Facial Basal Cell Carcinoma Research Articles

Clinical efficacy of Mohs surgery combined with topical photodynamic therapy for facial basal cell carcinoma.

The purpose of this study is to investigate the clinical efficacy of Mohs surgery in combination with topical photodynamic therapy (PDT) for facial basal cell carcinoma. Eighty-six patients with facial basal cell carcinoma treated in our department from April 2011 to December 2013 were included. Mohs surgery was used to remove the lesions followed by direct suturing, skin flap grafting, or medium thickness free-skin grafting to repair the incisions. Topical PDT was performed three times, at an interval of 2 weeks, immediately after the sutures were removed. The patients were followed up for 2 years after the operation to evaluate tumor recurrence. Recurrence was not observed within 1 year after Mohs surgery combining PDT; however, one case of recurrence was found at the 2-year follow-up. The efficacy of Mohs surgery combining topical PDT is a definite treatment for facial basal cell carcinomas, as it reduced the tumor recurrence rate and maintained the relative integrity of the local tissues and appearance. This method could be a new effective treatment method for the facial basal cell carcinoma.

Histological verification of autofluorescence borders of periorbital skin tumors

To compare histological borders of periorbital skin tumors with their autofluorescence borders built from the analysis of non-induced protoporphyrin IX autofluorescence. The study group included 8 patients with skin tumors of the eyelids, periorbital region, eyebrow and zygomatic regions aged 54-88 years. The tumors varied in size from 2 to 8 mm and all displayed signs of basal cell carcinoma (BCC). At admission, all the patients underwent non-induced autofluorescence diagnosis. The images were processed with the «CancerPlot» program. During radio excision, the autofluorescent border of each neoplasm was marked with a surgical incision of about 5 mm long and 2 mm deep. Upon pathomorphological examination, solid BCC was identified in 7 cases. The remaining case was senile keratosis. All reference incisions were located in healthy tissues not farther than 1 mm from the tumor (or keratosis locus, correspondingly). By the example of facial BCC, an evident correlation was established between histological borders of the tumor and its native (non-induced) protoporphyrin IX autofluorescence.

Recurrent basal cell carcinoma with maxillary bone invasion

Background: Basal cell carcinoma (BCC) is a malignant, slow growing, and locally invasive skin tumor. Advanced and neglected BCC may invade adjacent structures. The 5-year recurrence rates of facial BCCs are 4.1% after excision and 2.5% after Mohs Micrographic Surgery (MMS) . The number of BCC cases invading the bones of the head and neck region is limited. Case Illustration: A 75-year-old male complained of bleeding and ulcer enlargement on the right cheek expanding to the right nasal ala for 1 month. The patient had a history of an enlarged and painful lenticular nodule with a hyperpigmented spot that appeared 10 years ago on the right cheek and was diagnosed as BCC. The patient was treated with a wide excision having a negative pathological margin 3 years ago. He noticed that the similar lesion reappeared at the same location 2.5 years ago. Post-operative histopathological results showed nodular infiltrative BCC and maxillary bone invasion. Discussion: Based on history taking, physical examination, and diagnostic evaluation, the diagnosis of the patient was recurrent nodular infiltrative BCC. The final histopathology confirmed that tumor cells invaded the maxillary bone. After considering the treatment options, the patient opted to proceed with radiotherapy. Conclusion: Recurrent nodular BCC with invasion to the maxillary bone is a rare and interesting case. Among 140 BCC cases that we treated with MMS in our hospital from June 2014 to September 2019 , this case is the first recurrent BCC with maxillary bone invasion. Keywords: basal cell carcinoma, skin tumor, MMS, bone invasion

ADVANCED STAGE OF FACIAL BASAL CELL CARCINOMA

An eighty years old man presented with a slowly progressing, ulcerative mass near the left eye diagnosed as the advanced stage of facial basal cell carcinoma (rodent ulcer) which has involved his left eye and orbit, left nostril and left cheek area. According to the patient, it was a very slow growing tumor and has reached this stage over a span of more than ten years. He has been advised removal of his left eye and adjacent structure along with plastic reconstruction of the damaged half of the nose and face. It will be important to excise the tumor along with healthy margins to prevent recurrences. Take home message is that basal cell carcinoma should be excised early to prevent damage to the eye and nearby structures.

Long-term recurrence rates of whole specimen intraoperative frozen section analysis in basal cell carcinomas of the face with WIFSA.

Recent studies show that whole specimen intraoperative frozen section analysis (WIFSA) is a reliable method for margin analysis in basal cell carcinoma (BCC) and has low recurrence rates after five-years follow-up. There are no studies with longer follow-up. Our aim is to present long-term recurrence rates after WIFSA. All patients with a facial BCC receiving excision with WIFSA between 1992 and 2007 were evaluated. Recurrence rates were examined for primary BCC (pBCC), recurrent BCCs (rBCC), and the different histological subtypes. The accuracy of WIFSA was assessed by comparing with formalin-fixed paraffin-embedded section analysis. A total of 1140 patients with 1265 BCCs underwent excision with WIFSA, with a median and maximum follow-up of 10 and 25.3 years, respectively. Of all tumors, 90.0% were primary. Excisions were radical after an average of 1.4 excision rounds;5, 10, and 15-year recurrence rates for pBCCs are 3.3%, 5.1%, and 7.3%, respectively. An aggressive growth pattern and rBCCs are associated with more recurrences. The accuracy of WIFSA is 98.4%. WIFSA provides a highly accurate analysis and has a low recurrence rate for primary BCCs. The increasing recurrence rates over time imply 5 years of follow-up may be insufficient.

Facial basal cell carcinoma: evaluation of risk factors and adequacy of surgical excision

Facial basal cell carcinoma: evaluation of risk factors and adequacy of surgical excision

Extensive bony metastases from facial metatypical basal cell carcinoma: a case report

Metastatic basal cell carcinoma (BCC) is rare. We treated a 44-year-old woman with an extended facial metatypical BCC in whom staging showed no local or distant metastases, but one year after resection, we diagnosed a local recurrence. Re-staging, using a fludeoxyglucose positron emission tomography-computed tomogram, (FDG PET-CT) showed suspected accumulations of FDG in the whole axial skeleton. Bone punch biopsy examination confirmed extensive bony metastases, and after resection of the relapse, we began her on a systemic treatment with a Hedgehog-pathway inhibitor (vismodegib), which resulted in partial remission.

Reconstruction of Basal Cell Carcinoma over Face by Facial Flaps –Study of 30 Cases

Background: Basal cell carcinoma (BCC) is the most common skin cancer.85% of BCC are located in the head and neck area, of which 30% on the nose. After excision of BCC on the face, the options of treatment for a skin defect are variable. Many surgeons prefer to use a local flap rather than skin graft or free flap for small or moderately sized circular defects after excision of BCC on the face.Methods: All of the patients were histopathologically diagnosed as Basal cell carcinoma, thirty patients underwent various flaps like V-Y advancement flap, bilobed flap, forehead flap, nasolabial flap, glabellar flap repair over 3 years, between January 2014 to December 2016. We observed post-operative complications as flap loss either partial or complete, wound dehiscence, hematoma and wound infection and recurrence of carcinoma. The cosmetic outcome of the face also evaluated.Results: There were 19 men and 11 women. The age ranged from 48 to 73 years with a mean age of 62 years. The causes were BCC in all cases. The tumour locations were the face in all patients. All of the flaps survived, but in one case recurrence of BCC occur, which was managed surgically. Post-operative recovery was very nice.Conclusions: Our study shows facial flaps give nice result and first choice for facial reconstruction in BCC of face. Most defects can best closed by various facial flaps and outstanding functional and cosmetic results can be achieved.TAJ 2017; 30(2): 20-25

Increased Marginal Stiffness Differentiates Infiltrative From Noninfiltrative Cutaneous Basal Cell Carcinomas in the Facial Area: A Prospective Study.

Basal cell carcinoma (BCC) is the most common dermatologic malignant skin cancer. Infiltrative histologic variants are more aggressive and require wider surgical margins or Mohs surgery, in contrast with noninfiltrative variants, which are commonly treated with standard surgical excision. Elastography has not been used to date to differentiate between the histologic variants of BCC. The purpose of this study was to differentiate infiltrative from noninfiltrative BCCs on elastography. A total of 31 facial BCCs were studied. Preoperatively, color Doppler ultrasound and strain elastographic examinations of the lesions were performed. The size, intralesional vascularization, and presence of hyperechoic dots were considered relevant B-mode and color Doppler variables. Strain ratios of the tumors were obtained with respect to adjacent healthy tissue. Increased marginal stiffness, which was considered hardness in greater than 50% of the tumor margin, was also blindly evaluated. Histologic confirmation and subtyping (infiltrative or noninfiltrative) were performed in all cases. Infiltrative BCCs did not differ in the size, presence or absence of hyperechoic dots, or vascularization from noninfiltrative BCCs. Strain ratios were similar in both infiltrative and noninfiltrative BCCs (mean ± SD, 1.82 ± 0.879 versus 2.2 ± 1.11). However, infiltrative BCCs had statistically increased marginal stiffness in comparison with noninfiltrative BCCs (88.0% versus 18.8%). Increased marginal stiffness had sensitivity and specificity of 0.89 and 0.82 respectively, with a positive predictive value of 0.67 for infiltrative BCCs and a negative predictive value of 0.95 for noninfiltrative BCCs. Histologic variants of BCC have different elastographic patterns. These differences may be of help in preoperative assessments of the BCC subtype and specific surgical planning, avoiding unnecessary skin biopsies.

Retalho de Rotação Súpero-Medial: Resultados em Três Doentes

INTRODUÇÃO: O retalho de rotação súpero-medial é um retalho cutâneo local, randomizado, e predominantemente de rotação, que permite encerrar defeitos de média e grande dimensão, nas regiões malar súpero-medial e pele palpebral inferior.
 MATERIAL E MÉTODOS: Dois homens e uma mulher foram submetidos a exérese alargada de lesões clinicamente sugestivas de carcinoma basocelular da face, sob anestesia local, seguida de reconstrução com retalho de rotação súpero-medial.
 RESULTADOS: Não se registaram complicações pós-operatórias imediatas ou tardias. Os resultados funcionais e morfológicos foram aceitáveis. Os doentes não apresentaram recidivas nos 12 meses de seguimento.
 DISCUSSÃO: O retalho de rotação súpero-medial é um procedimento simples, realizado em tempo operatório único, sob anestesia local. Constitui uma excelente opção dentre as várias técnicas cirúrgicas reconstrutivas perioculares clássicas. O ectrópio é uma complicação rara.
 CONCLUSÃO: O retalho de rotação súpero-medial revelou-se uma opção cirúrgica segura e eficaz nos três casos.

Application of Mohs microsurgery in nasal basal cell carcinoma

Objective: To discuss the application of Mohs microsurgery in nasal and facial basal cell carcinoma (BCC) and analyze the pathological and clinical features. Methods: The clinical data of 127 patients who were diagnosed by pathology as nasal and facial BCC in Qilu Hospital of Shandong University from January 2010 to January 2015 were retrospectively analysed. The value of Mohs microsurgery was discussed and the nasal & facial sites of BCC lesions, clinical and histopathology features were summarized. Results: The proportion of male and female was 1.27︰1 in 127 patients, the ages ranged from 27 to 91 years. The top three inflicted area in nasal and facial was followed by nasal dorsum, nasal root and upper lip.The most frequent clinical type was nodular ulcerative type.The most common pathological type was nodular and pigmented. Routine surgical resection was performed in 62 cases (48.8%) while Mohs micrographic surgery in 38 cases (29.9%). Follow-up duration was 37 months on average. Local recurrence occurred in 5 cases in routine surgical resection group while there was no recurrence in Mohs micrographic surgery group. There was no distant metastasis in all cases. Conclusions: There are few specific clinical manifestation in nasal & facial BCC. Surgical treatment is prefered, especially by Mohs micrographic surgery, because it can strictly control the scope of surgical resection and obtain malformation repairment as well as beauty in nasal and facial region.

FACE-Q Skin Cancer Module for measuring patient-reported outcomes following facial skin cancer surgery.

The patient's perspective of their facial scar after skin cancer surgery influences perception of care and quality of life (QoL). Appearance satisfaction after surgery is also an important but often overlooked treatment outcome. To report the psychometric validation of the FACE-Q Skin Cancer Module consisting of five scales, measuring appearance satisfaction (Satisfaction with Facial Appearance, Appraisal of Scars), QoL (Cancer Worry, Appearance-related Psychosocial Distress) and the patient experience (Satisfaction with Information: Appearance). Participants underwent Mohs surgery for facial basal or squamous cell carcinoma or excision of early facial melanoma. Cohort 1 received a set of scales before and after surgery. Cohort 2 received the scales on two occasions in the postoperative period for test-retest reliability. Rasch measurement theory was used to select (item-reduce) the most clinically meaningful items for the scales. Reliability, validity, floor and ceiling effects and responsiveness were also analysed. Of 334 patients, 209 (response rate 62·6%) were included. Rasch analysis reduced the total scale items from 77 to 41. All items had ordered thresholds and good psychometric fit. Reliability was high (Person separation index and Cronbach's α ≥ 0·90) and scales measuring similar constructs were correlated. High floor and ceiling effects were seen for the scales. The Cancer Worry scale demonstrated responsiveness (P = 0·004). The FACE-Q Skin Cancer Module meet the requirements of the Rasch model providing linearized measurement. Discriminating between patients with minimal appearance or worry impairment may be a limitation. The scales can be used for larger validation studies, clinical practice and research.

Mohs Micrographic Surgery for Treatment of Non-melanoma Skin Cancer

The aims of this report are to review literature supporting the use of Mohs micrographic surgery for treatment of non-melanoma skin cancer and to address indications and potential limitations of this form of therapy for non-melanoma skin cancer. The first randomized controlled trial comparing standard excision to Mohs micrographic surgery for treatment of facial basal cell carcinoma has recently been published, demonstrating a lower recurrence rate after Mohs surgery compared to standard excision after a 5-year and 10-year follow-up period, supporting its use in the treatment of high-risk basal cell skin cancer. Mohs micrographic surgery is indicated for treatment of basal cell carcinomas and cutaneous squamous cell carcinomas at high risk of recurrence and for tumors located in areas where tissue conservation and/or functional preservation is desired.

The clinical features and surgical treatment of facial basal cell carcinoma

Objective:To investigate the clinical features and reasonable surgical treatment of facial basal cell carcinoma (BCC). Method:The clinical features of primary facial BCC from 37 patients were analyzed.All patients were cured by standard surgical excision with intraoperative frozen section examination and ensuring margins negative,the defects were reconstructed by using adaptive flaps after resection. Result:The patients were followed up for 12 to 36 months after operation.Two cases of 37(2/37,5.41%) with unclear margin developed local recurrence during 4-6 months after resection,the cure rate was 94.59% (35/37). Except 4 cases were suffered with distal skin flap necrosis, the others were well developed. Conclusion:The clinical feature of primary facial basal cell carcinoma was various. The complete resection of primary nidus with clear margin is the key to a successful treatment of facial basal cell carcinoma, and satisfactory therapeutic effects can be obtained after repairing defects by using adaptive flaps after resection.

The value of skin endoscopy in the diagnosis of pigmented basal cell carcinoma of the head and face

Objective To evaluate and analysis the value of skin endoscopy in the diagnosis of pigmented basal cell carcinoma of the head and face. Methods A retrospective study was performed on 36 cases of patients(male 20 cases, female 16 cases, aged from 34~66 years old)with suspected pigmented basal cell from January to December 2014.The lesions mainly located in the head and neck, all patients received skin lesion endoscopy, and by 2 senior physicians from department of dermatology, according to the pathological characteristics of mirror skin pigmented basal cell carcinoma, independent of disease diagnosis, the pathological lesion diagnosis as the 'gold standard’, compared and studied the consistency of skin biopsy with pathological findings in the diagnosis of head to head facial pigmented basal cell carcinoma, and analyzed the sensitivity and specificity of diagnosis method. Results Among 36 cases of suspected patients, 25 cases of pigmented basal cell carcinoma were confirmed by histopathology; 27 cases of pigmented basal cell carcinoma were confirmed by A physician, the accuracy, misdiagnosis rate, the rate of missed diagnosis, sensitivity, specificity and Youden index were 92.6%, 27.3%, 4.0%, 87.5%, 33.3% and 68.7%, respectively, A physician diagnosed Kappa index was 0.965, P=0.326, and there was no statistically significant difference between the detection rate of basal cell carcinoma by A physician and pathological examination(P>0.05); 28 cases of pigmented basal cell carcinoma were confirmed by B physician, the accuracy, misdiagnosis rate, the rate of missed diagnosis, sensitivity, specificity and Youden index were 89.3%, 36.4%, 4.0%, 90.6%, 25.0% and 59.6%, respectively, B physician diagnosed Kappa index was 0.465, P=0.496, and there was no statistically significant difference between the detection rate of basal cell carcinoma by A physician and pathological examination(P>0.05). Conclusion Dermoscopic diagnosis of head facial pigmented basal cell carcinoma can achieve examination consistent with pathology; the diagnostic is speedy, convenient and noninvasive, which has important clinical value. Key words: Dermoscopic; Pigmented basal cell carcinoma; Diagnostic methods; Pathological examination

Risk factors for recurrence of facial basal cell carcinoma after surgical excision: A follow-up analysis

Several tumour features and surgical factors have been implicated in an increased risk of BCC recurrence after excision; however, there are limited data on facial lesions specifically. This study sought to evaluate risk factors of facial BCC, which may influence future treatment and follow-up regimes. Facial BCCs excised from a single surgeon practice over a 2-year period were included in the study. Data pertaining to patient demographics, lesion depth of invasion, surface area, excision margins, perineural infiltration, location, previous history of recurrence, histological subtype and ulceration were extracted. A search of recurrence was conducted over the following 70-80 months. In total, 331 cases of facial BCC were included, and 10 lesions recurrences (3%) were identified within the observation period. Infiltrative (p=0.02) and micronodular (p=0.04) subtypes as well as incomplete or close (within 1mm) peripheral (p=0.01) and deep excision margins (p=0.04) were significantly associated with tumour recurrence. Five of the 10 recurrent lesions had been re-excised for a recurrence previously, placing them at much greater risk of future recurrence (p=0.00). Incomplete and close excision margins, infiltrative and micronodular subtypes and previous excision are strong risk factors for facial BCC recurrence. Although depth of invasion, perineural infiltration, ulceration and surface area may indicate the aggressive nature of a lesion, the results suggest that with adequate excision margins, these factors may not influence the recurrence rate. The strongest risk factor was a lesion having already recurred after previous excision, and it suggested that these lesions be treated with particular caution and a closer follow-up regime be employed.

Oncoplasty: how to start and experience from Yogyakarta

Abstract Reconstruction surgery after tumor removal is increasingly essential because of changes in patient expectations and demand. With the advance of early screening and detection, our ability to detect early stage cancer is significantly improved. Reconstruction is mostly suitable in patients with early stage cancer. In addition, there is growing ability that that immediate reconstruction in particular selected patients can be performed in a single time operation combining oncological and aesthetic procedures with considerably excellent result. With the implementation of full coverage insurance by BPJS, most oncological surgery including in breast cancer will be performed by general surgeon in regency hospital. Reconstruction in selected patients usually is performed as delayed procedure by plastic surgeon. With the advance in surgical oncology training, breast surgery should be performed by surgical oncologist with specific oncoplasty training that can offer immediate reconstruction with both extensive removal tumor and reconstruction. Therefore, training in oncoplasty is very important for surgical oncologist. In Yogyakarta, we performed reconstruction after surgery of breast tumor, thyroid cancer, radical neck dissection and facial basal cell carcinoma with relatively excellent results. Further training and innovation are required to improve this early stage oncoplasty practice in Yogyakarta. Keywords :

Adherence to recording the minimum data set in the histological reporting of facial basal cell carcinomas

Adherence to recording the minimum data set in the histological reporting of facial basal cell carcinomas

Clinical and pathologic parameters predicting recurrence of facial basal cell carcinoma: a retrospective audit in an advanced care center.

This study was designed to investigate the associations between clinical, pathologic, and therapeutic parameters of facial basal cell carcinoma (BCC) and recurrence rates in patients treated at an advanced care center. A retrospective cohort study was performed. Patients who presented to an advanced care center within a 6-year period with facial BCC and who received surgical treatment were included for further review according to predefined inclusion criteria. The predictor variable was defined as "negative-margin (R0) resection after the first surgery". The primary outcome variable was defined as "BCC recurrence". Descriptive and inferential statistics were computed. The significance level was set at P ≤ 0.05. A total of 71 patients (29 female, 42 male; average age: 71.76 years) were found to meet all of the study inclusion criteria. All BCCs had been referred, and 50.7% had been submitted to previous surgery. The mean ± standard deviation tumor diameter was 2.3 ± 1.8 cm. Recurrence of BCC was observed in 11 patients (15.5%). Large tumor diameters, increased patient age, and failure to achieve R0 resection at the first surgical appointment significantly increased recurrence rates. Complete facial BCC excision at the first surgical appointment is pivotal in reducing the likelihood of recurrence. The influence of the anatomic location of facial BCC on recurrence rates may be limited.

Surgical Treatment of Facial Basal Cell Carcinoma: Patient-Based Assessment of Clinical Outcome in a Prospective Cohort Study

Background: There are limited data on the esthetic, functional, and morphological outcomes of surgical treatment of facial basal cell carcinoma (BCC). Objective: The aim of our study was to assess the determinants of the evaluation of both the patients and the investigator of the esthetic, functional, and morphological impact of the surgical treatment of facial BCC. Methods: A prospective observational study evaluated 111 patients treated surgically for facial BCCs (n = 135 BCCs), using the Patient and Observer Scar Assessment Scale (POSAS), a validated and reliable scale designed for the evaluation of all types of scars by professionals and patients. Results: Scar assessment rated by the patients was very good. Skin aging was associated with a better surgical outcome as evaluated by POSAS (OR = 0.30, 95% CI: 0.09-0.98; p = 0.04). Conversely, histologically infiltrative or sclerosing BCC (OR = 2.33, 95% CI: 0.95-5.71; p = 0.06) was independently associated with poorer POSAS. In terms of the investigator's evaluation, aging signs (protective factor: OR = 0.17, 95% CI: 0.04-0.73; p = 0.01), location on the H-zone of the face (risk factor: OR = 2.95, 95% CI: 1.07-8.15; p = 0.03), and histologically infiltrative or sclerosing BCC (risk factor: OR = 2.89, 95% CI: 1.01-8.29; p = 0.04) were independently associated with POSAS. Conclusion: Esthetic, functional, and morphological outcomes of facial BCC surgery provide high patient satisfaction overall. Taking wider margins requires specific measures to improve the surgical outcome.