Facial Basal Cell Carcinoma Research Articles

Surgical Management of Facial Basal Cell Carcinoma: A Case Report Emphasizing the Need for Individualized Margin Assessment

Surgical Management of Facial Basal Cell Carcinoma: A Case Report Emphasizing the Need for Individualized Margin Assessment

Quality of Life in Patients Affected by Facial Basal Cell Carcinoma: Prospective Longitudinal Pilot Study and Validation of Skin Cancer Index in Lithuanian Language.

Facial basal cell carcinoma (BCC) poses significant challenges due to its potential for local destruction and impact on quality of life (QoL). Continuous research is necessary to identify novel factors influencing the quality of life within this demographic across diverse cultural settings. The aims of this study were to translate, culturally adapt, and validate the Lithuanian version of Skin Cancer Index, subsequently utilizing this questionnaire in the pilot phase of the study to achieve the following: (1) identify the differences in short- and long-term QoL, (2) establish empirical correlations between SCI scores and aesthetic facial regions, evaluate the potential differences between age, gender, and tumor size groups. A prospective longitudinal study was conducted with 100 consecutive patients. The SCI was translated into Lithuanian language, with a rigorous assessment of its psychometric properties to confirm validity. Alongside hypothesis testing, a detailed analysis of variables was conducted. Statistical techniques, including t-tests and ANOVA, were employed to compare scores across demographic and clinical groups, with effect size calculations for further interpretation. Our findings demonstrate that the Lithuanian SCI successfully fulfills the criteria established by the COSMIN checklist. Surgical treatment for facial BCC notably enhances QoL, particularly evident six months post-surgery. Analysis of SCI scores identified demographic and clinical factors associated with lower QoL, including female gender, treatment with skin plasty, and tumor sites in aesthetically sensitive areas like the cheek, nose, and eyelid. The Lithuanian version of the SCI is a reliable and valid tool for assessing QoL in facial BCC patients. Our findings underscore the global relevance of understanding the multifactorial influences on QoL in BCC patients. Early diagnosis, less invasive treatment approaches, and tailored post-operative care are crucial in minimizing the psychological, social, and appearance-related burdens of facial BCC.

High-Dose-Rate Brachytherapy for Treatment of Facial Skin Cancers: Local Control, Toxicity, and Quality of Life in 67 Patients.

While treatment of localized cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) is based on surgery, brachytherapy, which delivers a high dose of radiation to tumor tissue while sparing healthy tissue, is an alternative. Since the withdrawal of iridium wires from the market, brachytherapy has mainly been performed with high-dose-rate iridium-192 (HDR). This study evaluated the efficacy of HDR brachytherapy in terms of local control, survival, toxicity, and quality of life in patients with facial periorificial cutaneous SCC or BCC treated in our center between 2015 and 2021. Sixty-seven patients were treated for SCC (n = 49) or BCC (n = 18), on the nose (n = 29), lip (n = 28), eyelid (n = 7), or ear (n = 3). The majority had Tis or T1 tumors (73.1%). After a median follow-up of 28 months, 8 patients had a local recurrence. The local control rate at 3 years was 87.05% (95% CI 74.6-93.7). All patients developed grade 1-2 acute radio-mucositis or radiodermatitis and one experienced reversible grade 3 acute radio-mucositis. Of the 27 patients who completed the quality-of-life questionnaire, 77.8% recommended the treatment. This study confirms that HDR brachytherapy for facial cutaneous carcinomas provides good local control, good tolerance, and satisfactory functional outcome.

Importance of Both Clinical and Dermoscopic Findings in Predicting High-Risk Histopathological Subtype in Facial Basal Cell Carcinomas.

Being able to recognize high-risk facial basal cell carcinoma (BCC) may lead to fewer incomplete excisions and inappropriate treatments. We sought to investigate clinical and dermoscopic criteria for predicting facial BCC subtypes, analyze the interobserver agreement between readers, and develop a diagnostic algorithm to predict high-risk histopathological subtype. In this single-center, retrospective investigation, 6 independent readers evaluated predefined clinical and dermoscopic criteria in images of histopathologically verified primary facial BCCs including: topography, border demarcation, vessels, ulceration, white porcelain areas, shiny white blotches and strands, and pigmented structures and vessels within ulceration. Overall, 297 clinical and dermoscopic image pairs were analyzed. The strongest associations with high-risk subtype were: "bumpy" topography (OR 3.8, 95% CI, 3.1-4.7), ill-defined borders (OR 3.4, 95% CI 3.1-4.7), white porcelain area (OR 3.5, 95% CI 2.8-4.5), and vessels within ulceration (OR 3.1, 95% CI 2.4-4.1). Predominantly focused vessels were a positive diagnostic criterium for either nodular (OR 1.7, 95% CI 1.3-2.2) or high-risk (OR 2.0, 95% CI 1.6-2.5) subtypes and a strong negative diagnostic criterium for superficial BCC (OR 14.0, 95% CI 9.6-20.8). Interobserver agreement ranged from fair to substantial (κ = 0.36 to 0.72). A diagnostic algorithm based on these findings demonstrated a sensitivity of 81.4% (95% CI, 78.9-83.7%) and a specificity of 53.3% (95% CI, 49.7-56.9%) for predicting high-risk BCC subtype. Integration of both clinical and dermoscopic features (including novel features such as topography and vessels within ulceration) are essential to improve subtype prediction of facial BCCs and management decisions.

Aesthetic Evaluation of Facial Scars in Patients Undergoing Surgery for Basal Cell Carcinoma: A Prospective Longitudinal Pilot Study and Validation of POSAS 2.0 in the Lithuanian Language.

Facial basal cell carcinoma (BCC) surgery enhances the quality of life (QoL) but leaves patients with inferior QoL, presumably caused by scarring, emphasizing the need to understand post-surgery aesthetic satisfaction. This study aimed to validate the Lithuanian version of the Patient and Observer Scar Assessment Scale (POSAS) 2.0 and utilise it to identify scar evaluation differences and correlations among POSAS scores and specific aesthetic facial regions, age, gender, surgery types, and short- and long-term QoL. Employing a prospective longitudinal design, 100 patients with facial scars after surgical BCC removal were enrolled. The validation phase confirmed the translated POSAS 2.0 psychometric properties, while the pilot phase used statistical analyses to compare scores among demographic and clinical groups and evaluate correlations between scar assessment and QoL. The findings indicate that the translated Lithuanian version of POSAS 2.0 exhibits good psychometric properties, revealing insights into aesthetic satisfaction with post-surgical facial scars and their impact on QoL. The Lithuanian version of the POSAS 2.0 was established as a valid instrument for measuring post-surgical linear scars. QoL with scar assessment statistically significantly correlates, 6 months after surgery, with worse scores, particularly notable among women, younger patients, and those with tumours in the cheek region.

Can the Safe Surgical Margin Be Narrowed in Early-Stage Facial Basal Cell Carcinoma?

To examine factors that affect the positive surgical margins of facial basal cell carcinoma (BCC) and investigate whether the surgical margin value can be narrowed in early-stage facial BCCs. Ninety-five patients were divided into the three groups based on prognosis: good (n = 48), mixed (n = 32), and poor (n = 15). The good prognosis group (group 1) included nodular and superficial subtypes; the mixed prognosis group (group 2) included nodular-infiltrative, nodular-micronodular, and nodular-sclerosing subtypes; and the poor prognosis group (group 3) included infiltrative and micronodular subtypes. Groups 1 and 2 differed from each other significantly in terms of positive surgical margin (P = .002) and tumor thickness (P = .008), but group 3 did not (P = .851 and P = .804, respectively). With regard to surgical method (primary vs local flap repair), only tumor localization varied significantly (P < .001). Groups differed significantly in terms of surgical margin positivity, the distance of the tumor to the surgical margin, and the tumor thickness. The intact surgical margin was 2 mm on average in this study, and the authors suggest that it may be possible to revise the surgical margin values recommended in the literature.

Advances in Diagnosis and Treatment of Basal Cell Carcinoma.

Basal cell carcinoma (BCC) is one among the most prevalent malignant neoplasms that has exhibited a notable surge in global incidence over recent decades. This slow-growing malignancy is typified by its localized invasiveness while demonstrating an exceedingly rare metastatic proclivity. It predominantly afflicts the sun-exposed skin of aging individuals, with a heightened predilection for the maxillofacial region. Scraping cytology offers numerous benefits, including the potential for an earlier diagnosis and the absence of scarring, as opposed to a biopsy. The cytodiagnosis of BCC proves to be straightforward with various techniques, making it highly advantageous in an outpatient environment as a swift diagnostic method when planning a surgical excision. Our study sought to scrutinize the clinicopathological facets of BCC within the maxillofacial region. We compared advanced cytological techniques for diagnosis, including scraping, scratching, and imprinting using Papanicolau and Diff-Quick stains. In addition, we evaluated the therapeutic effectiveness of diode lasers operating at wavelengths of 940nm and 980n. A retrospective analysis was undertaken, encompassing facial BCC lesions smaller than 2.5cm in diameter that underwent treatment through diode laser ablation between September 2021 and August 2023 at Ramadi Teaching Hospital and a private clinic in Ramadi City, Iraq. Among the cohort of 48 patients with BCC, a majority (58%) were 50 years of age or older, with a predominance of males (62%). The mean duration of lesion existence exceeded 4 months. The anatomical region most commonly involved was the middle 1/3 of the face, accounting for 34% of cases. Intriguingly, the therapeutic approach of diode laser ablation yielded exceptional esthetic and functional outcomes, which were consistently observed throughout the follow-up period post-healing. The occurrence of complications following diode laser ablation was relatively infrequent. This investigation revealed that cytological examination is easily conducted, eliminating the need for local anesthesia, saving time, being more cost-effective than a conventional biopsy, and delivering swift diagnoses. The process of smear-taking for cytology is well-tolerated, inflicting minimal trauma or discomfort on the patient. BCC predominantly afflicts elderly males and most frequently affects the middle third of the face. Notably, nodular BCC emerged as the prevailing histological subtype. The use of diode laser ablation exhibited a commendable track record, producing exemplary functional and esthetic outcomes over a 6-month follow-up period.

Bilobed flap utility for local defects due to facial basal cell carcinoma. Case reports. Instituto de Prevision Social

El carcinoma basocelular, es una patología de presentación frecuente centros nacionales de referencia. La región del ala nasal sufre una des- ventaja con respecto a otras regiones del cuerpo debido a su exposición prolongada a la luz solar. Pero, estos tumores son de buen pronóstico en general. La falta de diseminación linfática y de metástasis a distancia los hacen bastante controlables. El colgajo bilobulado representa una excelente opción para defectos pequeños en esta región, es práctico y deja resultados estéticos excelentes.

Preoperative evaluation of high-risk basal cell carcinoma with line-field confocal optical coherence tomography (LC-OCT) reduces Mohs micrographic surgery stage number: A case-control study

BackgroundMohs micrographic surgery (MMS) is the preferred surgical approach for high-risk basal cell carcinoma (BCC). Pre-surgical tumor margins delineation with line field confocal optical coherence tomography (LC-OCT) is expected to reduce MMS stages number. Objectiveto investigate the effectiveness of LC-OCT preoperative evaluation of high-risk BCC margins in reducing the number of MMS stages to achieve tumor clearance. Patients and methodshigh-risk BCC patients undergoing MMS at Policlinico A. Gemelli Foundation, IRCCS – Rome during January 2018 – December 2022. The LC-OCT group included patients undergoing preoperative lateral tumor margin demarcation by clinical, dermoscopic, and LC-OCT examination; patients in the control group underwent preoperative lateral tumor margin demarcation by clinical and dermoscopic examination only. LC-OCT imaging was compared to MMS histopathological sections. Results63 facial high-risk BCCs from 60 patients, mean age of 68.3 years (SD 11.9). The LC-OCT and the control group included 22 and 41 BCCs, respectively. LC-OCT imaging showed almost perfect agreement with histopathology for low- versus high-risk of recurrence BCC histopathological subtypes discrimination (Cohen’s kappa 0.88). We reported a significant difference in the mean number of MMS stages between the LC-OCT and the control group (1.23 ± 0.43 SD, and 1.89 ± 1.05 SD, respectively; p-value =0.007). At univariate regression analysis, LC-OCT preoperative mapping of BCC tumor margins significantly reduced patients’ risk of undergoing >1 MMS stage (crude odds ratio [ORc]: 0.3 95% CI 0.1–0.8, p-value =0.032). ConclusionLC-OCT preoperative evaluation of high-risk BCC margins significantly reduced the number of MMS stages to achieve tumor clearance.

Giant neglected unresectable ulcerated basal cell carcinoma of face: Radiotherapy at rescue

Abstract Basal cell carcinomas are typically considered indolent and slowly progressing tumors, but giant basal cell carcinomas are more aggressive with more risk of invasion and poor prognosis. management of such giant BCCs is difficult due to difficulty in surgical approach. we hereby reporting a case of giant ulcerated BCC of face treated with radiotherapy as a rescue treatment.

Reconstructive Options for Basal Cell Carcinoma Defects in the Head and Neck Region: An Institutional Experience.

Basal cell carcinoma (BCC) is the most common skin cancer with more than 80% occurring on the face occurring mainly due to exposure to ultraviolet rays in the elderly due to cumulative exposure of the UV rays during their lifetime. Though various treatment modalities are available for the treatment of basal cell carcinomas, wide local excision is the standard line of management. However, reconstruction of facial BCC poses a challenge to the reconstructive surgeon. Over a 4-year-old period from 2017 to 2021, a total of 30 patients of head and neck basal cell carcinoma were surgically excised in our institution. We have explored all modes of reconstruction from small to large BCC defects in terms of cosmesis, form and function. Four patients underwent primary closure, 8 patients underwent skin grafting, 13 patients underwent closure by local and advancement flaps and 5 patients with large defects underwent free flap reconstruction. No flap loss was reported. None reported any functional deficit. To achieve adequate aesthetic surgical outcomes after reconstruction, knowledge of facial aesthetic regions is of utmost importance. The size and location of the defect and the presence of vital structures adjacent to the defect should be assessed to determine the kind of reconstruction that should be carried out without adversely affecting adjacent structures. For greater patient satisfaction, the method of reconstruction should be tailor made, where donor tissue resembles native tissue with good contour and texture match, suture line scars are camouflaged, and complications are nil.

Recurrence of Basal Cell Carcinoma Treated with Surgical Excision and Histopathological Analysis with Frozen Section Technique with Complete Margin Control (CMC-FS): A 15-Year Experience of a Reference Center.

Basal cell carcinoma (BCC) is the most common type of eyelid malignancy and it is considered to be dangerous due to its proximity to functionally essential organs. Early diagnosis and complete excision of the primary lesion are crucial to prevent infiltration and metastasis. The study aims to evaluate the extent of recurrence in subjects affected by BCC of the upper third of the face treated with surgical eradication and the frozen section technique with complete margin control (CMC-FS), in comparison with the gold standard Mohs micrographic surgery (MMS). The study included 111 patients with 111 biopsy-proven eyelid BCCs. On clinical examination, all lesions were removed with 2 mm margins clinically free of neoplasm. Prior to reconstruction, CMC-FS analysis of all surgical margins was performed on each tumor for histopathologic confirmation. Subsequently, all margins were presented for the permanent paraffin sections. There were 69 primary carcinomas and 42 secondary carcinomas among the 111 samples. No recurrence occurred in 109 tumors followed-up for at least 5 years, with a total recurrence rate of 1.8%. The median time between lesion excision and diagnosis of recurrence was 20 months. at 5-year follow-up, CMC-FS guided excision of BCCs of the eyelids resulted in recurrence rates equivalent to MMS. Intraoperative microscopic control of all margins reduced the recurrence rate of the upper third of the facial BCCs, correlating with easier reconstruction with better esthetic and functional outcome.

DS24 Prospective study comparing ex vivo confocal laser scanning microscopy and frozen section histopathology of 23 basal cell carcinomas treated with Mohs micrographic surgery

Abstract Ex vivo confocal laser scanning microscopy (CLSM) is an emerging technique that is used for the rapid analysis of freshly excised tissue during Mohs micrographic surgery (MMS). Previous studies on fluorescence CLSM have shown 88% and 99% sensitivity and specificity, respectively, of diagnosing basal cell carcinomas (BCCs) vs. conventional histology. The fourth-generation Vivascope 2500 allows fresh tissue to be scanned after minimal preparation with acetic acid and acridine orange, creating digitally coloured mosaic images, mimicking conventional histological haematoxylin and eosin slides. The scanning speed of &amp;lt; 3 min creates the potential to improve patient experiences, allowing multiple stages and repair in a single session, reducing overall operating times and improving efficiency. After a 2018 pilot study on a limited case series, we have begun the process of testing the real-world use of this technology. We present an initial prospective case series to assess BCC excision of stage 1 Mohs specimens using the Vivascope 2500 vs. conventional frozen section histology. Caldicot approval was sought. Over a 3-month period, 23 cases of stage 1 facial BCCs on one Mohs list were processed. Samples were obtained as standard bevelled Mohs excisions, and Mohs maps were created for all cases. There were three false-negative BCCs, of which two were infiltrative BCCs with small foci missed on the initial review on CLSM images and one superficial BCC not visible due to lack of epidermal capture. Of the four false-positive cases, the foci appearing to be BCC included inflammation in one, follicular structures in two and conjunctival glands misinterpreted as BCC in one eyelid case. Time taken to process specimens and read the digital images by CLSM was compared with the time taken to obtain and read frozen section slides. The shortest time recorded for CLSM and frozen sections was 6 min and 31 min, respectively. The longest time recorded for CLSM and frozen sections was 20 min and 57 min, respectively. In summary, CLSM shows promise in MMS for selected BCCs. Improved techniques to flatten the epidermis for better visualization and further experience with image reading and interpretation have the potential to minimize errors.

A critical re-evaluation of Mohs micrographic surgery for a facial basal cell carcinoma in older adults: Should we waive this treatment in certain patients?

Skin cancer incidences are increasing. Treatment for basal cell carcinomas (BCCs) can be questioned in certain patients. Treatment options are various, but Mohs micrographic surgery (MMS) has the highest cure rate. It is, however, time-consuming and results in high logistical burden and treatment costs for both patients and society. This study critically re-evaluates MMS for facial BCCs in older adults. The main objective is to examine all clinical, tumour and patient characteristics in relation to safety and survival to detect a subgroup in which MMS was not the best choice. The overall aim is to identify characteristics that support clinical decision-making in daily practice. Patients that received MMS between November 1998 and December 2012 were included. Only patients >75 years with a facial BCC were withheld for analysis. This is a retrospective cohort study, since evaluating the outcome of MMS in accordance with life expectancy is the main objective. Patient charts were evaluated towards comorbidities, complications and survival. This cohort comprises 207 patients. Median survival was 7.85 years. The age-adjusted Charlson comorbidity index (aCCI) was divided into low/medium scores (aCCI < 6) and high scores (aCCI ≥ 6). Median survival was 11.58 years in the low aCCI group and 3.60 years in the high aCCI group (p < 0.001). There was a very strong association between high aCCI and survival (HR, 6.25; 95% CI, 3.83-10.21). Other characteristics were not associated with survival. Clinicians should assess the aCCI in older patients presenting with a facial BCC before deciding if MMS is an eligible treatment option. High aCCI has shown to be an indicator for low median survival, even in MMS patients with usually high functional status. MMS should be waived as treatment in older patients with high aCCI scores in favour of other, less intensive and less expensive treatment options.

Results of local flaps of the face for reconstruction after wide local excision in facial basal cell carcinoma

Background: Basal cell carcinomas (BCCs) are the most common skin cancers of the face. Surgical treatment must ensure safe surgical margins and effects in functional and cosmetic aspects. Therefore, the selection of surgical excision and postoperative reconstruction methods remains a challenge in treatment. Methods: We conducted a prospective descriptive clinical intervention study with 34 patients with basal cell carcinoma of the face (35 lesions) who met the inclusion and exclusion criteria of local flaps of the face for reconstruction after wide local excision in facial basal cell carcinoma at Hue University of Medicine and Pharmacy Hospital from January 2017 to April 2021. Results: The most common sites of tumor were nose and cheek (68.5%); with clinical features mostly non-healing ulcers (54.3%). The safe surgical margins were 2-10mm in 94.3% of cases. The functional outcome was 100% satisfactory and the aesthetic result was good in 91.4% of patients, with a low complication rate (5.7%) and no recurrence, metastasis was recorded after 19.5 months of follow-up. Conclusions: 2 to 10 mm margins of wide local excision and reconstruction by local flap ensures safety and aesthetics in the surgical treatment of facial basal cell carcinomas Key words: skin cancer, basal cell carcinomas, facial area, wide local excision, local flap

Optical coherence tomography for presurgical delineation of basal cell carcinomas on the face-A comparison with histopathology.

To minimize the risk of incomplete excision of basal cell carcinomas (BCC) the macroscopic tumor margins should be adequately defined. Optical coherence tomography (OCT) is a non-invasive imaging tool that can provide structural and vascular information about skin cancer lesions. The study objective was to compare the presurgical delineation of facial BCC by clinical examination, histopathology, and OCT imaging in tumors undergoing full excision. Ten patients with BCC lesions on the face were examined clinically, with OCT and histopathology at 3-mm intervals, from the clinical lesion border and beyond the resection line. The OCT scans were evaluated blinded and a delineation estimate of each BCC lesion was made. The results were compared to the clinical and histopathologic results. OCT evaluations and histopathology were in agreement in 86.6% of the collected data points. In three cases the OCT scans estimated a reduction of the tumor size compared to the clinical tumor border set by the surgeon. The results of this study support the notion that OCT can have a role in the clinical daily practice by aiding clinicians in delineating BCC lesions before surgery.

Facial basal cell carcinoma: A retrospective study of 67 cases.

Basal cell carcinoma (BCC) is a slow-growing malignant tumor characterized by local invasiveness but an exceptionally rare metastatic potential. It ideally affects sun-exposed skin of older patients with more propensity for the facial region. To evaluate the different clinicopathological characteristics of the facial BCC and the efficacy and safety of diode laser for the treatment of these lesions. We retrospectively reviewed facial BCC lesions of < 1.5 cm in diameter and subjected them to diode laser ablation during the period from September 2016 to August 2021 at Al-Ramadi Teaching Hospital, Ramadi City, Iraq. Data matching the age, gender, duration, site, and clinical and histological types were registered for every subject. The functional and aesthetic outcomes and complications following diode laser ablation for each patient were also recorded. Of 67 patients with facial BCC, there was 65.67% from the age group ≥ 60 years and 58.21% males. The mean duration of the lesions was 5.15 ± 1.836 mo. The most involved location was the nose (29.85%). About half of the cases belong to the noduloulcerative type. Solid histological type comprises 40.3% of the cases, while the least was keratotic (13.4%). Moreover, 65.2% of the solid cases were from the age group ≤ 60 years and 38.6% of the adenoid type from the age group > 60 years (P value = 0.007). Excellent aesthetic and functional outcomes were reported in all cases after 6 mo of follow-up. Few complications were reported after diode laser ablation. Facial BCC was mostly seen in the elderly and men. The mean duration was 5.15 mo. The nose was the commonest involved site. Noduloulcerative lesions were seen in approximately half of the lesions. The age of the patients determined the histological type of the lesion (solid type was mostly seen in the age group ≤ 60 years, while, adenoid in the age group > 60 years). Diode laser ablation showed excellent functional and aesthetic outcomes following a 6-mo follow-up.

Basal Cell Carcinoma in Xeroderma Pigmentosa: Reduced CD1a Expression as a Sensitive Predictor of Recurrence.

Xeroderma pigmentosa (XP) is a rare genetic disorder that is characterized by defective DNA repair after ultraviolet induced damage with a great tendency for recurrent cutaneous malignancies including basal cell carcinoma (BCC). BCC is frequently linked to impaired local immune response with a major role played by Langerhans cells (LCs). The current study aims at investigating LCs in BCC specimens of XP and non-XP patients, in a trial to study its possible impact on tumor recurrence. It included 48 retrospective cases of primary facial BCC (18 for XP patients and 30 for non-XP controls). Each group was subdivided, based on the 5 years follow-up data, into recurrent and non-recurrent BCC groups. LCs were assessed immunohistochemically using the sensitive marker; CD1a. Results showed significantly reduced LCs count (intratumoral, peritumoral, and in perilesional epidermis) in XP patients compared with non-XP controls ( P ˂0.001 for all). Intratumoral ( P =0.008), peritumoral ( P =0.005), and perilesional epidermal ( P =0.02) LCs mean values were significantly lower in recurrent versus non-recurrent BCC specimens. Also, within each group (XP and controls), LCs were of significantly lower means in recurrent versus non-recurrent cases ( P ≤0.001 for all). Regarding recurrent BCC cases, peritumoral LCs showed a significant positive correlation with 1ry BCC duration ( P =0.05). Also, intratumoral and peritumoral LCs correlated positively with BCC relapse interval ( P =0.04 for both). Among non-XP controls, periocular tumors had the least LCs count (22.00±3.56), whereas tumors located in the rest of the face had the greatest count (29.00±0.00) ( P =0.02). Sensitivity and specificity of LCs to predict BCC recurrence in XP patients reached 100% in intartumoral area and perilesional epidermis when cutoff points were less than 9.5 and 20.5, respectively. In conclusion; reduced LC count in primary BCC specimens of XP patients and also in normal subjects could help to predict its recurrence. Thus, it might be identified as a risk factor for relapse to apply new strict therapeutic and preventive measures. This presents new avenue for the immunosurveillance against skin cancer relapse. However, being the first study to investigate that link in XP patients recommends further research to confirm.

Reconstruction of Defects Following Excision of Basal Cell Carcinoma of Face: A Subunit-based Algorithm.

Basal cell carcinoma (BCC) is a locally invasive, slowly spreading tumor arising in the basal layer of epidermis and rarely metastasizes. Surgical excision with adequate margins is curative. Reconstruction of post-excisional defects on the face is both essential and challenging. A retrospective review of hospital records for patients operated for BCC of the face excluding the pinna at our institute in the last 3 years was done and a review of the literature was carried out to identify the most common principles governing the optimal reconstruction of post-excisional defects on the face. Literature search was made in Embase, Medline, and Cochrane databases in the last two decades with the filters placed for human and English language studies with the search terms (Facial Basal cell carcinoma) AND reconstruction AND (Humans[Mesh]). Records of 32 patients with facial BCC who underwent excision and reconstruction at our hospital were identified and details were recorded. Our literature search with the terms and filters mentioned above revealed 244 studies with duplicates removed. After further hand-searching, 218 journal articles were identified, reviewed, and a reconstruction algorithm was designed based on the findings. Reconstruction of post-BCC excisional defects of the face relies on an adequate understanding of the general principles of reconstruction, subunit principle of facial esthetics, flap anatomy and vascularity as well as operator experience. Complex defects need innovative solutions, multidisciplinary approaches, and newer methods of reconstruction like perforator flaps and newer techniques like supermicrosurgery. Multiple reconstructive options for post-excisional defects of the BCC over the face are available and most defects can be approached in an algorithmic manner. Further well-designed prospective research studies are needed to compare outcomes of different reconstructive options for a given defect and identify the most suitable options.

The Feasibility of Immunocryosurgery in the Treatment of Non-Superficial, Facial Basal Cell Carcinoma That Relapsed after Standard Surgical Excision: An Experience Report from Two Centers.

In this retrospective, chart review study, we evaluated the feasibility of immunocryosurgery in facial, non-superficial basal cell carcinomas (BCC) that had relapsed after standard surgery. Inclusion criteria were (a) 'biopsy confirmed relapse of facial BCC', (b) known 'calendar year of surgical excision(s)', and (c) 'relapse within 10 years after the last surgical excision'. Tumors treated from 1 January 2011 to 31 December 2020 with a standard 5-week immunocryosurgery cycle (daily imiquimod application for 5 weeks and a cryosurgery session at day 14) were included. Descriptive statistics, Kaplan-Meier method, and Cox proportional hazards model were calculated with significance at p < 0.05. From the n = 27 BCC evaluated, n = 20 (74.1 ± 8.4%) cleared after one immunocryosurgery cycle. Two of the remaining cases cleared completely after a repeat cycle, one patient favored surgery, and four BCC did not clear despite additional immunocryosurgery cycles (feasibility 81.5 ± 7.5%). Of the 22 tumors with clinical outcome 'complete clearance with immunocryosurgery', three BCC relapsed at 9, 28, and 50 months. Overall, the 5-year treatment efficacy rate was 60.2 ± 13.4% (mean follow-up 94.6 ± 15.1 months). In total, 20/27 BCC relapses after surgery (74.1%) were tumor-free at the end of personalized follow-up times (66.7 ± 12.4% tumor free patients at 5-year follow-up). Number of tumor relapses before immunocryosurgery was the single predictor of tumor progression after immunocryosurgery (p = 0.012). Conclusively, immunocryosurgery could be further evaluated as an alternative, definitive treatment of selected facial BCC relapsing after surgery.