Nodular Basal Cell Carcinoma Research Articles

Dermoscopy of Linear Basal Cell Carcinomas, a Potential Mimicker of Linear Lesions: a Descriptive Case-series.

Among the various widely recognized basal cell carcinoma (BCC) clinical patterns, linear basal cell carcinoma (LBCC) is an uncommon morphologic variant of BCC. Describe the clinical and dermoscopic characteristics of LBCC. Retrospective study including LBCC cases from 5 dermatology centers in North and South America. Biopsy-proven primary BCCs, that presented with at least 3:1 length:width ratio on physical examination, irrespective of tumor subtype or location, were included. Clinical and dermoscopic analysis were performed by 2 experts in dermoscopy. Eighteen cases of LBCC met our inclusion criteria and were included in the study. Median age at diagnosis was 86.0 years, 10 patients (58.8%) were males. Regarding anatomic location, 11/18 (61.1%) were located on the head and neck, 5/18 (27.7%) cases were found on the trunk, and 2 on lower extremities (11.1%). Under dermoscopy, 15/18 (83.3%) of LBCC were pigmented. All tumors displayed at least one of the BCC-specific dermoscopic criteria the most common being blue-grey globules (72.2%). Dermoscopy might be useful in the differentiation of LBCC from other diagnoses presenting as linear lesions such as scars, scratches/erosions, and tattoos, among others. Some of these lesions might be confused by naked eye examination alone.

3D-Aided Manufacturing of Nose Prosthesis after Total Rhinectomy

A 75-year-old woman treated for T3N0M0 nodular basal cell carcinoma on the nose with erosion. Plastic surgeons reconstructed a total rhinectomy defect with a free flap. Pre surgery CT scans was used in collaboration with in-house 3D engineers to regenerate a mirrored image for the anaplastologists to create the prosthesis.

Lobulated red nodule on right lower back.

A 60-year-old man with a history of basal cell carcinoma (BCC) on his forehead excised 10 years ago presented to the dermatology clinic with an enlarging red bump on his back for the past few months. He had no other personal or family history of malignancy and no known radiation exposure (Fig. 1). Physical examination revealed a 2 cm lobulated red nodule with multiple serpiginous vessels coursing through it located on the right lower back. There was no regional lymphadenopathy clinically. Histopathology showed lobules of basaloid tumor cells displaying vesicular, overlapping nuclei, and prominent nucleoli. Admixed aggregates of mature sebocytes, scattered foci of necrosis, and easily identifiable mitotic figures were seen (Fig. 2). Sebaceous carcinoma. This is sebaceous carcinoma, with an estimated incidence of 1–2 cases per 1,000,000 person-years.1, 2 Most cases of sebaceous carcinoma are ocular, and extraocular sites are usually in the head and neck area as a yellowish or red nodule with ulceration.1, 3 Histopathology shows sheets of basaloid and sebaceous cells sheets or asymmetric sebaceous lobules and other signs of malignancy like necrosis, pleomorphism, hyperchromatism, and numerous mitotic figures.1 Mohs surgery is considered first-line for removal of nodules suspicious for sebaceous carcinoma, as is wide-local excision with frozen sections.1 Further studies should include margin assessment of both peripheral and deep tissue edges, with regional lymph node biopsy if there is clinical suspicion of lymphatic involvement.1 As this patient had no clinical lymphadenopathy, no lymph node biopsy was indicated. However, the further pathological analysis showed negative nuclear staining for MSH2 and MSH6, concerning for Muir–Torre syndrome. Muir–Torre syndrome is an autosomal dominant phenotypic variant of Lynch syndrome, and typical findings include a constellation of sebaceous cutaneous neoplasms and visceral malignancies, most commonly colon cancer.4 Immunohistochemistry can be conducted on sebaceous neoplasms to identify mismatch repair gene mutations, and a thorough review of family and personal history of neoplasms as well as personal history of radiation exposure and immunosuppression is indicated. With this patient's multiple sebaceous nodules and DNA mismatch mutation on histology, extensive malignancy workup was started. To date, computed tomography (CT) revealed a multicystic pancreatic tail lesion and multiple metastatic lesions to the liver, with plans to conduct further colonoscopy and upper gastrointestinal (GI) imaging. This case is an excellent example of how dermatologic evaluation can help identify unsuspected internal disease. Sebaceous hyperplasia is incorrect. This is common in older adults and can often be confused with nodular BCC.3 Clinically, these appear as smooth yellow soft umbilicated papules and may elicit sebum with lateral compression, and histopathology would show enlarged sebaceous glands with normal morphology. Typical MCC includes a cutaneous or subcutaneous pink to violet dome-shaped rapidly growing papule or nodule with intact overlying skin in an immunosuppressed patient.3 Histopathology reveals aggregated, deeply blue staining small basaloid or lymphoma-like cells in sheets with CK20 positivity. SCC is incorrect, as these lesions are often plaques or nodules and can be differentiated (hard, keratinized) or undifferentiated (soft, no keratinization).3 These are tumors of pleomorphic keratinocytes that extend into the dermis, and histopathology yields keratinocyte anaplasia, multiple mitoses, and varying degrees of keratinization. FeP is considered a rare variant of BCC characterized by a skin-colored, firm, sessile, fleshy papule, or plaque which often develops in patients with a history of BCC.5 Histopathology is definitive with thin anastomosing basaloid or squamous strands of keratinocytes in a fibrous stroma projecting down from the epidermis, resembling a honeycomb.

Advances in Topical Treatments of Cutaneous Malignancies.

Surgical excision has been the preferred treatment for cutaneous malignancies, but can be affected by various considerations. Noninvasive, self-administered topical treatments represent an alternative option. The aim of this review was to evaluate and summarize evidence-based recommendations for topical treatments of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (CSCC), in situ melanoma (MIS), and extramammary Paget's disease (EMPD). Studies were reviewed on PubMed. Included studies were summarized, assessed for biases, and assigned alevel of evidence to develop treatment recommendations. For the treatment of superficial BCC, complete clearance rates ranged from 90 to 93% for 5% 5-fluorouracil (5-FU) and 71 to 76% for imiquimod (IMQ). For the treatment of nodular BCC, clearance rates for photodynamic therapy (PDT) were 91% at 3 months, with a sustained lesion clearance response rate of 76% after 5 years of follow-up. Clearance rates were 53to76% with IMQ. For squamous cell carcinoma in situ, clearance rates ranged from 52 to 98% for PDT, 67 to 92% for 5-FU, and 75 to 93% for IMQ. For MIS, clearance rates ranged from 53 to 92% for IMQ. For EMPD, 54% of 110 patients in cohort studies and case series had a clinical complete response with IMQ. While surgical intervention remains the standard of care for skin cancer, non-invasive, self-administered topical treatments are highly desirable alternative options. Ultimately, the patient and provider should find a treatment modality that aligns with the patient's expectations and maintenance of quality of life.

"Fingerprinting" Benign and Cancerous Skin Lesions Using Vibrational Optical Coherence Tomography: Differentiation among Cancerous Lesion Types Based on the Presence of New Cells, Blood Vessels, and Fibrosis.

In this study, we use vibrational optical coherence tomography (VOCT) to examine the morphology and stiffness of benign and cancerous lesions. Lesion images and 3D plots of weighted displacement versus frequency and depth were used to compare the cellular, dermal collagen, new blood vessels, and fibrotic composition of normal skin, actinic keratoses (AK), nodular and superficial basal cell carcinomas (BCCs), squamous cell carcinomas (SCCs), and melanomas. The results of this study suggest that benign and cancerous lesions differ based on the addition of new cells with increased resonant frequency and stiffness (80 Hz, 1.8 MPa), new blood vessel peaks (130 Hz, 4.10 MPa) that appear to be less stiff than normal blood vessels, and new fibrous tissue peaks (260 Hz, 15–17 MPa) that are present in carcinomas but not in normal skin and only partially present (80 Hz and 130 Hz only) in AKs. Results obtained by creating images based on the location of the 80 Hz, 130 Hz, and 260 Hz peaks of cancerous skin lesions suggest that the fibrous tissue appears to surround the new cells and new lesion blood vessels. The results of this study suggest that the morphology and location of the fibrous tissues in relation to the new cancer-associated cells and lesion blood vessels may provide information on the invasiveness and metastatic potential of skin cancers. The invasiveness and metastatic potential of melanomas may be a result of the cancer-associated cells laying down fibrous tissue that is used as a pathway for migration. The new cancer-associated blood vessels in the vicinity of the new cancer-associated cells may promote this migration and eventual metastasis. The ratios of peak heights 50/130 Hz and 80/130 Hz of normal cells, new lesion cells, new lesion blood vessels, and fibrotic tissue may be used as a “fingerprint” for detecting melanoma and to differentiate it from other skin cancers non-invasively using VOCT.

Gold nanorods-loaded hydrogel-forming needles for local hyperthermia applications: Proof of concept

Basal cell carcinoma (BCC) is the most common form of skin cancer and responsible for most of the cancer related morbidities and pose a significant public health concern worldwide. Surgery treatment modality is able to clear the BCC, yet it mostly leads to scar formation. Plasmonic photothermal therapy (PPTT) which involves using gold nanostructures and near-infrared (NIR) light to kill the BCC cells by local heating is associated with excellent tissue preservation and healing without scarring. Parenteral administration of such gold nanostructures suffers from off-target delivery and side effects. Delivering such phototherapeutics directly to the BCC proved to be an attractive alternative route of administration yet encountered with penetration limitations due to the stratum corneum (SC) fierce barrier. In the current study, we developed and optimised a novel NIR light-responsive hydrogel-forming long needle (HFLN) loaded with Gold nanorods (GNRs) as a potential plasmonic photothermal device for localised treatment of nodular BCC. The HFLN was prepared from Gantrez® S-97 and poly(ethylene glycol) (PEG) 200 Da and characterized in terms of swelling, insertion and mechanical properties. GNRs were synthesised and tunned using seed-mediated growth method. The integrated devices developed could revolutionise BCC treatment benefiting both patients and healthcare providers.

Combining Reflectance Confocal Microscopy with Optical Coherence Tomography for Noninvasive Diagnosis of Skin Cancers via Image Acquisition.

Skin cancer is one of the most common cancers worldwide. Diagnosis relies on visual inspection and dermoscopy followed by biopsy for histopathological confirmation. While the sensitivity of dermoscopy is high, the lower specificity results in 70%-80% of the biopsies being diagnosed as benign lesions on histopathology (false positives on dermoscopy). Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) imaging can noninvasively guide the diagnosis of skin cancers. RCM visualizes cellular morphology in en-face layers. It has doubled the diagnostic specificity for melanoma and pigmented keratinocytic skin cancers over dermoscopy, halving the number of biopsies of benign lesions. RCM acquired billing codes in the USA and is now being integrated into clinics. However, limitations such as the shallow depth (~200 µm) of imaging, poor contrast for nonpigmented skin lesions, and imaging in en-face layers result in relatively lower specificity for the detection of nonpigmented basal cell carcinoma (BCCs) - superficial BCCs contiguous with the basal cell layer and deeper infiltrative BCCs. In contrast, OCT lacks cellular resolution but images tissue in vertical planes down to a depth of ~1 mm, which allows the detection of both superficial and deeper subtypes of BCCs. Thus, both techniques are essentially complementary. A "multi-modal," combined RCM-OCT device simultaneously images skin lesions in both en-face and vertical modes. It is useful for the diagnosis and management of BCCs (nonsurgical treatment for superficial BCCs vs. surgical treatment for deeper lesions). A marked improvement in specificity is obtained for detecting small, nonpigmented BCCs over RCM alone. RCM and RCM-OCT devices are bringing a major paradigm shift in the diagnosis and management of skin cancers; however, their use is currently limited to academic tertiary care centers and some private clinics. This paper familiarizes clinicians with these devices and their applications, addressing translational barriers into routine clinical workflow.

Serum Vitamin D Levels Explored in the Latvian Cohort of Patients with Basal Cell Carcinoma Linked to the Sonic Hedgehog and Vitamin D Binding Protein Cutaneous Tissue Indices.

Ultraviolet radiation is known as one of the major contributors to skin malignancies, including basal cell carcinoma (BCC), which is the most common type of skin cancer. It is a heterogeneous tumor, which presents with various types that are stratified into low- and high-risk tumors. Sunlight is important for overall health and vitamin D synthesis in the skin, whereas deviations from the optimal level of vitamin D are shown to be associated with the risk of the development of BCC. The accumulating evidence suggests the ability of vitamin D to antagonize the Sonic Hedgehog (SHH) signaling, the key tumor pathway, and play a protective role in the development of BCC. Additionally, a vitamin D binding protein (DBP) is shown to be implicated in the complex regulation of vitamin D. Here, we aimed to explore serum vitamin D in patients with different primary and recurrent BCC of the head and neck and investigate cutaneous DBP and SHH indices, confirmed immunohistochemically in these subjects. According to the results, 94.9% of the Latvian cohort of BCC patients were found to be deficient in vitamin D. No significant differences in serum vitamin D levels were found between genders, primary and recurrent tumors, and different types of BCC. Serum vitamin D was inversely associated with tumor size. Susceptible male individuals with low blood vitamin D levels were recognized at risk of developing aggressive and recurrent BCC confirmed by the use of hierarchical clustering analysis. In smaller tumors with a favorable course, such as superficial and nodular BCC, the association between high DBP and low SHH tissue expression was found, providing supportive evidence of the existence of a link between vitamin D, proteins involved in its metabolism, as exemplified by the DBP and SHH signaling pathway. The assumption of a deficiency in the protective effect of vitamin D in patients with high-risk BCCs was proposed in low DBP and high SHH tissue indices. New extensions to existing knowledge and characterization of the BCC signaling pathways and their cross-talk with vitamin D are warranted when searching for a preferential effect of vitamin D on skin cancer.

PRAME Expression in Cancer. A Systematic Immunohistochemical Study of >5800 Epithelial and Nonepithelial Tumors.

Preferentially expressed antigen in melanoma (PRAME) is considered a useful marker in the differential diagnosis between malignant melanoma and its melanocytic mimics. Recently PRAME expression was documented in nonmelanocytic tumors, but much of the data are based on mRNA studies. This investigation evaluated PRAME expression in the spectrum of normal tissues and >5800 human tumors using immunohistochemistry and EP461 monoclonal antibody. In normal tissues, PRAME was expressed in the testis and proliferative endometrium. In tumors, PRAME was variably expressed in malignancies of different lineages. Among epithelial tumors, >50% of PRAME-positive lesions were found among endometrial carcinomas (82%), uterine serous carcinomas (82%), uterine carcinosarcomas (60%), ovarian clear cell carcinomas (90%), ovarian serous carcinomas (63%), adenoid cystic carcinomas (81%), seminomas (78%), thymic carcinomas (75%), and basal cell carcinomas (62%). In mesenchymal and neuroectodermal malignancies, PRAME was frequently expressed in synovial sarcoma (71%), myxoid liposarcoma (76%), neuroblastoma (61%) and metastatic melanoma (87%). Also, PRAME was consistently expressed in 4 melanomas that lacked all melanoma markers including S100 protein and SOX10 but harbored typical for melanoma BRAF or NRAS driver mutations. However, strong and diffuse PRAME immunoreactivity was seen in many types of nonmelanocytic poorly differentiated carcinomas and sarcomas. Based on this study, PRAME is a relatively unspecific immunohistochemical marker, which limits its use in diagnostic surgical pathology. However, immunohistochemistry is a reliable and unexpensive method useful in detecting PRAME-positive malignancies for potential immunotherapy.

An international survey characterizing Mohs tissue processing techniques and Mohs margin thresholds: how close is too close?

From practice, we identified heterogeneity in Mohs micrographic surgery (MMS) specimen tissue processing techniques and specifications, and in the Mohs surgeons' assessment of MMS specimen histological tumour clearance. By surveying an international cohort of Mohs surgeons, we determined to characterize variation in margin threshold assessment (number of wafers/sections free of tumour to declare tumour clearance). An online questionnaire was distributed to Mohs surgeons in the UK, European countries, Australia and New Zealand, assessing the background demographics of the surgeons and the technical factors involved in MMS tissue processing and posing three MMS scenarios to define margin thresholds. In total, 114 consultant/attending-level Mohs surgeons responded, giving a response rate of 33.5% from 20 countries (including UK nations). The first scenario posed was a 20-mm cheek basal cell carcinoma (BCC) excised by MMS with a fully complete first wafer (7 μm) clear of tumour and the second wafer (after trimming interval of 50 μm) demonstrating a small dermal focus of nodular BCC; of the 58 surgeons, 16 (27.6%) would not take another stage. With a follow-up question, 16 of the 58 (27.6%) surgeons specified wanting three clear sections to declare tumour clearance. When the same scenario had a change to a 20-mm infiltrative BCC, 84.2% (48 of 57 surgeons) required a second MMS stage, with a follow-up question clarifying that a third (19 of 57) wanted three clear sections to determine clearance. For a well-differentiated 15-mm squamous cell carcinoma with the same factors there was no majority consensus, with the same proportion of surgeons (22.6%; 12 of 53) calling tumour clearance after one, two and three clear section(s) respectively. For MMS specimen processing specifications, routine sections/wafers of 5-10 μm were reported by 77.4% of respondents (48 of 62) and for trimming interval values, 78.6% (48 of 61) specified a range between 20 and 200 μm. By surveying international Mohs surgeons, we highlight surgeon background characteristics, peer-compare assessment of margin thresholds for tumour clearance across three scenarios, and delineate tissue processing and intraoperative approaches.

Orbitomalar Erosive Basal Cell Carcinoma.

A 75-year-old Caucasian, immune-competent, and otherwise healthy male presented to the emergency department after a syncopal episode. He had a secondary complaint of left facial disfigurement and OS vision loss over the past few years. He reported this began as small “red nasal growth” 5 years ago. The lesion progressively grew and then became erosive; despite significant facial destruction, he did not seek medical care because of personal reasons. On exam, best corrected visual acuity was 20/40 in the OD and light perception in the OS. The right pupil and extraocular movements were within normal limits. He had left cicatricial hypotropia with diffusely restricted extraocular motility. Exam demonstrated erosion and absence of left midfacial soft tissues and bone including the orbital floor and anterior nasomaxillary area. The cornea was opaque with a chronic ulcer with temporal scleral thinning and uveal exposure (Fig. 1 and 2). Written consent was obtained for photography.FIG. 1.: External photograph demonstrating erosive changes of the orbit, maxillary sinus, nose, and face secondary to basal cell carcinoma.FIG. 2.: External photograph demonstrating corneal opacification, temporal scleral thinning and uveal exposure of the globe secondary to erosive basal cell carcinoma of the face.His syncopal episode was determined to be due to bacterial sepsis secondary to the facial infection. Pseudomonas aeruginosa and methicillin sensitive Staphylococcus aureus were isolated on facial wound culture. Treatment with broad spectrum antibiotics was initiated. Biopsies revealed ulcerated basal cell carcinoma (nodular type). CT imaging revealed no metastatic disease. Medical oncologic management was recommended for this nonresectable, advanced, facial-erosive disease. Eye removal surgery is contemplated for infectious disease control, but he currently has no significant pain. This case demonstrates the devastating oculofacial effects of neglected basal cell carcinoma.

Nodular and Micronodular Basal Cell Carcinoma Subtypes Are Different Tumors Based on Their Morphological Architecture and Their Interaction with the Surrounding Stroma.

Basal cell carcinoma (BCC) is the most frequent cancer of the skin and comprises low-risk and high-risk subtypes. We selected a low-risk subtype, namely, nodular (N), and a high-risk subtype, namely, micronodular (MN), with the aim to identify differences between them using a classical morphometric approach through a gray-level co-occurrence matrix and histogram analysis, as well as an approach based on deep learning semantic segmentation. From whole-slide images, pathologists selected 216 N and 201 MN BCC images. The two groups were then manually segmented and compared based on four morphological areas: center of the BCC islands (tumor, T), peripheral palisading of the BCC islands (touching tumor, TT), peritumoral cleft (PC) and surrounding stroma (S). We found that the TT pattern varied the least, while the PC pattern varied the most between the two subtypes. The combination of two distinct analysis approaches yielded fresh insights into the characterization of BCC, and thus, we were able to describe two different morphological patterns for the T component of the two subtypes.

Dermoscopy of trichoblastic carcinoma

Trichoblastic carcinoma is a rare malignant adnexal tumor deriving from the hair follicle. It is clinically highly similar to basal cell carcinoma (BCC), with a greater malignant potential and a higher metastatic risk [1,2]. Histopathology reveals lobules of small, basaloid cells, cytonuclear pleiomorphism, and numerous mitoses with follicular differentiation [1]. It is important to differentiate these two entities as they follow different clinical courses and, therefore, require different treatments [2]. To our knowledge, dermoscopy of this tumor has only been described once, showing scattered specks of brown pigment in a trichoblastic carcinoma of the scalp [3]. Herein, we present a dermoscopic description of a recurrent trichoblastic carcinoma. A 93-year-old patient, who underwent an excision of a lesion of the left nasolabial fold two years previously with no record of histopathology, presented to our dermatology department with a lesion on the same site of excision evolving for the lasts six months. A clinical examination revealed a well-limited ulceration surrounded by a bluish, peripheric halo with an infiltrated base. Pigmented papules and telangiectasias were also observed along the scar of the nasolabial fold (Fig. 1). Dermoscopy showed blue, ovoid nests, brown and blue globules, telangiectasias, and a central ulceration (Fig. 2). A biopsy revealed a dermal tumor proliferation made from lobules and trabeculae of basaloid cells with nuclear atypia and numerous mitoses, which was more in favor of a trichoblastic carcinoma than a BCC. A radiological assessment revealed no regional or distant metastasis. The patient was referred to the plastic surgery department for further management.

Periocular basal cell carcinoma results and surgical outcome during a 5-year period in a larger Danish population

BackgroundTo report tumour pathology, surgical procedure, complication rates and overall outcome of periocular basal cell carcinoma (BCC) in the Department of Ophthalmology at Sygehus Lillebaelt, Southern Denmark Region over a 5-year period.MethodsMedical records for all patients who underwent surgery for periocular BCC between January 2016 and December 2020 were reviewed. All tumours were excised with a 3 mm margin beyond the clinically apparent delimitation of the tumour and analysed by frozen section histological examination. Paraffin sections were subsequently examined for a final histopathological diagnosis. Patient age, gender, date of resection, former cancer history, referring unit and follow-up time were recorded. Furthermore, histological subtypes identified from biopsy and resection, lesion location, lesion diameter, free margin after the first operation, lacrimal punctum involvement, reconstructive techniques and complications were also recorded.ResultsA total of 242 surgical excisions from 237 patients were recorded. The mean age was 69.7 ± 12.6 with women significantly predominant compared to men (1.8:1, p < 0.0001, binomial test). The mean tumour diameter was 4.29 mm (range 0.5–20 mm). The most common location and histological subtype was the lower eyelid and nodular BCC respectively (64.9% and 74.0% of cases). In 17.4% of the patients, the initial resection margin on the frozen section histology was not free of tumour cells and the risk was significantly greater for BCC subtypes considered aggressive in terms of growth pattern (morphea form, infiltrative and micronodular features) as compared to non-aggressive BCC subtypes (nodular and superficial) (p = 0.002, X2). In 239 (98.8%) of the patients, the BCC was found to be radically removed after final histopathological examination.The sensitivity of identification of aggressive subtypes of periocular BCC in biopsies was 47.7%. No recurrences were found during the 5-year period.ConclusionThis study demonstrated a tendency towards more women than men being diagnosed with periocular BCC. The initial biopsy performed for all patients underestimated the aggressiveness of BCC in almost half of the cases while aggressive BCC subtypes were more likely to need further resection after frozen section compared to non-aggressive subtypes.

Characteristics of Malignant Eyelid Basal Cell Carcinoma in Dr. Mohammad Hoesin General Hospital: A Retrospective Study

Introduction: Incidence rates of skin cancer have risen significantly over the last two decades. Most tumors develop in sun-exposed areas of the head and neck. Basal cell carcinoma (BCC) rarely metastasizes but can cause significant morbidity and death due to direct spread to the orbit, head, and neck and frequent recurrence. In addition, approximately 40% of BCC patients have other lesions after 5 years. Although there has been a lot of epidemiological data regarding the characteristics of BCC in developed countries, reports of BCC in Asia, especially in Southern Sumatra, are still at a minimum rate.&#x0D; Methods: This study retrospectively reviewed the medical records specific to periocular BCC. Data were collected from the patient register book recorded from January 2021 to May 2022. The clinical characteristics of patients with BCC, such as gender and age, clinicopathological findings of BCC lesions, and BCC management, were reviewed retrospectively. This study aims to determine the epidemiological profile of the malignant eyelid BCC patient, the BCC lesion characteristics, and the management of BCC cases at Mohammad Hoesin General Hospital Palembang.&#x0D; Results: From 16 BCC patients recruited for this study, most of them were 51–60 years old and 71–80 years old, each with 5 patients (31.3%). The female preponderance of 56.3%. Occulus dextra (56.3%), lower eyelid (62.5%), T1 (87.5%), nodular BCC (75,0%), and primary lesion (75,0%) were the most side, periocular site, size, histopathological subtype and recurrence, respectively. Most therapy done is excision (93,8%), while the leading reconstructive technique was Tenzel’s flap (50,0%).&#x0D; Conclusion: There is a slight preponderance of females as BCC patients. BCC is commonly found in elderly people. The lower eyelid and right side are the most frequent anatomical locations. Nodular is the most common histological subtype. In addition, lesions often present in T1 size and primary lesions. Lastly, the treatment is mainly surgical (excision), with Tenzel's flap as the most used reconstruction technique option.

A Profile and Three-Year Follow-Up of Patients with Basal Cell Carcinoma in the Western Cape, South Africa.

Background Basal cell carcinoma (BCC) is an important malignancy in sub-Saharan Africa. There is a paucity of data regarding BCC in South Africa. Aims To describe the clinicopathological features of patients presenting with BCC in a cohort of South African patients. Methods This retrospective descriptive study reviewed the medical records of 149 patients with BCC who attended the dermatology clinic at Tygerberg Academic Hospital from September 2015 to August 2016. Demographic and clinical data of those patients with histologically proven BCC were retrieved from clinical records. The data included the assessment for BCC recurrence after three years (September 2016–August 2019). Results Of 390 patients, 155 (39.7%) had histologically confirmed BCCs. Complete medical records were available for 149 of these patients, and most were male (55.7%) and white (85.9%) with a median age of 70 years. Most patients had their BCC lesions for 12 months (43.1%) before diagnosis. BCCs were mostly located on the head and neck area (58.1%). In most patients (72.0%), a diagnostic punch biopsy confirmed BCC. Plastic surgeons subsequently excised the BCC lesions in 74.0% of these patients. The most common histological subtype was nodular BCC (74.0%). The National Comprehensive Cancer Network (NCCN) risk of recurrence was approximately evenly distributed between high- (54.1%) and low-risk groups (45.9%). The major high-risk feature was the location (36.6%). Histologically confirmed BCC recurrence occurred in 9 of the 149 patients (3.7%) over three years. Conclusions BCC represents a high burden of disease in our setting. Compared to existing studies, the BCCs in this study are clinically and histologically similar to international reports.

A Diagnostic Challenge: Desmoplastic Melanoma

Desmoplastic melanoma (DM) is uncommon and can be a diagnostic challenge both clinically and histologically. We report a unique presentation of DM presenting as an amelanotic, depressed, indurated plaque on the forehead. The lesion was clinically concerning for a morpheaform basal cell carcinoma and with an unrevealing initial punch biopsy, an excisional biopsy with IHC was necessary to determine a diagnosis of pure desmoplastic melanoma. When a patient presents with a depressed, indurated plaque of unknown etiology, including DM in the clinical differential diagnosis and communicating this to the dermatopathologist can potentially reduce the risk for a delay in diagnosis.

2021 international consensus statement on optical coherence tomography for basal cell carcinoma: image characteristics, terminology and educational needs.

Despite the widespread use of optical coherence tomography (OCT) for imaging of keratinocyte carcinoma, we lack an expert consensus on the characteristic OCT features of basal cell carcinoma (BCC), aninternationally vetted set of OCT terms to describe various BCC subtypes, and an educational needs assessment. To identify relevant BCC features in OCT images, propose terminology based on inputs from an expert panel and identify content for a BCC-specific curriculum for OCT trainees. Over three rounds, we conducted a Delphi consensus study on BCC features and terminology between March and September 2020. In the first round, experts were asked to propose BCC subtypes discriminable by OCT, provide OCT image features for each proposed BCC subtypes and suggest content for a BCC-specific OCT training curriculum. If agreement on a BCC-OCT feature exceeded 67%, the feature was accepted and included in a final review. In the second round, experts had to re-evaluate features with less than 67% agreement and rank the ten most relevant BCC OCT image features for superficial BCC, nodular BCC and infiltrative and morpheaphorm BCC subtypes. In the final round, experts received the OCT-BCC consensus list for a final review, comments and confirmation. The Delphi included six key opinion leaders and 22 experts. Consensus was found on terminology for three OCT BCC image features: (i) hyporeflective areas, (ii) hyperreflective areas and (iii) ovoid structures. Further, the participants ranked the ten most relevant image features for nodular, superficial, infiltrative and morpheaform BCC. The target group and the key components for a curriculum for OCT imaging of BCC have been defined. We have established a set of OCT image features for BCC and preferred terminology. A comprehensive curriculum based on the expert suggestions will help implement OCT imaging of BCC in clinical and research settings.

Basal cell carcinoma-clinico-pathological study in Eastern India in correlation with different risk factors.

To study the histological variants and mimickers of basal cell carcinoma (BCC) alongwith different risk factors among a group of patients from eastern India. The specimen for the study was sent by the dermatology department for histopathology after skin biopsy. Out of 42 patients, 15 patients studied were males and the rest of the cases were females. The male to female ratio was 0.55:1. Maximum (15 cases) cases were in the age group of 50-59 years. Apart from sunlight, chronic arsenic exposure is an important risk factor of BCC. Basal cell hyperplasia and squamous cell carcinoma are the histological differential diagnosis of nodular BCC and basosquamous BCC. BCC is a disease of the older age group and with female preponderance in our study. Nodular basal cell carcinoma was the most common histologic type of basal cell carcinoma. The face was the most common site for BCC followed by the scalp. UV radiations and Arsenic do play role in the pathogenesis of BCC. CD10 helps differentiate superficial BCC from basal cell hyperplasia.

The use of dermoscopy in distinguishing the histopathological subtypes of basal cell carcinoma: A retrospective, morphological study.

Background The role of dermoscopy in distinguishing the histopathological subtypes of basal cell carcinoma (BCC) is not fully elucidated. Aims To determine the accuracy of dermoscopy in diagnosing different BCC subtypes. Methods The dermoscopic features of 102 histopathologically verified BCCs were studied retrospectively. The tumours were classified as superficial (n=33,32.3%), nodular (n=46,45.1%) and aggressive (n=23,22.6%) BCCs by histopathology. Statistical analysis included Cohen's kappa test, proportion of correlation, measures of diagnostic accuracy, diagnostic odds ratio and the credibility ratio of positive (LR+) and negative (LR-) tests. Results The highest value in all performed tests was seen in superficial BCCs (kappa 0.85; proportion of correlation 93%; diagnostic accuracy 93.1%), good correlation was noted in nodular BCCs (kappa 0.62, proportion of correlation 80%; diagnostic accuracy 80.4%) but dermoscopic correlation with histopathology was low for aggressive BCCs (kappa 0.13; proportion of correlation 79%; diagnostic accuracy 78.4%). Short, fine telangiectasias (83.3%) showed the greatest importance for the diagnosis of superficial BCCs, blue-grey ovoid nests (61.8%) had the highest diagnostic accuracy in nodular BCCs, while arborising vessels (79.4%) was the most significant dermoscopic feature for the diagnosis of aggressive BCCs. Limitations This was a retrospective analysis and included only Caucasian patients from a single centre. Conclusion The highest agreement of dermoscopic features with the histologic type was found in superficial BCCs. We did not find any specific dermoscopic structure that could indicate a diagnosis of aggressive BCC. The presence of relevant dermoscopic features in the evaluated cases was determined by the depth of tumour invasion and not by its histology.