Features Of Basal Cell Carcinoma Research Articles

Nuclear morphometry and chromatin textural characteristics of basal cell carcinoma

Histological subtypes of basal cell carcinoma have biological, evolutionary and distinct prognostic behavior. The analysis of characteristics of the nucleus can provide data on their cellular physiology and behavior. The authors of this study evaluated nuclear morphological parameters and textural patterns of chromatin from different subtypes of basal cell carcinoma: nodular (n=37), superficial (n=28) and sclerodermiform (n=28). The parameters were compared between neoplasms' subtypes and with unaffected adjacent basal epithelium. Nuclear area and diameter of sclerodermiform neoplasms were superior to the other subtypes. Chromatin's color intensity and fractal dimension were less intense in superficial subtypes. Nuclear roundness and chromatin's entropy presented lower values in tumors than in normal epithelium. There was significant correlation between morphological and textural variables of normal skin and tumors. Morphometric elements and textural chromatin's homogeneity of basal cell carcinomas may be related to evolutionary, biological and behavior particularities related to each histotype.

Clinical, Histological and Dermoscopic Findings in Familial Cylindromatosis: a Report of Two Cases

Abstract Cylindromas are benign appendage tumors mainly found on the scalp, but they can occur on any hair-bearing skin. Mutations in the cylindromatosis (CYLD) gene, a tumor suppressor gene located on chromosome 16q12–13, are responsible for multiple cylindromas, which are usually inherited in an autosomal dominant way, as in familial cylindromatosis and Brooke-Spiegler syndrome. The latter is characterized by the presence of multiple cylindromas, multiple trichoepitheliomas and spiradenomas. Based on genetic studies and the identification of heterozygous mutations in the same CYLD gene in familial cylindromatosis, multiple familial trichoepitheliomas, and the Brooke–Spiegler syndrome, it is suggested that these three conditions have the same genetic basis and are phenotypic expressions of the same disease. The diagnosis of each of the tree conditions is based on the dominant tumor type: cylindroma in familiar cyindromas, trichoepithelioma in multiple familial trichoepitheliomas, or a variety of skin appendage tumors including cylindromas, spiradenomas and trichoepitheliomas in Brooke-Spiegler syndrome. The onset of the disease is usually in the early adulthood, but may also occur in childhood or adolescence. We report on two sisters, 37 and 43 years of age, with multiple cylindromas on the face and the scalp. Both patients reported that their mother also had multiple tumors on her head. Dermoscopy revealed arborizing vessels on a white-ivory or pink background, resembling dermoscopic features of basal cell carcinoma, though histopathological analysis revealed cylindroma. In conclusion, in this study we report two cases of a very rare familial cylindromatosis, presenting with multiple benign cylidromas with dermoscopic features of basal cell carcinoma. All patients with multiple cylindromas in familial cylindromatosis should be counseled about increased risk for developing further tumors. Systemic and multidisciplinary approach with follow up is strongly recommended.

Clinical characteristics of basal cell carcinomas of the dorsal hand: A 7-year, single institution retrospective review

Clinical characteristics of basal cell carcinomas of the dorsal hand: A 7-year, single institution retrospective review

Basosquamous Carcinoma of the Head and Neck: Clinical and Histologic Characteristics and Their Impact on Disease Progression

OBJECTIVES: Basosquamous carcinoma (BSC) is a rare tumor entity, and the most common onset is in the head and neck region (BSC-HN). The data on diagnosis, treatment, and especially risk assessment concerning disease course and outcome are deficient or inconsistent. This study aimed to evaluate risk factors for local relapse (LR) and lymph node metastasis (LNM) and their impact on progression-free survival (PFS). MATERIALS AND METHODS: In a retrospective monocentric study, patients with BSC-HN treated between 1999 and 2011 were analyzed regarding clinical and histologic characteristics. Prognostic parameters for LR, LNM, and PFS were evaluated. In total, 89 patients (55 male, 34 female, mean age of 71.8 years) with a mean follow-up time of 47.7 months (range 12-112) were included. RESULTS: LR occurred in four patients (4.5%), LNM occurred in five patients (5.6%). Patients with LNM had a significantly shorter PFS time (16.1 months) compared with patients without LNM (154.2 months; P < .001). Tumor depth and size (T classification), incomplete resection, localization at the ear, deep maximal vertical infiltration, muscle and vessel invasion all showed significant (P < .05) associations with LR, LNM, and shorter PFS time. BSC showed more histologic features of basal cell carcinoma (BCC), especially with regard to BerEP4 expression. CONCLUSION: While histology shows some typical characteristics of BCC, the biologic behavior and aggressiveness of BSC are similar to those of cutaneous squamous cell carcinoma. This is the first study to show that LR and, especially, LNM indicate a higher risk of an unfavorable outcome.

High-definition optical coherence tomography algorithm for discrimination of basal cell carcinoma from clinical BCC imitators and differentiation between common subtypes.

Preliminary studies have described morphological features of basal cell carcinoma (BCC) imaged by high-definition optical coherence tomography (HD-OCT) and suggested that this technique may aid in its diagnosis and management. However, systematic studies evaluating the accuracy of HD-OCT for the diagnosis of BCC are lacking. The aim of this study was to identify three-dimensional (3-D) HD-OCT features able i) to distinguish BCC from clinical BCC imitators and ii) to discriminate between the most common BCC subtypes. Based on these particular features, a diagnostic algorithm will be suggested. A total of 50 histopathologically confirmed BCCs (18 superficial, 19 nodular, 13 infiltrative) were imaged by HD-OCT at the centre of the lesion prior to standard surgical excision and subsequent histopathological analysis. Fifty images of clinical BCC imitators were also retrieved as a 'pitfalls' group. The simultaneous presence of grey/dark subepidermal (hemi-spherical) or intradermal lobulated structure(s) presenting a typical cockade feature in both HD-OCT modes was a significant feature for BCC diagnosis. Features discriminating between BCC subtypes were location of the roof of BCC lobules, vascular pattern of the papillary plexus and stretching effect on the stroma. Clinical BCC imitators such as actinic keratosis, compound and intradermal naevi, amelanotic melanoma, sebaceous hyperplasia and small haemangioma could be differentiated from BCC by means of HD-OCT. This study provides a thorough description of 3-D HD-OCT features that can permit discrimination of BCC from clinical BCC imitators and differentiation of BCC subtypes. Based on these features, a diagnostic algorithm is proposed which requires additional validation, but enhances current understanding of the morphological correlates of HD-OCT images in skin.

Melanoma of unknown primary origin coexisting with early-onset multifocal basal cell carcinoma.

Melanoma of unknown primary origin coexisting with early-onset multifocal basal cell carcinoma.

Trichoepithelioma and Basal Cell Carcinoma with Squamous Differentiation: Is it Causal or Coincidental?

Trichoepitheliomas (TEs) are benign cutaneous tumors that occur either as solitary non-familial or multiple familial. We report a case of multiple familial trichoepithelioma (MFT) in a 55-year-old female patient and her son who came with complaints of single ulcerated mass involving the left nasolabial fold and cheek. She had multiple papules and nodules all over the face and neck since 25 years. Histopathological examination of an ulcerated lesion revealed features of basal cell carcinoma (BCC) with squamous differentiation, which was confirmed by immunohistochemistry. A skin biopsy obtained from the papule on neck showed features of TE. However, whether BCC developed independently or by transformation from TE was uncertain. Her 36-year-old son presented with similar lesions on the face and a skin biopsy showed features of TE. Though malignant transformation of TE is quite rare, awareness of the potential for evolution of carcinoma in patients with MFT is important for management of these patients.

Health care characteristics of basal cell carcinoma in Germany: the role of insurance status and socio-demographic factors.

In Germany population-based data on health care of basal cell carcinoma (BCC) are rare. To analyze the relationship between socio-demographic and regional factors, health insurance status and clinical features of BCC. Data base was from a nationwide dermatopathology laboratory. All consecutive excisions from 2010 were analyzed regarding tumor-specific and socioeconomic characteristics of BCC. 9,467 histologically verified BCC derived from 7,116 patients (54.1 % male, mean age 70 years) were analyzed. 33 % of patients had multiple tumors. The average vertical depth of invasion of BCC was 1.27 mm. It was increased significantly (p ≤ 0.001) in men (1.33 mm vs. 1.19 mm in women) and in persons over 70 years of age (1.36 mm vs. 1.14 mm). Controlled for age and sex, members of agricultural health-insurances (LKK) and of German local public health insurances (AOK) showed the highest tumor depths (1.45 mm resp.1.42 mm). The lowest depths (1.17 mm) were found in insurees of the substitute health funds (Ersatzkassen) (p ≤ 0.001). Vertical depth of invasion was significantly increased for patients living in rural counties (1.34 mm) compared to patients from urban areas (1.21 mm). Furthermore, the distribution of BCC locations varied by type of health insurance. Area of residence, health insurance status, age and gender are relevant determinants of BCC health care in Germany. Prevention programs and activities to improve early detection by health insurances should take this into account.

Clinical characteristics of basal cell carcinoma with aggressive subclinical extension

Clinical characteristics of basal cell carcinoma with aggressive subclinical extension

Basal Cell Carcinosarcoma With PTCH1 Mutations in Both Epithelial and Sarcomatoid Primary Tumor Components and in the Sarcomatoid Metastasis

Basal cell carcinosarcoma is a rare biphenotypic malignant skin tumor, in which one tumor component has light microscopic features of basal cell carcinoma, whereas the other has features of sarcoma. Clinical experience with this tumor is limited, and associated molecular genetic alterations are unknown. Herein, we report a unique case of metastatic basal cell carcinosarcoma, in which we analyzed the 2 components of the primary tumor as well as the metastasis by next-generation sequencing. The patient was a 72-year-old man who presented with a 7-year history of a large tumor of the left forearm. The tumor showed mixed features of basal cell carcinoma and undifferentiated sarcoma. The patient underwent a wide local excision and sentinel lymph node biopsy, which revealed microscopic subcapsular deposits of metastatic sarcomatoid tumor. One year later, intra-abdominal metastatic tumor was detected and resected. It had sarcomatoid features by light microscopy and failed to stain for epithelial markers by immunohistochemistry. DNA was extracted separately from the epithelial and sarcomatoid component of the primary tumor, intra-abdominal metastasis, and normal tissue. All exons of 230 cancer-associated genes were sequenced to an average read depth of >500-fold. This revealed multiple identical mutations in epithelial and sarcomatoid tumor compartments. Both compartments harbored 2 identical mutations, a truncating and a missense mutation, in the patched gene (PTCH1). This finding is not only of interest for a shared heritage of different subpopulations in a biphenotypic tumor, but also relevant clinically. It provides a rationale for the clinical use of hedgehog pathway inhibitors for treatment of patients affected by this tumor. Unfortunately, the patient reported herein died of metastatic disease before targeted therapy could be initiated.

Epidemiologic and pathologic characteristics of basal cell carcinoma in northern Taiwan: Experience from a medical center

Background: The epidemiologic studies of basal cell carcinoma (BCC) in Taiwan are lacking. Aim: This study aimed to provide the epidemiologic and pathologic information of BCC among the northern Taiwanese population and try to identify the association of patient demographic characteristics with histopathological findings. Materials and Methods: We retrospectively analyzed 103 BCC cases diagnosed between December 1985 and December 2011 at the Tri-Service General Hospital, Taipei, Taiwan. The patients' age and sex, and anatomic distribution, subtype, depth, and pigmentation of the lesions were analyzed. Results: Of the patients, 59 were men and 44 were women (male-to-female ratio, 1.34). The overall mean age was 69.5 ± 12.91 years; with the mean age of the women lower than that of the men (66.9 vs. 71.4 years). The frequency of microscopic pigmentation in BCC was 52.4%. Nodular BCC was more inclined to develop microscopic pigmentation. The BCCs with depths greater than 3.3 mm tended to have no microscopic pigmentation. Superficial BCCs tended to involve the trunk and to occur in people younger than 60 years of age. Conclusions: This updated analysis study of BCC showed the mean age of BCC had a trend to increase in northern Taiwan. The male-to-female ratio in our study was slightly higher than those of other Asian countries. We suggest that excision of BCC without pigmentation could be deeper than pigmented BCC.

Intraoral Basal Cell Carcinoma, a Rare Neoplasm: Report of Three New Cases with Literature Review

Intraoral basal cell carcinoma (IOBCC) is an extremely rare entity that bears close microscopic resemblance to and is often confused with the peripheral ameloblastoma (PA). Basal cell carcinomas are thought to arise from pluripotential basal cells present within surface epithelium and adnexal structures, so theoretically they can arise within the oral cavity. Many of the early cases reported as IOBCC actually represent PA. Most of the well documented cases arise from the gingiva. The histologic features of basal cell carcinoma that help separate it from a PA include: tumor arising from surface epithelium, scattered mitotic figures and apoptotic cells, presence of mucoid ground substance and tumor infiltrating widely throughout the connective tissue and often exhibiting a prominent retraction artifact. Clinically IOBCC resemble carcinomas, compared to the benign and innocuous appearance of the PA and typically presents as surface ulcerations varying from rodent ulcer to an ulcerated erythroplakia appearance. This contrasts with the classic "bump on the gum" appearance of PAs with usually intact surface and appearing as small discrete, sessile, exophytic lesions. Importantly, the proliferative basaloid epithelium demonstrates positive immunoreactivity for the anti-epithelial antibody, Ber-EP4, a cell surface glycoprotein. The IOBCC has the potential for local recurrence and aggressive behavior and should be treated with wide surgical excision and close clinical follow up. We present 3 rare cases of IOBCC and discuss the salient histologic, immunohistochemical and clinical features.

Metastatic basosquamous carcinoma detected by sentinel lymph node biopsy

We describe a rare case of basosquamous carcinoma (BSC) in a 69-year-old man. He had noticed a pigmented nodule on his left thigh. Dermoscopic examination showed ulceration at the center and non-typical leaf-like areas at the periphery. Linear-irregular vessels were also seen. He underwent tumor excision in addition to sentinel lymph node biopsy (SLNB). Histopathological examination revealed both features of basal cell carcinoma (BCC) and squamous cell carcinoma. The sentinel lymph node was positive for tumor cells. Immunostaining for Ber-EP4 was focally positive for invasive tumor cells. Although complete inguinal lymphadenectomy had been performed, multiple in-transit metastases around the primary lesion and left iliac lymph node metastasis developed after the operation. It is considered that BSC has a worse prognosis than BCC with a potential for metastasis. Based on the findings of previously reported cases and our case, SLNB may be applied for certain high-risk cases including BSC larger than 3cm in size and careful follow up is recommended for patients with BSC.

Clinical and histopathological characteristics of basal cell carcinoma in Chinese patients

Background The clinical and histopathological characteristics of basal cell carcinoma (BCC) have been relatively well studied in Caucasian population. To characterize BCC in Chinese population, we analyzed the association of the histopathological subtypes with gender, age and anatomical location in this study. Methods The clinical and histopathological data of 243 BCC cases diagnosed at three hospitals in Beijing from January 2000 to April 2009 were reviewed retrospectively. Gender, age, location and histopathological subtype were analyzed. Results Among 243 patients enrolled, 118 were males and 125 were females. The male/female ratio was 0.94:1. The mean age was (65.16±12.62) years old. The head and neck were the most common sites of BCC (77.4%). Of the BCCs, 53.9% were nodular, 18.9% superficial and 18.5% infiltrative-morphoeic. The nodular, infiltrative-morphoeic and micronodular subtypes were predominant located on the head and neck, whereas the trunk was the most common location for the superficial subtype (P &lt;0.05). The age at first presentation for females was lower than that for males (P &lt;0.05). The age at first presentation for the superficial BCCs was younger than the non-superficial subtypes (P &lt;0.05). Women with superficial BCC subtype visited hospital earlier than men (P &lt;0.05). Conclusions Consistent with previous reports in Caucasian patient, our study find that different histopathological subtypes of BCC has distinct clinical features. It is speculated that the mechanisms underlining the pathogenesis of the superficial BCC may be different than those of non-superficial subtypes of BCC.

Nevoid Basal Cell Carcinoma Syndrome

Figure 1: Clinical photograph showing frontal bossing and mutiple milia on forehead; Figure 2: Broad nasal root, linear ulcerated pigmented lesion on lower lid of right eye; Figure 3: Multiple pigmented lesions on face and neck; Figure 4: Clinical picture showing multiple palmer pits; Figure 5 (a,b,c): Hughes tarsoconjuctival bridge flap procedure with post auricular skin grafting (stage 1); Figure 5 (d): Clinical photograph after division of tarsoconjunctival flap (stage 2); Figure 6: Histopathological picture showing features of basal cell carcinoma. (Thin arrow-basaloid cells, thick arrow-palisading)

Characteristics of Basal Cell Carcinoma of the Lip Treated Using Mohs Micrographic Surgery

There is a lack of U.S-based studies on basal cell carcinoma (BCC) of the upper lip treated using Mohs micrographic surgery (MMS). To explore characteristics of BCC of the upper lip treated using MMS. We performed a chart review of BCC cases from 2005 to 2011. Two hundred eighty-one cases were identified. There was a slight female predominance (55%). Men had a larger initial (p<.01) and final (p=.03) defect size. Infiltrative tumors had larger initial (p<.01) and final areas (p<.01). Ten percent of tumors were designated recurrent after previous treatment. Recurrent lesions (p<.001) and older age (p=.03) were associated with larger initial size. Complex reconstruction was required: 44% by local flap or graft and 13% by plastic surgery. There was a 1.2:1 female to male ratio, in contrast to the previously reported female predominance of 3.5:1. This cohort showed a higher recurrence rate than reported in the literature. Men and elderly patients were also found to have significantly larger initial lesion size. Thirteen percent of patients required repair by plastic surgery, reflecting heightened levels of cosmetic concern. These findings suggest that MMS is important in delineating subclinical tumor spread and providing complex repairs.

High‐resolution imaging of basal cell carcinoma: a comparison between multiphoton microscopy with fluorescence lifetime imaging and reflectance confocal microscopy

The aim of this study was to compare morphological aspects of basal cell carcinoma (BCC) as assessed by two different imaging methods: in vivo reflectance confocal microscopy (RCM) and multiphoton tomography with fluorescence lifetime imaging implementation (MPT-FLIM). The study comprised 16 BCCs for which a complete set of RCM and MPT-FLIM images were available. The presence of seven MPT-FLIM descriptors was evaluated. The presence of seven RCM equivalent parameters was scored in accordance to their extension. Chi-squared test with Fisher's exact test and Spearman's rank correlation coefficient were determined between MPT-FLIM scores and adjusted-RCM scores. MPT-FLIM and RCM descriptors of BCC were coupled to match the descriptors that define the same pathological structures. The comparison included: Streaming and Aligned elongated cells, Streaming with multiple directions and Double alignment, Palisading (RCM) and Palisading (MPT-FLIM), Typical tumor islands, and Cell islands surrounded by fibers, Dark silhouettes and Phantom islands, Plump bright cells and Melanophages, Vessels (RCM), and Vessels (MPT-FLIM). The parameters that were significantly correlated were Melanophages/Plump Bright Cells, Aligned elongated cells/Streaming, Double alignment/Streaming with multiple directions, and Palisading (MPT-FLIM)/Palisading (RCM). According to our data, both methods are suitable to image BCC's features. The concordance between MPT-FLIM and RCM is high, with some limitations due to the technical differences between the two devices. The hardest difficulty when comparing the images generated by the two imaging modalities is represented by their different field of view.

Nonmelanoma Skin Cancers Among HIV-Infected Persons in the HAART Era

Nonmelanoma Skin Cancers Among HIV-Infected Persons in the HAART Era

Abstract 4090: Epigenetic profiling identifies differentially methylated loci in metastatic vs. non-metastatic primary squamous and basal cell skin cancers

Abstract Nonmelanoma skin cancer is the most commonly diagnosed cancer in the United States. Over 2 million new cases of these cancers are diagnosed each year, and incidence rates are increasing worldwide. Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of the skin are generally considered less aggressive than melanomas, which is reflected in their lower relative mortality rates. Despite this, a clinically relevant subgroup of both of these cancers will metastasize and develop an aggressive disease phenotype. In order to characterize the molecular pathways that may be involved in the development of metastatic disease in these common cancers, we measured DNA methylation profiles at 1505 CpG sites associated with 807 related to cancer using the Illumina Goldengate Methylation Cancer Panel BeadArray in BCCs and SCCs isolated from patients treated at the University of Michigan. DNA methylation was measured in metastatic (n=9) and non-metastatic (n=19) primary SCCs and in metastatic (n=3) and non-metastatic (n=9) primary BCCs. Due to the known divergent mechanisms of carcinogenesis of basal and squamous cell carcinomas, separate analyses were conducted for these tumor types. Unsupervised hierarchical clustering was used to identify overall differences in DNA methylation patterns between metastatic and non-metastatic disease. Gene specific analyses using linear modeling coupled with an empirical Bayes method of variance estimation were conducted to identify if methylation at individual CpG sites is associated with metastatic potential. SCCs were not found to cluster based on metastasis, however, metastatic BCCs were found to cluster together, suggesting that metastatic BCCs may share common mechanisms of pathogenesis. In gene specific analyses, FRZB was found to be statistically significantly hypermethylated in metastatic compared to non-metastatic primary SCCs (median methylation: 54.2% vs. 4.7%; p=3.8x10-5). Two sites in MYCL2 were found to be significantly hypomethylated in metastatic vs. non-metastatic BCCs (3.7% and 4.0% vs. 77.9% and 53.5%; p=1.87x10-6 and 3.69x10-5 respectively). The results from this pilot study give insight into the molecular mechanism of metastasis for nonmelanoma skin cancers and identify the divergent characteristics of BCCs and SCCs. The differentially methylation regions identified in this study may be useful epigenetic biomarkers of metastatic potential for nonmelanoma skin cancers to be examined in an extended patient population in future studies. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4090. doi:1538-7445.AM2012-4090

Preoperative Characterization of Basal Cell Carcinoma Comparing Tumour Thickness Measurement by Optical Coherence Tomography, 20-MHz Ultrasound and Histopathology

Optical coherence tomography (OCT) is a new imaging method with promising results for several dermatological indications, including preoperative skin tumour characterization. While high-frequency ultrasound (HFUS) is frequently used for this purpose, overestimation of tumour thickness is a problem, due to subtumoral inflammatory infiltration that cannot be differentiated from tumour tissue. The aim of this single-centre study was to describe OCT features of basal cell carcinoma (BCC) and to determine vertical tumour thickness accurately, including a comparison with HFUS and histopathology. Tumour thickness values of 10 BCCs measured by OCT did not differ significantly from those measured by histopathology (median difference 0.12 mm). By contrast, the difference between HFUS and histopathology was greater (median difference 0.3 mm). A Pearson's correlation coefficient of 0.83 showed a stronger correlation of OCT in measuring tumour thickness compared with HFUS (0.59). Bland-Altman plots revealed a better agreement of OCT and histopathology concerning tumour thickness measurements. On the basis of this explorative study cohort, OCt was more exact than HFUS in preoperative tumour thickness estimation of BCCs compared with histopathological measurements.