Extensive Basal Cell Carcinoma Research Articles

The free style “Twin V/Y Nasal Perforator Flaps”. An alternative to the forehead flap for nasal tip reconstruction. A case control study

IntroductionReplacing the skin along the nasal tip remains a challenge.Depending on the extent of the skin loss different local or regional flaps are available for reconstruction. If cutaneous replacement involves the nasal tip, the forehead flap can be used successfully. However, it requires a multi-stage procedure and can leave considerable scarring on the patient’s forehead. As an alternative, the authors present the free style “Twin V/Y Nasal Perforator Flaps” (TVYNPF), which can be used as a one-stage procedure for nasal tip reconstruction. Material and MethodsA series of five patients aged between 69 and 89 years with extensive basal cell carcinomas (BCC) at the nasal tip are presented (Table 1). The surgical procedure is explained in detail. Follow up ranged from 8 to 12 months. ResultsHealing was uneventful for all five patients and the shape, symmetry and aesthetical unity of the nasal tip and the alae of the nose were preserved in all patients without any functional impairment. All scars presented inconspicuous. ConclusionIn selected patients the free style TVYNPF proved to be a good alternative to the forehead flap for one-stage reconstruction of significant skin loss along the nasal tip, while preserving the aesthetics and function of the nose.

Challenges in Diagnosing and Initial Treatment of Advanced Eyelid Basal Cell Carcinoma in Rural Area: A Case Report

Introduction : Basal cell carcinoma (BCC) is the most common non-melanoma eyelid cancer with a high risk of recurrence. This case report discusses the management of extensive BCC in a rural setting with limited resources.
 Case Illustration : A 62-year-old Timorese female, presented to the hospital with a mass on the left periocular region. It appeared as a mole in the lower left eyelid and extended to the surrounding tissues over nine years. As a farmer, she was frequently sun-exposed. A blackish mass was found at the left orbit, buccal, and entire nose (8 x 7.5 cm) with an ulcerated surface and attached firmly. The right eye had bedside visual acuity >6/60, with palpebral edema, free eye movement, hyperemia nasal conjunctiva, and transparent cornea. The left eye is difficult to examine. Two submandibular lymphadenopathies were palpated. A Head CT scan showed a suspected malignant soft tissue mass with irregular thickening of soft tissue with ill-defined borders. Histopathology examination revealed a nodulocystic type of basal cell carcinoma.
 Discussion : Locally advanced BCC cases need a multidisciplinary approach. In a limited resources setting, the treatment highlights are histological diagnosis, complete surgical excision, and exenteration with margin control. From a broader perspective, the role of primary health care in educating and revering for early treatment is paramount.
 Conclusion : Prevention and early treatment are the most important factors in managing locally advanced BCC.

Multidisciplinary Surgical Management of Extensive Basal Cell Carcinomas

Basal Cell Carcinoma (BCC) is the most common malignancy that can cause local tissue destruction. While treatment options for BCC vary depending on the degree of malignant progression, surgical intervention is generally required when there is significant tissue involvement. We present a case of a 40-year-old woman with extensive BCCs requiring a multidisciplinary surgical approach for treatment. Our case highlights the importance of utilizing a multidisciplinary team as well as different surgical management options for late stage BCCs.

Complex techniques of eyelid reconstruction following extensive basal cell carcinoma resection

Complex techniques of eyelid reconstruction following extensive basal cell carcinoma resection

William’s syndrome associated with extensive infiltrative basal cell carcinoma

William’s syndrome associated with extensive infiltrative basal cell carcinoma

Efficiency of long-term high-dose intravenous ascorbic acid therapy in locally advanced basal cell carcinoma - a pilot study.

IntroductionThe anti-cancer properties of high-dose intravenous ascorbic acid have been demonstrated in various malignancies. In our recent study, we tested topically applied ascorbic acid to treat basal cell carcinoma (BCC), and achieved a good clinical response.AimBased on these results, we decided to examine the efficacy and tolerability of high-dose intravenous ascorbic acid (IVA) for locally advanced BCC.Material and methodsIn this pilot study, patients diagnosed with locally advanced BCC who were not amenable to radiation, surgical or local therapy (no other treatment option was available at the time) received intravenous ascorbic acid (1–1.8 g/kg), in an outpatient setting, 1–3 times per week for a mean duration of 42 ±23.6 weeks. This therapy was generally well tolerated.ResultsAmong 4 patients who had a total of 165 (mean: 41 ±51, range: 1–114) skin lesions, 3 patients achieved stable disease and one had progressive disease. There was substantial variability in individual tumor response to therapy. With the aid of two-photon microscopy and second harmonic generation imaging techniques, alterations in collagen structure were observed between tumor nests during IVA therapy.ConclusionsOur results suggest that IVA is well tolerated in a small group of patients with extensive BCCs. However, in the era of smoothened (Smo) receptor inhibitors, it may only be considered as an adjuvant therapy in treatment-resistant cases.

Extensive perianal basal cell carcinoma: a case report.

Introduction: Basal cell carcinoma is the most common skin cancer. It usually occurs in sun-exposed areas; perianal location is rare. The extension to the anal canal is exceptional, only a few cases were reported in the literature. Observation: we report the case of a 58 years old patient, referred for a chronic ulceration of the perianal area. Histopathology revealed an extensive basal cell carcinoma. a large excision was performed, with a favorable outcome. conclusion: the main lesson from this case is that although basal cell carcinoma is exceptional in the perianal region, a biopsy is mandatory for all chronic perianal ulcerations.

Atypical tumor lysis syndrome in a patient on vismodegib for extensive basal cell carcinoma

Atypical tumor lysis syndrome in a patient on vismodegib for extensive basal cell carcinoma

Flap-plasty and closure by second intention: an option in the reconstruction of the ear and external auditory canal

Non-melanoma skin cancer is the most common type of neoplasia. Basal cell carcinoma is the most common cancer of them, the incidence of which is steadily increasing, implying an important public and financial health issue. The authors present the case of a patient with an extensive basal cell carcinoma affecting part of the external auditory canal and auricular concha, treated with a combination of surgical techniques: flap-plasty associated with second intention closure of the external auditory canal. Due to the excellent aesthetic and functional outcomes, this technique should be considered as a therapeutic option for auricular lesions.

Hyperthermic isolated limb perfusion: Does it still have a role?

BACKGROUND: Hyperthermic-isolated limb perfusion (ILP) with melphalan is an established modality for the treatment of irresectable malignancy of an extremity, including melanoma. ILP isolates the affected limb from the systemic circulation, using an extracorporeal bypass circuit, and administering high-dose intra-arterial chemotherapy. While this technique remains the “gold standard” and is practiced at high-volume surgical oncology centers worldwide, as new systemic treatments have become available, it is timely to review the current place of regional chemotherapy. PATIENTS AND METHODS: Twenty-six ILPs were performed between 2006 and 2013 at a single center. Patient's parameters, clinical outcomes, and survival were evaluated. Twenty procedures were for melanoma, five for sarcoma, and one for extensive basal cell carcinoma (BCC). RESULTS: ILP was well tolerated with few intraoperative or postoperative complications. Within the melanoma group, limb toxicities were low with one Grade III and no severe (Wieberdink IV+) toxicities. Limb salvage was achieved in 2/5 sarcoma patients. At 6 weeks' postprocedure, 13 melanomas, two sarcomas, and the BCC patient reported a complete response (16/26). However, 5 years after the last procedure, and a median follow-up of 23 months, the majority of melanoma and all sarcoma patients went on to develop local recurrence or metastatic disease. CONCLUSIONS: ILP is a useful technique to provide high-dose chemotherapy to refractory limb malignancy to provide effective palliation, delay progression, or even obtain cure. However, as new effective systemic therapies emerge, the role of isolated regional chemotherapy (ILP and isolated limb infusion) needs to be reevaluated.

Salvage complex lower eyelid defect reconstruction combining a modified Hemi-Tripier flap after forehead resurfacing based on the Crane principle

Repair of a failed primary lower eyelid reconstruction is a difficult prospect and requires special thought after the best available reconstructive option has already been utilized. Reconstruction must be tailored specifically to the defect and the local reconstructive options. Here, we describe the case of an 88-year-old male with a successful salvage reconstruction of his lower eyelid after a cicatricial failure of the primary composite reconstruction for a 90% lower eyelid defect secondary to extensive basal cell carcinoma in the setting of a lack of standard reconstructive options.

Dermatologic radiotherapy in the treatment of extensive basal cell carcinomas: a retrospective study

Background: The increase of the number of new cases for year of basal cell carcinoma (BCC) has brought also an increase of BCC difficult to treat (extensive, locally advanced and high risk forms).Objective: To evaluate retrospectively the results obtained with dermatologic radiotherapy (RT) for better defining the indications respect to new emerging treatments.Methods: A series of extensive 115 BCC treated with RT from 1977 to 2014 were selected for the study, since endowed with histological diagnosis on the amount of 181 extensive BCC. RT was performed with conventional energies (50–160 kV) administering a total dose ranging from 47 to 85 Gy (median 55 Gy). The mean follow up was 40.66 months (median 21 months). A statistical evaluation was performed with chi-square test to analyse the possible correlations among therapeutic and cosmetic results and size, localisation and clinical type of the lesions.Results: A complete remission (CR) was obtained in 70.43%, a partial remission (PR) in 20% of the lesions treated, while in 9.56% a no response (NR) or not evaluable response (NER) was registered. In 19% of the lesions a relapse was observed, with a five-year cure-rate of 55.13%. Cosmetic results were good in 28%, acceptable in 50% and not acceptable in 22% of the lesions in CR. In six lesions, localised at the trunk region, a chronic radiodermatitis developed. A statistically significative correlation was observed between therapeutic results and size, between cosmetic results and size and between therapeutic results and clinical type of BCC.Conclusion: The treatment of extensive BCC is still a challenge and radiotherapy is one of the possible choices, preferred in the elderly, in relapsing cases, after incomplete excision, and in difficult localisations of the face. Radiotherapy might be included in sequential schedules of treatment to improve final results.

Nasal reconstruction with a prefabricated free flap

We report a case of a 61-year-old patient who presented to us for nose and cheek reconstruction post multiple excisions of an extensive recurrent basal cell carcinoma (BCC) of the right cheek and most of the nose. Nasal reconstruction was achieved with a free helical rim flap for the right ala and a staged prefabricated radial artery forearm free fascial flap. We were successful in producing a very favorable esthetic result and restoring nasal function.

Reconstruction of the lower eyelid using the modified Fricker technique

The reconstruction of the eyelid is a considerable challenge for surgeons due to the fact that it is a delicate organ of the utmost importance. The procedure is indicated in defects of congenital origin, post-trauma, or neoplasia. There are many techniques described in the literature. The authors report a case of a female patient bearer of xeroderma pigmentosum with extensive basal cell carcinoma in the lower right eyelid, who underwent tumor resection and reconstruction of the lower eyelid using the modified Fricker technique with excellent functional and aesthetic result.

Extensive basal cell carcinoma responsive to Imiquimod: a thirty-six-month follow up

Basal cell carcinoma is the most common type of cancer and its non-surgical treatment has been the subject of many studies. Large lesions of this tumor are therapeutic challenges and the effective topical treatment has good applicability. The authors present a female patient diagnosed with multicentric superficial basal cell carcinoma in the lumbar region for more than 20 years, who refused to be treated surgically. The tumor reached dimensions of 12 cm x 10 cm. A decision was made for a non-surgical therapy, with the application of Imiquimod in a treatment of 5 weekly applications for 2 months. The treatment led to a clinical and histological cure, without recurrence to date (36 months), with excellent aesthetic results and few side effects.

Microscopically Controlled Surgery

I am a co-author of the S2k-guideline on basal cell carcinoma (BCC), which is in its final stages of development. Supported by 40 years’ experience in tumor surgery on facial skin and by long-term analyses of more than 3800 operations for facial BCC, my views differ somewhat from those expressed in the article. Hedgehog signaling pathway inhibitors allow a new therapeutic principle in BCC. Because of their short time of use, however, many questions remain open. In the guideline indications are defined for so extensive and metastatic cases of BCC, which therefore can be neither treated by radiation nor by surgery. — A tumor board decides on their use. Competent surgeons and radiologists are a mandatory on such a board. Non-surgical local therapies (laser, cryotherapy, immunomodulators imiquimod, 5-fluorouracil, photodynamic therapy) are reserved for individual cases because of barely predictable oncological and esthetic results. Local recurrences or residual tumors occur in more than 10% of cases after such treatments. For the surgery that is potentially required subsequently, these cause problems regarding R0 resection because of multilocal and poorly localizable tumor residues. According to the guideline, the surgical approach with the highest possible degree of control of the resection margin (Microscopically controlled surgery- MCS) is the method of choice. Compared with conventional surgery, MCS lowers the recurrence rate in primary BCC by only 1% and thus does not significantly improve the prognosis. When treating tumor recurrences, MCS reduces the recurrence rate from 12% to 2.4%. According to my own analyses, surgical treatment for BCC by means of MCS using plastic-surgical or rare epithetic defect repairs on the face, will—in primary BCC—yield a probability for 20 tumor-free years of 98.2%; in the treatment of recurrences in a retrospective analysis of 74%; and in a prospective analysis, consistenly using our variant of MCS, of 98%. Untreated R1 results lower this probability of success drastically, to 52% (primary BCC) and 29% (BCC recurrence). This confirms the validity of the R1 finding for tumor clearance. It does not affect survival. Diverse methods for reconstructions of the defects in the repertoire of maxillofacial surgeons in association with MCS allow a high degree of oncological certainty even in extensive BCC in combination with good esthetic results, even in the problematic facial region.

The Impact of Neoadjuvant Hedgehog Inhibitor Therapy on the Surgical Treatment of Extensive Basal Cell Carcinoma

The Impact of Neoadjuvant Hedgehog Inhibitor Therapy on the Surgical Treatment of Extensive Basal Cell Carcinoma

Extensive basal cell carcinoma of the forehead and anterior scalp: use of helical tomotherapy as a radiotherapy treatment modality

Extensive basal cell carcinoma of the forehead and anterior scalp: use of helical tomotherapy as a radiotherapy treatment modality

Microvascular submental island flap prelaminated with oral mucosa in recon­struction of the lateral defect of nose

Reconstruction of perinasal area is still a challenge for the surgeon who is involved in excisional tumor surgery. The authors report their experience in reconstruction of hemi-nose defects with the free microvascular submental island flap prelaminated with oral mucosa. A 73-year-old male patient with recurrent extensive basal cell carcinoma of the right hemi-nose (nasal ala and lateral nasal part) and portion of the upper lip underwent to excisional surgery and creation of lateral nasal defect 3 x 2 cm in size. Six months after the first surgery the reconstruction of postoperative defect was done by means of free microvascular submental flap prelaminated with oral mucosa. After necrosis of flap 3 mm x 4 mm in size around the tip zone of the nose on the 7" postoperative days, the rest of microvascular submental flap prelaminated with oral mucosa survived completely with good cosmetic and nasal respiratory results. This flap can be used successfully in reconstruction of the hemi-nose area. Color and texture of the flap match with adjacent tissue and adequate diameter of submental vessels and reasonably long vascular pedicle enables successful microvascular anastomosis.

Red Eye and a Rodent Ulcer

A 58-year-old woman presented with a 1-week history of poor vision in the right eye associated with a red eye. She was transferred for vitreoretinal management of suspected endophthalmitis. On examination, she had extensive ulceration of her forehead, exposing a pulsating mass covered with white antiseptic powder. The ulcer extended to involve the nose and right upper eyelid. Computed tomography demonstrated widespread erosion of the frontal bone, exposing the dura; histopathology confirmed the lesion to be basal cell carcinoma. The ulcer had slowly progressed for 30 years, but the patient was in denial about her condition. She had kept the ulcer well hidden by combing her hair forward over it. She was married, with an adult child, and was employed as a courier. Despite three assessments of her eye by medical staff in the preceding 24 hours, the diagnosis of the extensive basal cell carcinoma had been missed as she had refused to lift her hair for a complete examination.