%) that were multicentric, 67 (69.1%) that were nodular, one (1%) that was ulcerative, 13 (13.4%) that were infiltrative, and 12 (12.4%) that were the mixed variant. Follow-up was obtained on 8 of the 12 patients with mixed basal cell carcinoma. Three tumors recurred, but there were no tumor-related deaths. One of these patients underwent numerous eyelid resections over a 2-year period and then underwent an orbital exenteration. The authors conclude that mixed type basal cell carcinomas are not infrequent and behave as aggressively as basal cell carcinomas of the morphea type. A greater awareness and recognition of mixed type basal cell carcinomas by ophthalmologists and pathologists should result in fewer recurrences and better patient management.