Differential Diagnosis Of Basal Cell Carcinoma Research Articles

Dermoscopy-based Radiomics Help Distinguish Basal Cell Carcinoma and Actinic Keratosis: A Large-scale Real-world Study Based on a 207-combination Machine Learning Computational Framework.

This study has used machine learning algorithms to develop a predictive model for differentiating between dermoscopic images of basal cell carcinoma (BCC) and actinic keratosis (AK). We compiled a total of 904 dermoscopic images from two sources - the public dataset (HAM10000) and our proprietary dataset from the First Affiliated Hospital of Dalian Medical University (DAYISET 1) - and subsequently categorised these images into four distinct cohorts. The study developed a deep learning model for quantitative analysis of image features and integrated 15 machine learning algorithms, generating 207 algorithmic combinations through random combinations and cross-validation. The final predictive model, formed by integrating XGBoost with Lasso regression, exhibited effective performance in the differential diagnosis of BCC and AK. The model demonstrated high sensitivity in the training set and maintained stable performance in three validation sets. The area under the curve (AUC) value reached 1.000 in the training set and an average of 0.695 in the validation sets. The study concludes that the constructed discriminative diagnostic model based on machine learning algorithms has excellent predictive capabilities that could enhance clinical decision-making efficiency, reduce unnecessary biopsies, and provide valuable guidance for further treatment.

Glioma-Associated Oncogene-1 Expression in Basal Cell Carcinoma and Its Histologic Mimics.

Basal cell carcinoma (BCC) is the most common skin cancer, and it has numerous histologic mimics with variable prognoses and treatments. Although some immunohistochemical stains can be used for the differential diagnosis of BCC, variability and overlap in results can complicate their interpretation. Immunohistochemical staining for glioma-associated oncogene-1 (Gli-1) was performed on 26 nodular BCCs, 22 infiltrative BCCs, 9 basaloid squamous cell carcinomas, 12 desmoplastic trichoepitheliomas, 19 Merkel cell carcinomas, 11 sebaceous carcinomas, 10 cylindromas, 14 spiradenomas, 12 adenoid cystic carcinomas (AdCC), and 1 solitary trichoepithelioma. Strength of staining was scored as 0, 1+, 2+, or 3+, and distribution of staining was categorized as diffuse, multifocal, or focal. Strong, diffuse Gli-1 expression was seen in all tumors with basal epidermal-type differentiation, including BCC, trichoepithelioma, and basaloid squamous cell carcinoma. All examples of Merkel cell carcinoma were negative for cytoplasmic expression. Seven out of 11 sebaceous carcinomas were negative for Gli-1, and the remaining 4 showed 1+ expression. Cylindroma, spiradenoma, and AdCC, each an adnexal skin tumor, showed the most variable staining, but with cylindroma and spiradenoma demonstrating comparable labeling patterns. Overall, although Gli-1 may not distinguish between basal epidermal-type tumors, it may have a role in separating that group from lesions with adnexal differentiation, particularly sebaceous carcinoma, but also cylindroma, spiradenoma, and AdCC. Any cytoplasmic staining seems to exclude the diagnosis of Merkel cell carcinoma.

Osteoma Cutis of the Scalp in a Case of Multiple Basal Cell Carcinoma Induced by Radiotherapy

Introduction: Multiple osteoma cutis is a rare skin disorder characterized by tiny bone fragments deposition in the skin. It is a benign disease, which occurs as primary or secondary forms. Secondary osteoma cutis most commonly appears on the facial acne scars in middleaged women. The exact etiology of this phenomenon is unknown, but it may be induced by osteoblastic metaplasia of mesenchymal elements.
 Case Presentation: Herein, we report a 70-year-old man with a history of multiple basal cell carcinoma (BCC) of the scalp caused by radiotherapy, who referred to our tumor clinic with multiple skin-colored subcutaneous papules and nodules on his scalp from 2 years ago along with cutaneous side effect changes of radiodermatitis. In the histological examination of lesions with differential diagnosis of BCC, cysts, and adnexal tumors, the diagnosis of osteoma cutis was established without any evidence of BCC.
 Conclusion: Osteoma cutis is a rare disorder most commonly affecting the face, but our patient had multiple lesions of the scalp. The inflammatory changes of radiodermatitis may be the principal cause of this change.

The importance of cytokeratin 19 expression in the differentiation of Basal cell carcinoma and trichoepithelioma.

Basal cell carcinoma (BCC) is the most common skin neoplasm reported in human. On the other hand, trichoepithelioma (TE) is a rare, benign tumour of skin adnexa. The differentiation of BCC and TE may be difficult since their morphological findings are similar. In a few studies, it has been determined that undifferentiated basaloid cells are highly positively stained with cytokeratin 19. The aim of this study was the comparison of cytokeratin 19 expression in cases of BCC and TE. Sections of skin tissues of 17 TE, 25 BCC and 12 non-neoplastic cases were used for cytokeratin 19 (CK19) immunohistochemical staining. Staining with CK19 of the BCC cases gave 15(60%) diffuse, 7 (28%) focal and 3 (12%) negative staining. On the other hand, among TE cases, 2 (12%) gave diffuse, 5 (29%) focal and 10 (59%) negative staining with CK19. In the non-neoplastic skin tissue samples, while positive staining with cytokeratin 19 in the outer root sheath of hair follicles and sweat glands were observed, there was no staining in basal layers. CK19 expression may be helpful in the differential diagnosis of BCC and TE especially in small skin biopsy samples in which morphologic differentiation is difficult.

High-Definition Optical Coherence Tomography in the Diagnosis of Basal Cell Carcinoma Evaluated by an Experienced Versus Inexperienced Investigator

Background: Histopathology is the gold standard in the diagnosis of basal cell carcinoma (BCC) but biopsies are invasive and often not the preferred diagnostic method for patients. In this context, non-invasive diagnostic imaging tools such as high definition optical coherence tomography (HD-OCT) have shown promising results in diagnosing BCC in real time, atraumatically and repeatedly. Objective: To evaluate the sensitivity and specificity of HD-OCT in the diagnosis of BCC by an experienced versus an inexperienced investigator and describe typical features in common differential diagnosis of BCC. Patients and methods: Forty three patients with clinical suspicion for BCC were included. The HD-OCT images were evaluated in a blinded manner by an experienced and inexperienced investigator. The results were compared to the histopathological diagnosis. Results: Histopathology revealed 22 BCC, 10 fibrous papules of the face, 5 actinic keratoses, 3 intradermal nevi, 2 squamous cell carcinomas and 1 sebaceous hyperplasia. The sensitivity and specificity in diagnosing BCCs correctly by HD-OCT in the experienced investigator was 86.4% and 90.5%, respectively. In the inexperienced investigator the sensitivity and the specificity was 77.3% and 81.0%, respectively. There was a good inter-observer agreement found between experienced and inexperienced investigators. Conclusion: HD-OCT can be used as auxiliary diagnostic tool in the evaluation and treatment of BCC even by inexperienced investigators.

Expression of drebrin, an actin binding protein, in basal cell carcinoma, trichoblastoma and trichoepithelioma.

Drebrin, an F-actin binding protein, is known to play important roles in cell migration, synaptogenesis and neural plasticity. Although drebrin was long thought to be specific for neuronal cells, its expression has recently been reported in non-neuronal cells. As for skin-derived cells, drebrin was shown to be enriched at adhering junctions (AJs) in cultured primary keratinocytes and also be highly expressed in basal cell carcinoma (BCC) cells. Since BCC and two types of benign neoplasm, trichoblastoma and trichoepithelioma, are considered to derive from the same origin, follicular germinative cells, it is sometimes difficult to morphologically distinguish BCC from trichoblastoma and trichoepithelioma. In this study, we performed immunohistochemical staining of drebrin in BCC, trichoblastoma and trichoepithelioma, to examine whether drebrin could serve as a biomarker for BCC diagnosis. In western blotting, drebrin was detected highly and moderately in the lysates from a squamous cell carcinoma cell line, DJM-1, and normal human epidermis, respectively. In immunofluorescence analyses, drebrin was colocalized with markers of AJs and tight junctions in DJM-1 cells and detected at cell-cell junction areas of human normal epidermis tissue. We then examined the distribution patterns of drebrin in BCC, trichoblastoma and trichoepithelioma. In BCC tissues, intense and homogeneous drebrin expression was observed mainly at tumor cell-cell boundaries. In contrast, drebrin was stained only weakly and non-homogeneously in trichoblastoma and trichoepthelioma tissue samples. For differential diagnosis of BCC, drebrin may be a novel and useful marker.