Nodular Basal Cell Carcinoma Research Articles

Intradermal delivery of imiquimod using polymeric microneedles for basal cell carcinoma.

Despite being one of the most efficacious drugs used in the treatment of basal cell carcinoma (BCC), imiquimod has limited cutaneous permeation. The current work presents the development of polyvinylpyrrolidone-co-vinyl acetate (PVPVA) microneedles loaded with imiquimod for improving intradermal delivery of imiquimod for the treatment of nodular BCC. In vitro permeation studies, using full thickness ex vivo porcine skin were used to evaluate the effectiveness of these imiquimod loaded polymeric microneedles in comparison to the topical application of commercial Aldara™ cream. HPLC analysis demonstrated similar intradermal permeation of imiquimod from Aldara™ cream and imiquimod-loaded microneedles despite the microneedle having a six-fold lower drug loading than the clinical dose of Aldara™ used for BCC management. In addition, ToF-SIMS analysis of skin cross sections demonstrated intradermal localisation of imiquimod following microneedle-based delivery while the Aldara™ treated skin showed the drug localised predominantly within the stratum corneum. ToF-SIMS analysis also demonstrated intradermal co-localisation of the PVPVA polymer, used in fabricating the microneedle, with imiquimod within the microneedle channels in a label-free manner. This study demonstrates that a polymeric microneedle system may be a viable approach to improving the intradermal delivery of imiquimod for the treatment of nodular BCC with lower drug loading.

Effectiveness of a 595-nm Pulsed Dye Laser for the Treatment of Basal Cell Carcinoma Using One Double-Stacked Pulse Session: A Randomized, Double-Blinded Controlled Trial.

Surgical and nonsurgical methods are used for treating basal cell carcinoma (BCC). Few randomized controlled trials exist on the effectiveness of the pulsed dye laser (PDL) on BCC treatment. We investigated the effectiveness of PDL treatment in a single session for the management of nodular and superficial BCCs on the trunk and extremities of adults using a randomized, double-blind, controlled technique. We used settings of fluence 7.5 J/cm2, 3-ms pulse duration, no dynamic cooling, 10-mm spot size, 10% overlap between pulses, and 2 stacked pulses on a 595-nm wavelength laser. Histopathologic clearance on excision of tumor with 4-mm margins was the primary outcome measure. Twenty-four patients were included in the study, with 14 in the laser treatment group and 10 patients in the sham/control group. In total, 10/14 (71.4%) of the tumors in the treatment group were successfully treated with no residual tumor on excisional specimen histology, compared with 3/10 (30.0%) of the control group (p = .045). Our study shows that PDL may be an effective treatment for low-risk BCCs of the trunk and extremities, but the cure rate is lower than those of other treatments for BCC. Thus, PDL under the current settings cannot be recommended.

Comparison of the clinicopathological features between adenoid basal cell carcinoma and adenoid cystic carcinoma of the cervix

Objective: To compare the clinical and histopathological characteristics of cervical adenoid basal cell carcinoma and adenoid cystic carcinoma for improving the diagnosis accuracy and differential diagnosis of these tumors. Methods: A retrospective study was conducted on 9 cases of cervical adenoid basal cell carcinoma and 3 cases of adenoid cystic carcinoma which were diagnosed and consulted at the First Medical Center of PLA General Hospital from March 2009 to April 2019. Detailed clinical data were reviewed. All pathological sections and immunohistochemical results were reviewed and the clinicopathological characteristics were analyzed. Follow-up information by telephone was collected and relevant literature was consulted. Results: Both tumors were more commonly found in postmenopausal women (the age of onset ranged 43-74 years). Adenoid basal cell carcinoma was often clinical asymptomatic. Most of them presented as abnormal smears of the cervix during physical examination, and there was no definite mass in colposcopy.Adenoid cystic carcinoma was mostly presented with abnormal vaginal bleeding. A mass was seen in colposcopy.Histologically, the two tumors were characterized by nest-like growth of the tumors, consisting of basal-like tumor cells, and often surrounded by palisade structures. The two lesions might coexist, or be mixed with squamous cell carcinoma or high-grade squamous intraepithelial lesions. The difference was that adenoid basal cell carcinoma was mostly located at the junction of cervical squamous epithelium and columnar epithelium and beneath the overlying epithelium, the tumor cells were arranged in nests, with squamous differentiation in the center of the nests, or in double-layer adenoid arrangement. The cell morphology was bland with occasional mitoses, and the stromal reaction was not obvious. And adenoid cystic carcinoma cells in the nest arranged like a sieve, the homogenous red-stained and blue-stained secretions were observed in the sieve holes, with obvious cell atypia, frequent mitoses, and obvious stromal reaction.In one case of adenoid cystic carcinoma, sarcomatoid area presented around the nests.Both of them were positive in clinical HPV test. Among the 9 cases of adenoid basal cell carcinoma, 3 were tested for HPV and 5 were tested for p16, and all showed positive expression. Among the 3 cases of adenoid cystic carcinoma, 2 were tested for HPV and 3 were tested for p16, both of which showed positive expression. Telephone follow-up was conducted by June 2019(follow-up time ranged 2-37 months). No recurrence or metastasis occurred in 7 of the 9 cases of adenoid basal cell carcinoma, while 1 case had a ground-glass nodule in lung and another had recurrence of vaginal stump 32 months after the surgery.One case of adenoid cystic carcinoma developed lung metastasis 8 months after surgery and died 2 years after surgery; another case was followed up for 6 months, which showed no recurrence or metastasis; the third case was lost to follow-up. Conclusions: Both adenoid cystic carcinoma and adenoid basal cell carcinoma of the cervix are the tumors originating from cervical reserve cells and are associated with high-risk HPV infection. Due to the differences in clinical treatment and prognosis, careful histological evaluation and immunohistochemical analysis should be carried out to make accurate pathological diagnosis.

Basal Cell Carcinoma Arising within a Trichoepithelioma: An Immunohistochemical Study

Abstract Background: Trichoepithelioma (TE) and basal cell carcinoma (BCC) of skin represent distinct tumor entities but they have a close histogenetic and phenotypic relationship. Objective: A unique case of a BCC arising within a TE is described with an emphasis on the analysis of different and for each tumor type typical immunophenotype. Material and Methods: A 71-year-old man presented with a subcutaneous solid tumor in the lumbar region. The resected tumor specimen was studied by immunohistochemistry. Results: Histology revealed a coexistence of classic TE and nodular BCC. Both tumors were strongly positive for BerEP4 and negative for EMA. Neoplastic epithelium of the BCC showed a diffuse staining for Bcl-2, while the TE expressed Bcl-2 almost exclusively in the peripheral cells of tumor islands. In the BCC, neoplastic nodules exhibited a focal staining for CD10, while the peritumorous stroma did not. In contrast, the TE showed a focal immunoreactivity for CD10 in the stromal cells around the neoplastic islands which were completely negative. The TE contained intratumorous CK20-labeled Merkel cells but they were not detected in the BCC. A stromal immunore-activity for CD34 was found in both tumors. Proliferative activity (Ki-67) was slightly higher in the BCC than in the TE. Conclusion: Although a concomitant presence of TE and BCC in the same skin lesion is a unique finding, it may be sometimes encountered in a biopsy practice. Pathologists should provide a careful histologic examination of the whole TE lesion with precise section sampling to unveil such possible association.

Clinicopathological features of polypoid basal cell carcinoma: the first study in Japan.

Clinicopathological features of polypoid basal cell carcinoma: the first study in Japan.

Circulating tumour cells as a potential biomarker for lung cancer screening: a prospective cohort study

Lung cancer screening with low-dose chest CT (LDCT) reduces the mortality of eligible individuals. Blood signatures might act as a standalone screening tool, refine the selection of patients at risk, or help to classify undetermined nodules detected on LDCT. We previously showed that circulating tumour cells (CTCs) could be detected, using the isolation by size of epithelial tumour cell technique (ISET), long before the cancer was diagnosed radiologically. We aimed to test whether CTCs could be used as a biomarker for lung cancer screening. We did a prospective, multicentre, cohort study in 21 French university centres. Participants had to be eligible for lung cancer screening as per National Lung Screening Trial criteria and have chronic obstructive pulmonary disease with a fixed airflow limitation defined as post-bronchodilator FEV1/FVC ratio of less than 0·7. Any cancer, other than basocellular skin carcinomas, detected within the previous 5 years was the main exclusion criterion. Participants had three screening rounds at 1-year intervals (T0 [baseline], T1, and T2), which involved LDCT, clinical examination, and a blood test for CTCs detection. Participants and investigators were masked to the results of CTC detection, and cytopathologists were masked to clinical and radiological findings. Our primary objective was to test the diagnostic performance of CTC detection using the ISET technique in lung cancer screening, compared with cancers diagnosed by final pathology, or follow up if pathology was unavailable as the gold standard. This study is registered with ClinicalTrials.gov identifier, number NCT02500693. Between Oct 30, 2015, and Feb 2, 2017, we enrolled 614 participants, predominantly men (437 [71%]), aged 65·1 years (SD 6·5), and heavy smokers (52·7 pack-years [SD 21·5]). 81 (13%) participants dropped out between baseline and T1, and 56 (11%) did between T1 and T2. Nodules were detected on 178 (29%) of 614 baseline LDCTs. 19 participants (3%) were diagnosed with a prevalent lung cancer at T0 and 19 were diagnosed with incident lung cancer (15 (3%) of 533 at T1 and four (1%) of 477 at T2). Extrapulmonary cancers were diagnosed in 27 (4%) of participants. Overall 28 (2%) of 1187 blood samples were not analysable. At baseline, the sensitivity of CTC detection for lung cancer detection was 26·3% (95% CI 11·8-48·8). ISET was unable to predict lung cancer or extrapulmonary cancer development. CTC detection using ISET is not suitable for lung cancer screening. French Government, Conseil Départemental 06, Fondation UNICE, Fondation Aveni, Fondation de France, Ligue Contre le Cancer-Comité des Alpes-Maritimes, ARC (Canc'Air Genexposomics), Claire de Divonne-Pollner, Enca Faidhi, Basil Faidhi, Fabienne Mourou, Michel Mourou, Leonid Fridlyand, cogs4cancer, and the Fondation Masikini.

LB919 Aging does not facilitate nodular BCC development in mice expressing oncogenic Smo

Aberrant Hedgehog (Hh) signaling drives the development of basal cell carcinomas (BCCs), which arise mainly in elderly patients. Loss-of-function PTCH1 or gain-of-function SMO mutations are oncogenic drivers in human BCC, but neither of these genetic alterations effectively yield nodular BCCs in genetically-engineered mice. Because nearly all prior BCC modeling studies have been performed in juvenile mice, we set out to assess whether aging is permissive for BCC development using a Cre-inducible oncogenic SmoM2 allele, activated in skin of young versus aged mice. As expected, young (4 month-old) SmoM2-expressing mice formed microscopic basaloid hamartomas following 9 weeks of transgene activation, with nodular BCC-like lesions never detected. Similarly, aged (22-24 month-old) mice, expressing SmoM2 for up to 8 months, also failed to develop nodular BCCs. Histology of SmoM2-driven hamartomas in skin of young and aged mice was indistinguishable, and nearly all epithelial cells in lesions from both groups expressed K5, K17, and Sox9. Remarkably, while Ki67+ proliferating cells were abundant in cells at the periphery of hamartomas in young mice, proliferation was markedly reduced in hamartomas in aged mice. Our findings show that oncogenic Smo expression yields similar histologic phenotypes in both young and old mice and an apparent reduction in proliferating cells in aged mice. The absence of BCCs both in young and elderly SmoM2-expressing mice argues against a critical role for aging in facilitating full-blown skin tumorigenesis in this mouse model.

632 UVB induced EMT-like phenotype in keratinocytes is mediated by TLR3 activation

Risk factors for non-melanoma skin cancer (NMSC) include UVB exposure, genetic mutations, immunosuppression, and chronic inflammation. Activation of Toll-Like-Receptor 3 (TLR3), which recognizes dsRNA, leads to downstream activation of NF-κB and an upregulation of inflammatory cytokines. TLR3 protein expression is higher in moderately differentiated squamous cell carcinomas (SCCs) and infiltrative basal cell carcinomas (BCCs) compared to well-differentiated SCCs by immunohistochemistry (n > 6) suggesting TLR3 expression correlates with more aggressive NMSCs.

Topical Imiquimod as a Treatment Option for Nodular Basal Cell Carcinoma: A Systematic Review.

Surgical excision is considered standard treatment for nodular basal cell carcinoma (nBCC). However, patients who reject or are unsuited for surgery may benefit from imiquimod (IMQ) 5% cream as an alternative treatment. The objective of this study was to conduct a systematic review on the efficacy and safety of IMQ for the treatment of nBCC. The terms basal cell carcinoma AND imiquimod OR Aldara were searched on Ovid-MEDLINE, EMBASE, and Cochrane Library databases. Articles were included if they reported the efficacy or side effects of IMQ for nBCC. Primary outcomes included clearance (clinical and histological), recurrence rates, and adverse events. Number of lesions/subjects, treatment regimens, length of treatment, and time to recurrence were secondary outcomes. Thirty-nine publications, totaling 738 lesions, revealed a 77.4% (335/433 lesions) clinical and 72.9% (390/535 lesions) histological clearance rate. Regimens ranged from once daily 2 days a week to twice daily 7 days a week. Average treatment duration was 8.81 (±3.49) weeks. There was a 1.80% recurrence rate after an average follow-up period of 13.03 (±15.09) months. Common adverse effects included erythema (77.2%), crusting (50.5%), pruritus (34.1%), tenderness/irritation (27.3%), ulceration (25.4%), burning (22.1%), and erosion (21.7%). Unforeseen side effects included conjunctivitis, keratitis, depigmentation, comedone formation, and ruptured epidermoid cysts. Imiquimod showed clinical and histological clearance rates of over 70% for nBCC, with a recurrence rate of 1.80%. Although clearance rates are lower than surgery, IMQ can be considered as a treatment option for nBCC in those who decline or are unfit for surgical intervention.

Sclerodermiform basal cell carcinomas vs. other histotypes: analysis of specific demographic, clinical and dermatoscopic features.

Among the various types of basal cell carcinoma, the sclerodermiform variant has a high risk of recurrence and local invasiveness. A systematic description of the dermatoscopic features associated with specific body localization is lacking. To describe the clinical and dermoscopic features of sclerodermiform basal cell carcinoma (BCC) according to localization in the body confronting with superficial and nodular types. Clinical and dermoscopic images of sclerodermiform, nodular and superficial BCCs were retrospectively evaluated to study the location in the various body districts, maximum diameter, clinical appearance of the lesion, features of edges and presence or absence of specific dermatoscopic criteria of BCCs. We examined 291 histopathologically proven BCCs showing that in nodular BCCs, classical arborizing vessels were more frequently found in the body macro-area (trunk and limbs; n=46, 97.9%) than in the head/neck area (n=43, 82.7%); within sclerodermiform BCCs, short arborizing vessels were found more frequently in the head/neck district (n=35, 49.3%) than in the body (n=6, 23.1%; P-value 0.02); within nodular BCCs, multiple blue-grey dots and globules were more frequently found on the trunk (n=23, 48.9%) than in the head/neck district (n=12, 23.1%; P-value 0.01). In sclerodermiform BCCs, ulceration was found more frequently in the head/neck district (n=38, 53.5%) than in the body (n=4, 15.4%; P-value>0.01), and in superficial BCCs, ulceration was found more frequently in the head/neck district (n=5, 38.5%) than in the body (n=8, 9.8%; P-value 0.02). Our study shows that superficial BCC are found frequently in the head/neck district dermoscopically characterized by ulceration and arborizing vessels; nodular BCCs are more frequently found in the body than in the head/neck district, and the dermoscopic pattern is characterized by the combination of three features: (i) classical arborizing vessels, (ii) multiple blue-grey dots and (iii) globules. Instead, sclerodermiform BCC is preferentially located in areas at high-moderate risk of recurrence; if pink-white areas and/or fine arborizing vessels are seen, clinicians should consider this diagnosis. Furthermore, location-specific dermatoscopic criteria have been described.

Long-term outcome of 117 patients with Erdheim-Chester disease and mixed histiocytosis receiving targeted therapies (BRAF and MEK inhibitors): A monocentric experience.

7560 Background: Erdheim–Chester disease (ECD), an inflammatory myeloid neoplasm from the L group, is an histiocytosis associated with multisystem infiltration. Around 1500 cases have been reported worldwide since 1930. In 15% of cases, ECD is associated with another histiocytosis corresponding to mixed histiocytosis. Before 2004, 60% of patients died within 3 years after diagnosis. The targetable BRAFV600Emutation is present in as much as 70% of all ECD cases. Targeted therapies (BRAF inhibitors in April 2012, followed by MEK inhibitors after 2015) have revolutionized the therapeutic options and prognosis of refractory ECD and mixed histiocytosis. Methods: This retrospective study was conducted between April 2012 and December 2019 on 117 ECD patients who received targeted therapies in the French National Referral Center for Histiocytosis at Pitié-Salpêtrière Hospital in Paris, France. 28 patients (pts) (24%) had a mixed histiocytosis. Results: 43 (36.7%) pts were female and 95/116 exploitable pts (81.9%) had a BRAF V600E mutation. 12 (10.3%) pts had a co-ocurring hemopathy (myeloproliferative neoplasm or myelodysplastic syndrom). Age at diagnosis was 57.2 yr (+/- 13.8). The main sites of involvement were: vascular (“coated aorta”) in 85 pts (73%), heart in 83 pts (71%), xanthelasma in 30 pts (26%), central nervous system in 56 pts (48%) and peri-renal (“hairy kidney”) in 84 pts (72%). 34 pts (29%) had previously received corticosteroids, and 63 pts (54%) interferon alpha regimen (mainly PEG interferon). 86 (74%) pts received the BRAF inhibitor vemurafenib, and 42 (36%) pts the MEK inhibitor cobimetinib (some patients receiving both). 25 pts died during follow-up. The median survival of patients with targeted therapies in december 2019 was undefined, whereas the patients with no targeted therapies had a median survival of 133 months (HR 0.64 (0.42-0.99); p = 0.04). Among the 117 pts, only 2 had a progression of VAF of mutations within genes frequently mutated in myeloid neoplasms. The most serious adverse events were cutaneous (squamous cell carcinoma, basocellular carcinoma, DRESS) and acute pancreatitis with BRAF inhibitors, whereas chorioretinitis and left ventricular dysfunction were seen with MEK inhibitors. None of the patients receiving targeted therapies progressed. Conclusions: Targeted therapies (BRAF and/or MEK inhibitors) were found dramatically efficacious in 117 patients with severe and refractory ECD and mixed histiocytosis, improving survival of patients.

Clinical Management of Locally Advanced Basal-Cell Carcinomas and Future Therapeutic Directions.

Treatment of choice for nodular basal-cell carcinomas (BCCs) is complete excision, implying that small lesions are of minor concern. Metastasis is very rare (< 1%). However, locally advanced basal-cell carcinomas (laBCCs), which are ineligible for surgery or radiation, are a therapeutic challenge. First-generation Smoothened (SMO) inhibitors (vismodegib, sonidegib) have been approved for treatment, but common side effects limit their use. Numerous new compounds are being investigated in clinical trials as potential therapeutic alternatives, among them second-generation SMO inhibitors, other Hedgehog signaling pathway inhibitors, immune-checkpoint inhibitors and intralesional modalities such as oncolytic viruses. Neoadjuvant treatment regimens open another field. This article deals with the clinical management of laBCCs, based on the description of an illustrative case from our department featuring multiple extensive lesions of the scalp. In this short review we will discuss therapeutic options and implications for the future. Some of the new strategies might potentially evolve as alternatives in the management of genodermatoses such as basal-cell carcinoma syndrome, if proven effective and safe.

CD73 Is Enriched in Cutaneous Carcinomas That Invade the Orbit.

To compare the expression of CD73 in indolent nodular basal cell carcinomas and cutaneous lesions that invade the orbit. Immunohistochemical staining for CD73 was performed on nodular basal cell carcinomas and invasive basal cell carcinomas. The numbers of positively staining cells were counted across 5 consecutive ×40 microscopic fields, and a statistical comparison was performed via a dedicated computerized software package. Ten control specimens and 11 invasive tumors were analyzed. In nodular basal cell carcinomas, the mean number of positively staining cells was 0.72/×40 field (standard deviation = 0.80 cells/×40 field), whereas invasive tumors demonstrated a mean of 6.53 positive staining cells/×40 field (standard deviation = 3.33 cells/×40 field). This difference was statistically significant (p = 0.0002). CD73 is enriched in orbital invasion of cutaneous carcinomas. This checkpoint may represent an important target for therapeutic management of these lesions. Immunotherapeutic agents that have been designed to treat other neoplasms may decrease the requirement for orbital exenteration in this clinical scenario.

Diagnosis and Management of Nonmelanoma Skin Cancer

Nonmelanoma skin cancer (NMSC) is the most common cancer in the world. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common types. SCC lesions are more likely to metastasize when compared to BCC, but due to low risk for metastasis, prognosis for NMSC is excellent. Ultraviolet radiation exposure is the main risk factor for developing NMSC. Merkel cell carcinoma and dermatofibrosarcoma protuberans are rare forms of NMSC. The most common BCC lesions types are nodular, superficial, and sclerosing. Nodular BCC typically consists of papular lesions with a pearly border. Superficial BCC lesions are flat or slightly raised, often red to brown. Sclerosing BCC lesions usually have nondiscrete margins. The gross appearance of SCC is that of an erythematous plaque with scale and/or ulceration. The diagnosis of NMSC starts with gross examination, followed by biopsy. Recommended biopsy techniques include punch, shave, and excisional biopsy. Dermatoscopy should also be used to aid in the evaluation of suspected NMSC and other skin cancers, as it greatly enhances the point-of-care diagnosis of skin malignancies. For low-risk lesions, surgical excision is the cornerstone of treatment, although depending on the clinical situation, curettage and electrodessication or non-surgical modalities may be used. Cryotherapy, topical treatments, photodynamic therapy, or radiation treatment can be used to treat BCC and SCC, but cure rates are lower than with surgical excision. High-risk lesions require specialist referral. All patients treated for NMSC should undergo regular complete skin exams, and counseling on the use of sun protection and avoidance.

Surgery versus combined treatment with curettage and imiquimod for nodular basal cell carcinoma: One-year results of a noninferiority, randomized, controlled trial

Nodular basal cell carcinoma (nBCC) is mostly treated with surgical excision. Interest in minimally invasive treatment of these low-risk tumors is increasing. We assessed the effectiveness of nBCC treatment with curettage and imiquimod cream compared with surgical excision. Patients with nBCC included in this randomized, controlled noninferiority trial were randomly assigned to either a curettage and imiquimod cream group or a surgical excision group. The primary endpoint was the proportion of patients free from treatment failure 1year after the end of treatment. A prespecified noninferiority margin of 8% was used. A modified intention-to-treat and a per-protocol analysis was performed (ClinicalTrials.gov identifier NCT02242929). One hundred forty-five patients were randomized: 73 to the curettage and imiquimod cream group and 72 to the surgical excision group. The proportion of patients free of recurrence after 12months was 86.3% (63/73) for the curettage and imiquimod group and 100% (72/72) for the surgical excision group. The difference in efficacy was -13.7% (95% confidence interval -21.6% to -5.8%; 1-sided P=.0004) favoring surgical excision. Noninferiority of curettage and imiquimod cream cannot be concluded. Given the still high efficacy of curettage and imiquimod cream and the indolent growth pattern of nBCC, curettage and imiquimod could still be a valuable treatment option with the possibility to prevent overuse of excisions. However, it cannot replace surgical excision.

Surgical treatment of basal cell carcinoma: a case series on factors influencing the risk of an incomplete primary excision.

Basal cell carcinoma (BCC) is the most common skin cancer form, and one first-line treatment is surgical excision. Complete excision is vital to minimize risk of recurrence. Studies on occurrence of incomplete excisions have given diverse results and seldom include large populations from a dermatological setting. The rate of positive surgical margins in primary surgery of BCC at a tertiary dermatology clinic is studied. Factors associated with an incomplete primary excision are analysed. Patients scheduled for standard excision, without perioperative margin control, of BCC during the years 2008-2015 were prospectively enrolled in the study. Tumour-specific factors, including histopathologic subtype, as well as postoperative outcome were registered. Incomplete excisions were analysed in relation to patient- and tumour-related factors. In total, 4.6% of 3911 BCC tumours were incompletely excised. The rate of incomplete excisions was higher for facial tumours and among tumours with an aggressive histological subtype. Morpheiform BCC on the nose or ear had the highest rate of an incomplete excision, 61.5% and 50%, respectively. Most BCCs, irrespective of subtype, were completely excised during the primary excision. Tumour sites nose and ears were associated with the highest rate of positive primary surgical margins, especially for infiltrative or morpheiform BCCs. Surgery with perioperative examination of margins is strongly recommended for these tumours.

Surgical margins required for basal cell carcinomas treated with Mohs micrographic surgery according to tumor features

Basal cell carcinomas (BCCs) with high-risk features are preferably treated by Mohs micrographic surgery. Studies have shown clinicopathologic characteristics that may predict more stages required for clearance. However, few studies have correlated such factors with the number of millimeters removed per stage. To determine margins necessary for BCC clearance according to tumor features, especially for tumors less than 6mm, and to suggest initial margins for Mohs micrographic surgery and margins for wide local excision. Retrospective analysis of 295 consecutive Mohs micrographic surgeries for primary BCCs. Variables analyzed included patient age, sex, immunostatus, lesion size, location, histologic subtype, borders, stage number, and millimeters excised per stage. BCCs less than 6mm had a clearance rate of 96% with 3-mm margins. In adjusted multivariable analysis, superficial, micronodular, infiltrative, and morpheaform subtypes were associated with larger margins, whereas clinically well-defined tumors were associated with smaller margins. Because of the limited sample of certain subtypes, a 3-mm margin is better suited for nodular tumors. These data help guide initial Mohs micrographic surgery and wide local excision margins required for tumor clearance according to tumor features. Nodular BCCs less than 6mm may be cleared with 3-mm margins instead of the current 4-mm margin recommendation.

Crateriform Nodule over a Scar

Keratoacanthoma is a low-grade epithelial neoplasm that originates from the pilosebaceous unit. The exact etiopathogenesis of keratoacanthoma is not known. It may arise secondary to other skin lesions such as psoriasis, herpes zoster, lichen planus. Clinically, it is characterized by rapidly growing, dome-shaped crateriform nodule with central keratotic core. The classic lesion shows rapid progression followed by spontaneous involution with a depressed, hypopigmented scar. Clinically differential diagnosis of keratoacanthoma includes squamous cell carcinoma, nodular basal cell carcinoma, nodular Kaposi sarcoma, and metastatic lesion to the skin. In contrast to these malignancies, keratoacanthoma undergo spontaneous resolution and it rarely spread through lymphatic, venous, or perineural routes. Surgical excision is the gold standard for the treatment of keratoacanthoma. Here, we describe a case of keratoacanthoma developing over a pre-existing scar following lichen planus hypertrophicus. High index of suspicion of keratoacanthoma is required while encountering rapidly growing nodule over a scar and histopathological examination is mandatory to rule out other malignancy.

Carcinoma basocelular como debut por exposición al sol.

Introducción: Es reconocida la importancia de la luz solar para la evolución de la vida en la tierra y su papel en el desarrollo humano. Sin embargo, todos los humanos, especialmente las personas cuya piel no está tan pigmentada o cuya ocupación o estilo de vida los expone a cantidades excesivas de luz solar, son potencialmente susceptibles a sus efectos nocivos. Es indiscutible el vínculo entre la exposición crónica al sol de la piel humana y las consecuencias clínicas nocivas como el fotoenvejecimiento y los cánceres de piel, como es el carcinoma basocelular.&#x0D; Objetivo: Describir el efecto que tiene la exposición prolongada al sol como factor de riesgo para desarrollar Carcinoma Basocelular.&#x0D; Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico de Carcinoma Basocelular por exposición al sol&#x0D; Resultados: Existieuna asociación entre la exposición excesiva a radiaciones solares por el paciente y la aparición de un carcinoma basocelular en la piel.&#x0D; Conclusiones: El Carcinoma Basocelular representa la neoplasia cutánea más frecuente, por lo cual se hace imprescindible para lograr el correcto diagnóstico y tratamiento, conocer su comportamiento clínico y evolución de la lesión. El factor de riesgo más importante a considerar es el tiempo de exposición a los rayos solares.

Local recurrence of clinically observed basal cell carcinomas following complete saucerization or punch removal with negative margins: Retrospective case series from 2010 to 2020

Local recurrence of clinically observed basal cell carcinomas following complete saucerization or punch removal with negative margins: Retrospective case series from 2010 to 2020