Nodular Basal Cell Carcinoma Research Articles

Clinical versus Histological Assessment of Basal Cell Carcinoma Subtype and Thickness of Tumours Selected for Photodynamic Therapy.

Photodynamic therapy is an approved treatment for primary, superficial, and small nodular basal cell carcinomas with a thickness of < 2 mm located on low-risk sites. Histologically verified basal cell carcinomas clinically assessed as suited for photodynamic therapy were included. The study aimed to investigate the agreement between clinical and histological assessments of basal cell carcinoma subtypes and thickness of tumours selected for photodynamic therapy with histopathological evaluation as a reference. A total of 343 tumours were included. The agreement between clinical and histological diagnosis of basal cell carcinoma subtype was 72% (p < 0.001). Clinical assessment of subtype had a sensitivity of 93% and specificity of 55% for superficial tumours and a sensitivity of 55% and specificity of 85% for nodular tumours. The mean ± SD thickness values by clinical and histological assessments were 0.95 ± 0.53 and 0.86 ± 0.75. The difference of 0.09 mm was statistically significant (p = 0.017), but not considered to be clinically relevant, although the differences between specific subgroups could be relevant. Among basal cell carcinomas clinically diagnosed as superficial, 91% were histologically consistent with the current photodynamic therapy criteria. The main results suggest that histopathological evaluation should precede photodynamic therapy to ensure selection of suitable basal cell carcinomas. In selected cases, the clinical diagnosis alone may be adequate before proceeding with photodynamic therapy.

Pulse Dosing Vismodegib Therapy as an Effective Treatment of Basal Cell Carcinoma: A Case Report

Basal cell carcinoma (BCC) is a common nonmelanoma skin cancer, frequently present on the face and head. BCC is linked to the Sonic Hedgehog (Shh) signaling pathway. Mutations within the Shh signaling pathway, involving the activation of the ligand-independent pathway by the Smoothened (Smo) protein, can lead to unregulated proliferation of basal cells, resulting in BCC. Vismodegib, a hedgehog pathway inhibitor, is a chemotherapy drug approved for targeting the Shh signaling pathway. We herein report a presentation of nodular BCC in a Caucasian female who was treated with Vismodegib. This case highlights the effectiveness of pulse dosing treatment to minimize side effects.

Nodular basal cell carcinoma in a young female at an unusual site – A rare presentation

Nodular basal cell carcinoma in a young female at an unusual site – A rare presentation

MicroRNA Signatures Associated with Basal Cell Carcinoma Subtypes

Basal cell carcinoma (BCC) is classified histologically into subtypes that determine treatment decisions. Micro RNAs (miRs) are short non-coding RNAs that may serve as diagnostic biomarkers. We investigated if particular miRs could distinguish BCC subtypes. We sequenced miRs from 55 archival BCC and 9 control skin specimens, and then validated these miRs by qRT-PCR assay on a second BCC cohort (18 superficial, 16 nodular, 15 infiltrative) and control skin (n= 12). Expression values for individual miRs were normalized to miR-16-5p, which was least variant among the control skin and BCC samples. We found that 1) miR-383-5p and miR-145-5p are downregulated in all BCC subtypes compared to control skin, 2) miR-181c-5p is downregulated in superficial compared to invasive (nodular/infiltrative) BCC, and 3) miR-22-5p and miR-708-5p are upregulated in infiltrative compared to superficial/nodular BCC and miR-30c-5p is downregulated in infiltrative compared to nodular BCC. Receiver operating characteristic analysis demonstrated excellent capacity of these miRs to discriminate between BCC and control skin (area under curve 0.94-0.98), while capacity to discriminate between superficial and invasive subtypes was less robust (area under curves 0.7-0.8). Future prospective studies may determine the utility of these miRs as diagnostic biomarkers to guide biopsy and treatment of BCC.

Cutaneous Superficial Basal Cell Carcinomais a Basal Cell Carcinoma In Situ: Electron Microscopy of a Case Series of Basal Cell Carcinomas.

Basal cell carcinoma (BCC) is the most common skin cancer. Skin cancers may present either as a non-invasive tumor or an invasive malignancy. The terminology of carcinoma in situ is used when the tumor is either just limited to epidermis or not present as single cells or nests in the dermis. However, currently the terminology superficial BCC is inappropriately used instead of BCC in situ when the skin cancer is limited to epidermis. In this study we compare the pathologic changes of superficial, nodular, and infiltrative BCCs using electron microscopy to identify the ultrastructural characteristics and validate the previously proposed terminology. Three cases of BCC (superficial BCC, nodular BCC, and infiltrative BCC) diagnosed by dermatopathologists at our institute were selected for review. Paraffin block tissues from these cases were sent for electron microscopy studies which demonstrated disruption of basal lamina in both nodular and infiltrative type of BCC, while it remains intact in BCC superficial type after extensive examination. Therefore, similar to other in situ skin cancers, there is no invasion of the neoplasm in superficial BCC into the dermis. Hence, the older term superficial BCC should be appropriately replaced with the newer terminology BCC in situ.

Dermoscopy of pigmented basal cell carcinoma: a descriptive study in Indian population

Background: Pigmented basal cell carcinoma (BCC) is more common in brown-skinned than white-skinned individuals. Histopathology is the gold standard for the diagnosis. There is a paucity of published literature on dermoscopy of BCC in brown skin, particularly in the Indian population. Aims: To study the dermoscopic features of pigmented BCC in brown skin. Methods: This was a cross-sectional, hospital-based study in which dermoscopy was performed on 20 patients with pigmented BCC. Results: Out of 20 patients studied, 12 patients had noduloulcerative BCC, 3 patients had nodular BCC, 4 patients had superficial spreading BCC, and 1 patient had morpheaform BCC. Blue-grey globules, ulceration, and arborizing vessels were noted predominantly in nodular BCC. In contrast, whereas maple-leaf-like areas, spoke wheel structures, erosions, and short-fine telangiectasia were seen in superficially spreading BCC. Morpheaform BCC showed the characteristic stellate pattern of vessels, homogenous white areas, and signature pattern observed in a patient with multiple BCCs. Conclusion: Dermoscopy, a non-invasive investigation, cannot replace the gold standard histopathology but can provide valuable information for its diagnosis, identifying the subtype and presence of pigment, differentiating from its clinical mimickers, and helping in its management.

Sclerodermiform Cell Epithelioma of the Palpebromalar Region.

This report describes a recurrent sclerodermiform basal cell epithelioma of the malar region next to the inferior eyelid in a 57-year-old woman. Three interventions were necessary to obtain a clear margin of resection. The area of resection was closed with a local cutaneous flap. We report a rare basal cell carcinoma subtype underestimated in its aggressiveness with often inadequate medical and surgical management. This tumor, generally localized in the face, often requires aggressive surgery, and aesthetic results can be poor. The patients require close long-term follow-up even when margins are clear. General practitioners, dermatologists, and surgeons should be aware of sclerodermiform basal cell carcinoma, which is a malignant, aggressive, and recurrent tumor.

Photodynamic Therapy for the Treatment of Basal Cell Carcinoma: A Comprehensive Review of Randomized Controlled Trials.

Basal cell carcinoma (BCC) is the most common skin cancer worldwide and has been reported to have a rising incidence in the last years. Multiple therapeutic modalities are approved for the treatment of BCC, making it difficult for physicians to choose the most suitable option for every patient. Photodynamic therapy (PDT) using either 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) as photosensitizing agents is an established treatment option for low-risk BCC. This review aims to summarize the available evidence from randomized clinical trials (RCTs) that utilize either ALA or MAL PDT and compare it with other treatment modalities. The main outcomes related to the effectiveness, adverse events, cosmetic outcomes and pain sensation, along with data from long-term follow-ups will be presented and discussed. Thorough literature searches were conducted through the electronic databases ClinicalTrials. gov and Pubmed/MEDLINE from inception up to 28 March 2023. Only studies in English were included. All relevant data were extracted accordingly from the eligible studies. Eight RCTs included superficial BCC (sBCC) alone, 7 included nodular BCC (nBCC), 2 included both sBCC and nBCC and 1 included BCC of unspecified subtype. Follow-up duration ranged from 3 months to 5 years. Both ALA-PDT and MAL-PDT demonstrated acceptable efficacy, adverse events, cosmetic outcomes and pain sensation while no major differences were observed between them. PDT was less effective than surgery but with better reported cosmetic outcomes. PDT is a safe and efficacious treatment option for sBCC and to a lesser extent nBCC.

Aneurysmal Dermatofibroma: Uncommon Presentation of Common Disease

Aneurysmal dermatofibroma is an uncommon, benign variant of dermatofibroma due to the slow extravasation of blood. Clinically, it is difficult to differentiate from other vascular occurring lesions like verrucous hemangioma and malignancies like malignant melanoma and nodular basal cell carcinoma. Hence, an excisional biopsy followed by a thorough histopathological examination is necessary to avoid misdiagnosis. Here, we report a case of a 38 year old female who presented with a brown colored nodular lesion on her left upper back for the last one year, and histopathological examination was consistent with aneurysmal dermatofibroma.

Photodynamic therapy for nodular basal cell carcinoma up to 5mm located on high-risk area: effectiveness and long-term follow-up results

SignificanceResponse rates evaluation of photodynamic therapy (PDT) for nodular basal cell carcinoma (BCC) treatment located on high-risk and low-risk areas of the face. ApproachTwo groups of nodular BCC were selected, debulked, and received 20% methyl aminolevulinate cream. After 3h, the first irradiation was performed (20min, 150J/cm2). Then, the cream was re-applied, and a second irradiation was performed after 1.5h (20min, 150J/cm2). Clearance at 30 days and recurrence-free survival rate were evaluated. ResultsThe clearance at 30 days after PDT was 89% for the low-risk area group and 87% for the high-risk group. The recurrence-free survival at 60 months was 82% and 85% for the high-risk and low-risk groups, respectively. ConclusionsNo significant differences were observed between groups, nor for clearance at 30 days, nor recurrence-free follow-up. These results make the PDT an option for nodular BCC less than 5 mm located in high-risk areas.

Long-term follow-up results of a pilot study for nodular basal cell carcinoma with PDT using partial home treatment protocol

SignificanceEvaluate a photodynamic therapy (PDT) protocol with less time at the hospital and less painful for low-risk basal cell carcinoma (BCC) treatment. ApproachEight BCCs were selected, debulked, and received 20% methyl aminolevulinate cream. After 3h, the first irradiation was performed at the hospital (20min, 150J/cm2). Then, the cream was re-applied, a portable irradiation prototype was fixed into the lesion. After 1.5h, the patients turned on the prototype for irradiation (2h, 312J/cm2) at home. Disease-free survival rate and pain score during irradiations were evaluated. ResultsThe clearance at 30 days after PDT was 87.5% by histological analysis. The mean follow-up was 21.5 months and the recurrence-free survival at 22 months was 75%. The pain score was significantly lower at home. ConclusionsA less painful and more comfortable PDT treatment protocol was proved long-term efficient. A randomized clinical trial has been conducted to confirm these results.

A spear flap surgical revision

A 55-year-old male presented with a recurrent infiltrative basal cell carcinoma of the right nasal ala. Previous incomplete excision was repaired with second intention healing resulting in a contracted ala with columellar deviation and nostril asymmetry. [...]

Laser-assisted topical delivery of vismodegib reduces hedgehog gene expression in human basal cell carcinomas in vivo.

Systemically delivered hedgehog inhibitors including vismodegib and sonidegib are widely used to treat basal cell carcinomas (BCCs). Ablative fractional laser (AFL)-assisted topical delivery of vismodegib has been demonstrated in preclinical studies. The aim of this explorative clinical study was to evaluate intratumoral vismodegib concentrations and effect on hedgehog pathway gene expression following AFL-assisted topical vismodegib delivery to BCCs. In an open-label clinical trial, 16 nodular BCCs (in n = 9 patients) received one application of CO2 -AFL (40 mJ/microbeam, 10% density) followed by topical vismodegib emulsion. After 3-4 days, vismodegib concentrations in tumor biopsies (n = 15) and plasma were analyzed and compared with samples from patients receiving oral treatment (n = 3). GLI1, GLI2, PTCH1, and PTCH2 expression was determined by quantitative polymerase chain reaction (n = 7) and GLI1 additionally by in situ hybridization (n = 3). Following AFL-assisted topical administration, vismodegib was detected in 14/15 BCCs and reached a median concentration of 6.2 µmol/L, which compared to concentrations in BCC tissue from patients receiving oral vismodegib (9.5 µmol/L, n = 3, p = 0.8588). Topical vismodegib reduced intratumoral GLI1 expression by 51%, GLI2 by 55%, PTCH1 and PTCH2 each by 73% (p ≤ 0.0304) regardless of vismodegib concentrations (p ≥ 0.3164). In situ hybridization demonstrated that GLI1 expression was restricted to tumor tissue and downregulated in response to vismodegib exposure. A single AFL-assisted topical application of vismodegib resulted in clinically relevant intratumoral drug concentrations and significant reductions in hedgehog pathway gene expressions.

Recurrence rates of periocular basal cell carcinoma following intra-operative en-face frozen section margin controlled excision.

To report the margin control process and rate of recurrence of periocular basal cell carcinomas (BCCs) managed by en-face, frozen section margin controlled (FSC), excision by a single surgeon with a 3-year follow-up. A retrospective analysis of all histopathologically proven cases of periocular BCC who underwent surgical excision with intra-operative, en-face, FSC, excision by a single surgeon from 2015 to 2019 was performed. Patients with less than 3-year follow-up were offered a virtual appointment to determine possible recurrence. A total of 88 BCC excisions from 86 patients were reviewed. Minimum 3-year follow-up data is available for 73 patients. The most common location and histological subtype was the lower eyelid and nodular BCC, respectively (47% and 83% of cases). Primary BCC (pBCC) comprised 98% (86/88) of cases and recurrent BCC (rBCC) comprised 2% (2/88) of cases. Negative frozen section margins were achieved in 93% (82/88) of excisions on the day of surgery. The overall recurrence rate during this time was 1.4% (1/73) at minimum 3years. Periocular BCC can be managed effectively by en-face, FSC, excision, with a high cure rate and low recurrence rate comparable to alternative excision techniques such as Moh's micrographic surgery. Advantages of en-face excision include same-day excision and reconstruction and reduced theatre time. Primary nodular BCCs with clear margins can be considered for early discharge with advice to self-monitor.

Advances in Diagnosis and Treatment of Basal Cell Carcinoma.

Basal cell carcinoma (BCC) is one among the most prevalent malignant neoplasms that has exhibited a notable surge in global incidence over recent decades. This slow-growing malignancy is typified by its localized invasiveness while demonstrating an exceedingly rare metastatic proclivity. It predominantly afflicts the sun-exposed skin of aging individuals, with a heightened predilection for the maxillofacial region. Scraping cytology offers numerous benefits, including the potential for an earlier diagnosis and the absence of scarring, as opposed to a biopsy. The cytodiagnosis of BCC proves to be straightforward with various techniques, making it highly advantageous in an outpatient environment as a swift diagnostic method when planning a surgical excision. Our study sought to scrutinize the clinicopathological facets of BCC within the maxillofacial region. We compared advanced cytological techniques for diagnosis, including scraping, scratching, and imprinting using Papanicolau and Diff-Quick stains. In addition, we evaluated the therapeutic effectiveness of diode lasers operating at wavelengths of 940nm and 980n. A retrospective analysis was undertaken, encompassing facial BCC lesions smaller than 2.5cm in diameter that underwent treatment through diode laser ablation between September 2021 and August 2023 at Ramadi Teaching Hospital and a private clinic in Ramadi City, Iraq. Among the cohort of 48 patients with BCC, a majority (58%) were 50 years of age or older, with a predominance of males (62%). The mean duration of lesion existence exceeded 4 months. The anatomical region most commonly involved was the middle 1/3 of the face, accounting for 34% of cases. Intriguingly, the therapeutic approach of diode laser ablation yielded exceptional esthetic and functional outcomes, which were consistently observed throughout the follow-up period post-healing. The occurrence of complications following diode laser ablation was relatively infrequent. This investigation revealed that cytological examination is easily conducted, eliminating the need for local anesthesia, saving time, being more cost-effective than a conventional biopsy, and delivering swift diagnoses. The process of smear-taking for cytology is well-tolerated, inflicting minimal trauma or discomfort on the patient. BCC predominantly afflicts elderly males and most frequently affects the middle third of the face. Notably, nodular BCC emerged as the prevailing histological subtype. The use of diode laser ablation exhibited a commendable track record, producing exemplary functional and esthetic outcomes over a 6-month follow-up period.

Initial clinical manifestations and early diagnosis of basal cell skin carcinoma

Background/Aim: Basal cell carcinoma (BCC) is the most common cancer of the skin. It is believed that increased UV radiation from the sun accounts for almost 90 % of the risk of BCC. There is a growing trend in the incidence of BCC in a younger population. The aim of study was to analyse the initial clinical symptoms of BCC that may be important for the early detection of this skin tumour. Method: The study was a prospective, multicentre study performed in the period from March 2017 to February 2022. A total of 69 respondents with BCC were analysed. Respondents applied for a targeted examination to examine a suspicious skin lesion (due to certain symptoms) or were diagnosed with BCC by accident, when examining other skin changes. Respondents were divided into 2 groups. The first, Group I (35 respondents), consisted of respondents with nodular BCC. The second, Group II (34 respondents), consisted of respondents with superficial spreading BCC. Initially, a careful history and data on the characteristics, shape and character of the tumour were taken from all respondents. Data on all (even the smallest) initial symptoms and relevant signs of evolution, as well as subjective problems related to the tumour were noted. All respondents underwent dermoscopy of suspected skin changes. Results: A significant difference was found between the examined groups in the characteristics of bleeding, crust formation and tendency to injury in lesions, where they occur more often in patients with nodular BCC. Symptoms such as burning and flaking occurred significantly more often in patients with superficial spreading BCC (p &lt; 0.01), as well as the diameter of lesions over 5 mm (p &lt; 0.05). Conclusion: Early clinical diagnosis of BCC is possible with a tumour diameter of only a few mm. The predominant initial (highly susceptible) symptoms of nodular BCC were initial bleeding and / or scab formation on the lesions, as well as propensity to injury. The superficial spreading form of BCC was often larger than 5 mm in diameter, with more frequent scaling of the lesion, as well as burning and stinging sensations in the tumour area. Itching was observed to be a very common previous occurrence in the BCC initial focus zone in subjects of both study groups. Dermsocopy is a highly reliable diagnostic method for early detection of BCC.

Line-field confocal optical coherence tomography of eyelid margin growths: A case series.

The clinical differential diagnosis of lesions arising on the eyelid margin may be challenging and an unneeded surgical approach may have serious functional and aesthetic consequences. Nonetheless, early recognition and treatment of malignant tumors of the eyelid margin is mandatory. Line-field confocal optical coherence tomography (LC-OCT) is a novel tool for the in vivo, real-time skin imaging. The aim of the study was to identify and analyze the LC-OCT features of a series of eyelid margin growths and to correlate these features with the histopathological findings. Patients with eyelid margin growths who were scheduled for lesion excision underwent LC-OCT examination. Inclusion criteria were a challenging clinical aspect of the lesions and a clinical history of recent onset (up to 12 months). In all cases, the histopathological examination of the excised lesions was performed for the final diagnosis. A total of 31 lesions located on the upper (13 cases) or lower (18 cases) eyelid margin from 28 consecutive patients (male=15, female=13; mean age: 64.7 years, range: 44-87 years) were evaluated and excised. The histopathologic diagnoses were nodular basal cell carcinoma (BCC) (nine cases), squamous cell carcinoma (SCC) (three cases), compound nevus (four cases), dermal nevus (two cases), seborrheic keratosis (four cases), pyogenic granuloma (one case), trichilemmal cyst (three cases), and hidrocystoma (five cases). LC-OCT allowed the in vivo recognition of the main microscopic features of the examined lesions. LC-OCT represents a promising tool for the evaluation of eyelid margin lesions. Advantages of non-invasive diagnosis particularly relevant in such a sensitive region include a more correct planning of the treatment and, in case of surgery, the most appropriate surgical approach and, importantly, a correct timing of intervention.

Incidence of malignant eyelid tumors: A 6-year period review (2015–2021)

Abstract Background: Basal cell carcinoma (BCC), the most common malignant tumor, accounts for 85%–95% of cases of eyelid malignant tumors. Demographic factors such as age, gender, tumor location, and subtype play a crucial role in epidemiological knowledge. We investigated eyelid BCC diagnosis and treatment at the Department of Ophthalmology in Centro Hospitalar de Setúbal (CHS). Methods: A retrospective study was conducted on patient cases with suspected eyelid epithelial tumors who underwent excisional biopsy surgery. The study included data from the CHS database between 2015 and 2021. Data collection and subsequent analysis were based on histopathological results. Results: In our study, were analyzed a total of 47 tumor cases, with 68.1% located on the lower eyelids and 31.9% on the upper eyelids. Among these cases, 25 (53.2%) were classified as benign, while 22 (46.8%) were identified as malignant eyelid tumors. BCCs accounted for 90.9% of all malignant cases, with an average age of 71.7 ± 16.6 years. The nodular subtype was the most prevalent, followed by infiltrative and superficial subtypes. Superficial BCC patients were older than infiltrative BCC patients (median age = 69.5 years vs. 61.5 years). BCC primarily affected the lower eyelids compared to the upper eyelid, and there was a slight female predominance (n = 11). All diagnosed BCCs correlated with sun-exposed regions. Conclusions: Timely intervention is crucial for reducing morbidity. These findings emphasize the need for improved registration and notification systems to enhance the prevention and treatment of eyelid BCCs. Furthermore, despite advancements in ultraviolet-blocking technologies, further development of sunscreen specifically formulated for ocular use remains necessary to reduce the incidence of eyelid tumors.

А very rare cutaneous epithelioid hemangioendothelioma in the right auricle on a male adult

Introduction. Epithelioid hemangioendothelioma is an extremely rare tumor of vascular origin, which mainly affects soft tissues and, in rare cases, also affects the skin. Case outline. A 71-year-old man came for an examination due to a tumor localized on the antihelix of the right ear. A radical excision of the tumor and reconstruction of the defect with a preauricular transposition tunnelized Banner flap was performed. Conclusion. Epithelial hemangioendothelioma of the skin is an extremely rare, vascular tumor. It is characterized by local aggression, the appearance of local recurrences and metastatic hematogenous and lymphogenic spread. Standard dermoscopic examination of this tumor is not important. The appearance of the tumor itself has no clinical specificity, and most often resembles nodular basal cell carcinoma. An early visit to the doctor and removing the change early are the key to success in treating this tumor. So far, no case has been reported that is localized on the antihelix of the ear. Radical surgical excision is the therapy of choice.

An Unusual Case of Mixed Superficial and Adenoid Basal Cell Carcinoma in a 57-year-old Filipino Female

Introduction: Basal cell carcinoma (BCC) is the most common cutaneous malignancy worldwide often occurring in sun-exposed areas. While the nodular variant accounts for the majority of cases, the adenoid type is extremely rare, comprising about 1.3% of all BCCs. Contrary to the typical presentation of BCC, adenoid BCC features a large sized lesion and a tendency to involve non-sun exposed areas such as the trunk. This case study presents a unique form of mixed superficial and adenoid BCC in a 57-year-old Filipino female. Case Report: A 57-year-old female presented with a 2-year history of a slowly enlarging bluish-black plaque with rolled borders on the left flank with noted bleeding, pain, and pruritus. Dermoscopy revealed arborizing vessels, leaf-like structures, blue gray globules, and white streaks, consistent with BCC. Histopathology showed a diagnosis of a superficial and adenoid type of BCC. Conclusion: Encounters with unusual forms of cutaneous carcinoma may arise in dermatologic practice. Dermoscopy serves as a powerful tool in identifying suspicious lesions and a pre-operative biopsy is done to correlate with the clinical diagnosis. Hence, the dermatologist will be able to decide the appropriate treatment option based on the clinical presentation and histopathologic type.