Forms Of Basal Cell Carcinoma Research Articles

Basal cell carcinoma-a clinical indicator of immunosuppression.

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are skin-derived carcinomas. The literature strongly connects SCC with acquired immunosuppression. Current data regarding BCC's association with immunosuppressive comorbidities are vague. The primary objective of this study was to establish the correlations between BCC and immunosuppressive comorbidities of patients. Materials and methods: We conducted a retrospective cohort study on 275 patients with a histopathological proven diagnosis of BCC from October 2019 to October 2023. Demographic data, BCC characteristics, and patients' comorbidities were analyzed. Comorbidities were classified as non-immunosuppressant and immunosuppressant (primary and secondary immunodeficiencies). We recorded 292 BCCs from 275 patients (142 females, 133 males), with equally distributed skin phototypes. 66.44% of the BCCs were detected in patients with various comorbidities (p < 0.001), of which 81.44% had immunosuppressive comorbidities (p < 0.001). All the immunosuppressive comorbidities were secondary and included diabetes mellitus (47.55%), history of solid or hematogenous cancer in the last 5 years (26.57%), chronic kidney disease (8.39%), chronic infections (9.09%), and antirheumatic immunosuppressive therapies (8.39%) (p < 0.001). BCC patients with immunosuppressive comorbidities did not develop larger BCCs (p = 0.2577) or more aggressive subtypes (p = 0.4269) and BCC did not arise earlier in their life (p < 0.001). BCC on the nasal pyramid was frequent in cancer history patients (p = 0.008). The ulcerated form of BCC is more confined to patients with chronic kidney disease (p = 0.006). Multiple BCCs are more frequent in patients with secondary immunodeficiencies (p = 0.027). BCC represents a clinical indicator of secondary immunodeficiency. Further research should establish if cancer screening campaigns may be beneficial in BCC patients.

Initial clinical manifestations and early diagnosis of basal cell skin carcinoma

Background/Aim: Basal cell carcinoma (BCC) is the most common cancer of the skin. It is believed that increased UV radiation from the sun accounts for almost 90 % of the risk of BCC. There is a growing trend in the incidence of BCC in a younger population. The aim of study was to analyse the initial clinical symptoms of BCC that may be important for the early detection of this skin tumour. Method: The study was a prospective, multicentre study performed in the period from March 2017 to February 2022. A total of 69 respondents with BCC were analysed. Respondents applied for a targeted examination to examine a suspicious skin lesion (due to certain symptoms) or were diagnosed with BCC by accident, when examining other skin changes. Respondents were divided into 2 groups. The first, Group I (35 respondents), consisted of respondents with nodular BCC. The second, Group II (34 respondents), consisted of respondents with superficial spreading BCC. Initially, a careful history and data on the characteristics, shape and character of the tumour were taken from all respondents. Data on all (even the smallest) initial symptoms and relevant signs of evolution, as well as subjective problems related to the tumour were noted. All respondents underwent dermoscopy of suspected skin changes. Results: A significant difference was found between the examined groups in the characteristics of bleeding, crust formation and tendency to injury in lesions, where they occur more often in patients with nodular BCC. Symptoms such as burning and flaking occurred significantly more often in patients with superficial spreading BCC (p &lt; 0.01), as well as the diameter of lesions over 5 mm (p &lt; 0.05). Conclusion: Early clinical diagnosis of BCC is possible with a tumour diameter of only a few mm. The predominant initial (highly susceptible) symptoms of nodular BCC were initial bleeding and / or scab formation on the lesions, as well as propensity to injury. The superficial spreading form of BCC was often larger than 5 mm in diameter, with more frequent scaling of the lesion, as well as burning and stinging sensations in the tumour area. Itching was observed to be a very common previous occurrence in the BCC initial focus zone in subjects of both study groups. Dermsocopy is a highly reliable diagnostic method for early detection of BCC.

The effectiveness of using a combination of laser radiation with wavelengths of 585 nm and 1064 nm in the treatment of patients with basal cell skin cancer.

Background: Basal cell skin cancer is the most common skin malignancy, and its incidence has been rapidly increasing throughout the world in recent decades.&#x0D; Aims: To study the effectiveness of using laser radiation with a wavelength of 585 nm and 1064 nm in a sequential (sequential) combined mode for the treatment of patients with superficial and nodular forms of basal cell skin cancer using dermoscopic and confocal microscopic in vivo examination.&#x0D; Materials and methods: The study included 30 patients with histologically confirmed basal cell skin cancer, who received treatment in the conditions of the Consultative and Diagnostic Center of the State Research Center of Dermatovenereology and Cosmetology of Russian Ministry of Health in the period from 2020 to 2021, using a pulsed dye laser (wavelength 585 nm) and long-pulse neodymium laser (wavelength 1064 nm).&#x0D; Results: In the subgroup of patients with the nodular form of basal cell carcinoma (n=15): in 11 patients the duration of treatment was 1 procedure, in 3 patients 2 procedures, in 1 patient 3 procedures. In the subgroup of patients with superficial basal cell carcinoma (n=15 ): in 2 patients the course of treatment was 2 procedures, in 13 patients 1 procedure. Patients have now completed treatment and are being followed up with visits every 6 months for 3 years. According to dermoscopic and confocal microscopic studies, there is no evidence of continued growth and relapse in all patients. No side effects or adverse events were recorded.&#x0D; Conclusions: The combined sequential use of 585 nm and 1064 nm laser radiation may be an effective treatment for patients with low-risk basal cell skin cancer of recurrence. The results of our study indicate that clinical tumor removal without scarring can be achieved and may be an alternative treatment option for those who do not wish to use traditional surgical approaches.

A national analysis of demographic trends in gynecological cases of basosquamous carcinoma.

e21598 Background: Basosquamous carcinoma (BSC) is an aggressive form of basal cell carcinoma. Research on BSC is minimal because of its rare nature and the lack of clinical features that distinguish BSC from other forms of basal cell carcinoma, meaning that a diagnosis is only confirmed following biopsy. BSC is distinct because it has features of squamous cell carcinoma, making it more locally invasive, more likely to metastasize and has a recurrence rate of 12 - 51% following surgical excision. While BSC most frequently presents in the head and neck, it can also occur in gynecological cases and this subset of cases has not been studied in literature. In order to more thoroughly understand the distinguishing features and epidemiological trends of this rare cancer, the National Cancer Database (NCDB) was analyzed to determine demographic factors in patients diagnosed with cases of BSC in the breast, vagina and vulva. Methods: The National Cancer Database (NCDB) was utilized to complete a retrospective cohort analysis from 2004 – 2020 that included all patients with histologically-confirmed gynecological cases of BSC (N = 211). Descriptive statistics were analyzed for demographic factors including age, sex, race, income level, insurance status, and Charlson-Deyo score. Results: Between 2004 and 2020 there were 211 identified gynecological cases of BSC. The average age of diagnosis was 71.1 years (SD = 14.6, range = 22 – 90 years) with the majority being non-Hispanic (89.1%) and White (86.3%). The primary site in the vast majority of cases was the vulva (88.6%) and remaining cases originated in other female organs including the breast, vagina and cervix (11.4%). Despite the older age of diagnosis, the majority of individuals (72.0%) had Charlson-Deyo comorbidity scores of 0. The greatest proportion of patients (38.8%) were in the top quartile of household income ( &gt; $74,063) with 15.7% in the lowest income quartile ( &lt; $46,277). Additionally, most patients were insured by Medicare (64.9%) which aligns with the older age of diagnosis. Conclusions: Classifying and fully understanding BSC has proved difficult due to the challenge of differentiating it from other forms of basal cell carcinoma. To further the overall understanding of this aggressive cancer and those that it impacts, this study specifically focuses on a unique subset of BSC cases that have not been well studied. To the best of our knowledge, this is the first NCDB analysis on gynecological cases of BSC. The majority of BSC patients are non-Hispanic and White with an average age of over 70 years old which is supported by the finding that most patients rely on Medicare to fund their treatment. Additional research is needed to better understand the sociodemographic factors, treatments, and overall survival of patients with BSC in aberrant locations.

Склеродермоформная базалиома кожи у пожилой женщины

The most commonly detected non-melacytic skin tumor in humans is "basal cell carcinoma". There are many clinical varieties of this tumor, some of which are quite rare. The attention of specialists is brought to the attention of a clinical observation of an elderly woman who was observed on an outpatient basis by a dermatologist with a rare form of basal cell carcinoma of the skin of the back. Of particular interest is a long history of the disease for about 15 years, the presence of a scar-like large lesion on the back of more than 11 cm in diameter, the absence of lymphadenopathy and weight loss, with a histologically confirmed sclerodema-like basalioma of the skin.

Types of surgical approaches in locally advanced forms of basal cell carcinoma of the scalp in elderly patients

Background. Basal cell cancer is the most common type of skin cancer in fair-skinned adults older than 50 years. The incidence rate of this disease is growing around the world. Basal cell carcinomas (BCC) are heterogeneous: from superficial or nodular lesions with benign prognosis to large lesions which are very difficult to cure. The prognosis of treatment is connected with the risk of recurrence of basal cell cancer or its local destructive ability. Hedgehog pathway activation is a distinctive molecular event in these tumors, which has allowed Hedgehog inhibitors for lesions that are difficult to cure to be developed, and which are also beyond the reach of surgical treatment or radiation therapy. Immunotherapy may be offered for the treatment of tumors with a high mutational load which leads to tumor resistance to Hedgehog inhibitors. Surgical intervention is a standard treatment method for most BCCs because it allows excision margins to be controlled and it shows a low risk of recurrence. The issue of removal of locally advanced forms with simultaneous reparative stage in elderly patients remains challenging.&#x0D; Purpose – to prove the high effectiveness of the surgical approach with simultaneous plastic surgery in locally advanced forms of BCC of the scalp in elderly patients.&#x0D; Materials and methods. Clinical observation of female patient A., 87 years old, who was receiving treatment in the Department of Surgical Oncology regarding multiple advanced BCC of facial skin, and patient V., 91 years old, who was undergoing treatment in the Department of Surgical Oncology regarding advanced basal cell skin carcinoma of the left pinna. Observation and treatment were performed in the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine».&#x0D; Results. Clinical cases of locally advanced basal cell skin cancer in 2 elderly patients (87 and 91 years old) are presented. The effectiveness of the surgical approach with broad excision of the tumor and simultaneous reparative stage has been proven: in one case – a free split-skin autoplastic graft, in the other one – a full-thickness musculo-subcutaneous flap with axial blood circulation. In both cases there was no rejection of transplants; the scalp defects were completely covered, and a good cosmetic appearance was successfully achieved. In both cases, there were no significant complications observed. These examples have proven that the patients’ age of more than 90 years is not a counterindication to broad resections with simultaneous reparative stage in locally advanced BCC of the scalp.&#x0D; Conclusions. Thus, modern methods of diagnostics and treatment of BCC allow the disease to be controlled in most cases. It is also possible to cure locally advanced BCCs in patients older than 85 years surgically with a simultaneous reconstructive stage, given the reasonable selection of the patients.

Effective laser correction of multiple teleangiectasia on the face

Telangiectasia is a persistent dilation of small-caliber skin vessels (arterioles, venules, capillaries) of a non-inflammatory nature, manifested by polymorphously convoluted and dilated vessels. Telangiectasias are classified according to the cause of occurrence, the form of changes in the vascular pattern, time and localization, and are also divided into 3 large groups ― essential (idiopathic); symptomatic in various diseases; congenital and hereditary syndromes and diseases accompanied by vascular anomalies. In addition, telangiectasias can be single and multiple, located locally or disseminated, differ in shape, location, color; sometimes they bleed. Differential diagnosis is carried out with flaming and telangiectatic nevus; multiple senile, glomerular, bundle angiomas; Fabry angiokeratoma, Sivatts poikiloderma. In addition, telangiectasia is a typical clinical symptom in the erythematous-telangiectatic form of rosacea, systemic scleroderma, discoid lupus erythematosus, nodular form of basal cell carcinoma, hyper- and atrophic scars, late radiation dermatitis.&#x0D; The article describes a case from the clinical practice of effective treatment of telangiectasias on the skin of the face using a neodymium crystal laser, which is of interest, among other things, due to the complexity of diagnosis within the existing International Classification of Diseases 10 revision, therefore the diagnosis is made syndromally based on macro- and microscopic morphological features. In addition, there is no single approach to the treatment of the pathology in question. External therapy, as well as systemic drugs, are often ineffective, sclerotherapy and exposure to a high-power vascular laser have a more pronounced clinical effect (broadband light; neodymium laser; pulsed dye laser; alexandrite, diode, ruby laser). Based on the recommendations of the laser manufacturer on percutaneous vascular coagulation and modern theories about the pathogenesis of telangiectasias, an algorithm for treatment with a long-pulse laser with a wavelength of 1064 nm on a clinical example is proposed. By prescribing a course of treatment of vascular malformation by laser percutaneous coagulation, we expect to obtain the destruction of pathologically dilated vessels of the papillary and mesh layer of the dermis by gluing the walls of the vessels (preferably) or complete thrombosis of their lumen while maintaining the structures of the dermis and epidermis intact. Laser percutaneous vascular coagulation has demonstrated excellent treatment results in a short period of time, significantly reducing the number of pathologically altered vessels. The rehabilitation period after laser coagulation of blood vessels did not exceed 3 days and was manifested by moderate edema of soft tissues in the area of laser exposure, hyperemia and single petechial hemorrhages, which resolved themselves.&#x0D; Laser coagulation of skin telangiectsies is a highly effective method with a long-term clinical effect.

Clinical observations of generalized and inoperable locally advanced forms of basal cell carcinoma

Background. Basal cell carcinoma (BCC) occupies around 80% of all the cases of diagnosed skin cancer (according to American Cancer Society). In various countries of the world the morbidity rate of BCC differs due to the main predisposing factor of BCC development – ultraviolet radiation. In Ukraine, according to National Cancer Registry, 15882 new cases of non-melanoma skin cancer were registered in 2019–2020. Standardized morbidity rate of this pathology increased by 2,6% compared to 2018. Basal cell cancer commonly recurs (according to different experts, the rate varies from 10% to 80%), at the same time, distant metastases are diagnosed quite rarely. Understanding contribution of Hedgehog (Hh) signaling pathway to carcinogenesis of BCC has become a serious achievement in molecular biology. In spite of relatively benign course of BCC and variety of treatment methods of this disease, there is a high risk of recurrence, and in some patients, lesions may progress to such extent that they become unsuitable for local therapy which makes it urgent to search for alternatives to surgery and radiation therapy.&#x0D; Purpose – to study the peculiarities of course, treatment, development of complications of recurrent, locally advanced, metastatic inoperable BCC by the example of clinical cases. Materials and methods. Clinical observation of female patient K., 73 years old, who was undergoing treatment in the Department of Clinical Oncology and Hematology by reason of multiple BCC lesions (observation time 14 years) and female patient D., 42 years old, who was undergoing treatment in the Department of Radiation Pathology and Palliative Care by reason of aggressive course of locally advanced form of basalioma (observation time 29 years). Observation and treatment were performed in the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine».&#x0D; Results. The clinical cases of observation and different stages of treatment of patients with constantly recurring aggressive BCC over a long period of time, 14 and 29 years, are demonstrated. Metastasing of BCC is confirmed in both cases, local advancement is shown, various methods of treatment were used: surgery, radiation therapy, cryodestruction, chemotherapy. Difficulty of patients' management is shown, especially when all available methods are used up. Treatment of complications of special therapy methods, multistage restoring plastic surgeries using different methods of plastic repair are described.&#x0D; Conclusions. Treating recurrent, metastatic, and locally advanced inoperable forms of BCC when one runs out of possibilities of the main treatment methods – surgery, radiation therapy, chemotherapy is a difficult task which requires further development of modern technology and treatment methods.

Assessment of Basal Cell Carcinoma Using Dermoscopy and High Frequency Ultrasound Examination.

Basal cell carcinoma (BCC) is the most common form of cutaneous neoplasia in humans, and dermoscopy may provide valuable information for histopathological classification of BCC, which allows for the choice of non-invasive topical or surgical therapy. Similarly, dermoscopy may allow for the identification of incipient forms of BCC that cannot be detected in clinical examination. The importance of early diagnosis using the dermoscopy of superficial BCC forms is proven by the fact that despite their indolent clinical appearance, they can be included in high-risk BCC forms due to the rate of postoperative recurrence. Nodular pigmentary forms of BCCs present ovoid gray-blue nests or multiple gray-blue dots/globules associated with arborized vessels, sometimes undetectable on clinical examination. The management of BCC depends on this, as pigmentary forms have been shown to have a poor response to photodynamic therapy. High frequency ultrasound examination (HFUS) aids in the diagnosis of BCC with hypoechoic tumour masses, as well as in estimating tumour size (thickness and diameter), presurgical margin delineation, and surgical planning. The examination is also useful for determining the invasion of adjacent structures and for studying local recurrences. The use of dermoscopy in combination with HFUS allows for optimisation of the management of the oncological patient.

BASAL CELL CARCINOMA WITH LYMPH NODE METASTASIS A CASE REPORT AND REVIEW OF LITERATURE

Basal cell carcinoma (BCC) is the most common skin cancer. Metastatic BCC is rare (0,0028% to 0,5%), with a very poor prognosis, survival rates of 3 years, in cases of locoregional lymphatic metastases,is estimated at 8 months. For this form of basal cell carcinoma,treatment is based on surgery and radiotherapy, chemotherapy bye Platinum-based or the inhibitors of the Hedgehog vismodegibcan be used for non-operative patients. We report a case of a 41 years old male man who suffered from BCC on his right cheek with lymph node metastases.

Cytotoxic T-Lymphocyte-Associated Protein-4 and Lymphocyte Activation Gene-3 Expression in Orbitally-Invasive Versus Nodular Basal Cell Carcinoma.

To compare the expression of cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) and lymphocyte activation gene-3 (LAG-3) in nodular and orbitally-invasive forms of basal cell carcinoma (BCC). Immunohistochemical staining for CTLA-4 and LAG-3 was performed on the pathology specimens of BCC from orbital exenteration and nodular forms. The numbers of positively-staining cells/×40 field were counted across 5 consecutive fields of each specimen and statistical analysis was performed to calculate the difference in expression between the 2 groups. Nine cases of orbitally-invasive BCC and 6 cases of nodular BCC were studied. The mean numbers of CTLA-4-positively staining cells were 11.51 cells/×40 field (median = 6.60 cells/×40 field, range = 0.4-31.8 cells/×40 field) in invasive BCC and 0.90 cells/×40 field (median = 0.60 cells/×40 field, range = 0.0-2.8 cells/×40 field) in nodular specimens. The difference between the 2 groups was statistically significant (p = 0.0030). The mean number of LAG-3-positively staining cells was 0.58 cells/×40 field (median = 0.0, range = 0.0-2.8 cells/×40 field) in invasive BCC and 3.13 cells/×40 field (median = 0.0, range = 0.0-18.18 cells/×40 field). There was no significant difference in LAG-3 positivity between tumor groups (p = 0.5564). CTLA-4 expression was enriched in orbitally invasive BCC compared with nodular forms of BCC, whereas LAG-3 expression did not differ between these entities. CTLA-4 mediated immune suppression may facilitate the development of orbitally invasive BCC. Treatment strategies that use existing medications to target CTLA-4 may decrease the requirement for orbital exenteration and provide enhanced survival outcomes.

Hedgehog Pathway Alterations Downstream of Patched-1 Are Common in Infundibulocystic Basal Cell Carcinoma

The infundibulocystic variant of basal cell carcinoma (BCC) is characterized histologically by anastamosing strands of basaloid epithelium with associated small infundibular-type cysts. Since its first description in 1987, this rare entity has generated considerable controversy with some authors classifying it as a benign follicular neoplasm rather than a BCC subtype. Prior studies aiming to settle this issue using immunohistochemical analysis reached opposite conclusions. The defining feature of BCC is activation of the Hedgehog signaling pathway, and mutations in Patched-1 (PTCH1) are the most common molecular finding in both sporadic and inherited forms of BCC. Mutations in other downstream components including Smoothened (SMO) and Suppressor of Fused (SUFU) also occur, but are much less common. Here, we report a molecular genetic analysis of a small series of infundibulocystic BCC using a next-generation DNA sequencing platform. All 4 cases harbored mutations or other genetic alterations in components of the Hedgehog pathway, supporting the classification of this entity as a BCC variant. Interestingly, these tumors were enriched for genetic alterations downstream of PTCH1, involving SUFU, SMO, GLI1, and GLI2. This observation was of particular interest given that rare kindreds of the Multiple Hereditary Infundibulocystic BCC syndrome (MHIBCC), which is related, but possibly distinct from the nevoid BCC syndrome, harbored mutations in SUFU. Our results support the classification of the infundibulocystic variant as a subtype of BCC, and suggest that the level at which genetic alterations occur within the Hedgehog pathway may be an important determinant of the morphologic features in BCC.

Photodynamic therapy in dermatology: Beyond current indications.

Photodynamic therapy (PDT) has long been used in dermatology as a therapeutic strategy for several malignant and premalignant conditions. Currently, it is approved in Europe for the treatment of actinic keratosis, squamous cell carcinoma in situ, and some forms of basal cell carcinoma, with favorable clearance rates associated with satisfying aesthetic results. Nonetheless, in the past few years, PDT has also demonstrated efficacy in many other conditions, including inflammatory and infectious dermatoses. These results, probably explained by its immunomodulatory, anti-inflammatory, and bactericidal effects, may lead to an expansion of PDT indications in the upcoming years. In this article, conditions where PDT may be useful are reviewed, thus highlighting the potential of this therapeutic modality for the dermatologist.

Spectrum of Tp53 gene mutation in basal cell carcinoma and its morphological subtypes in people of color.

Objectives: Basal cell carcinoma (BCC) is the most common cutaneous malignancy in white population. The pattern of exon specific p53 mutations in BCC and its subtypes remain undetected in our population. This study was designed to evaluate the prevalence and mutational spectrum of p53 mutations in basal cell carcinoma (BCC) and its subtypes in people of color in the population of Karachi, Pakistan. Study Design: Retrospective cross sectional study. Setting: Department of Pathology, Basic Medical Sciences Institute, Jinnah Post Graduate Medical Center Karachi, Pakistan. Period: Five-year study from January 2012 to December 2016. Material and Methods: Convenient sampling technique was used. Sample size was calculated using open EPI software. Analysis of 32 BCC cases for p53 gene mutations in exons 5-8 was detected by polymerase chain reaction technique. Sebaceous carcinoma and malignant melanoma were used as positive controls and normal skin was used as negative control. Results: Out of 32 BCC cases, 26 (81.2%) displayed p53 exon mutations. The number of cases with single exon mutation was 17 (65.3%). Exon 5 mutation was most frequently observed in 8 (30.7%) cases. This was followed by 5 (19.2%) cases with exon 6 mutation and 4 (15.3%) cases with exon 8 mutation. None of the cases revealed exon 7 mutation. A considerable number 9 (34.6%) of BCC displayed dual exon mutation. Dual mutations of exon 6 &amp; 8 were seen in 6 (23%) cases. Exon 5 &amp; 7 mutation was noted in 2 (7.6%) cases followed by a single (3.8%) case with exon 6&amp;7 mutation. The highest number 12 (46.1%) of single and dual exon mutations was recorded in nodular subtype of BCC. Conclusion: The current study confirms the expression of p53 gene mutation in BCC in colored population. Majority of the single mutations were observed in exon 5. Dual exon mutation was the most notable finding of this study. The highest number of single and dual exon mutations was recorded in nodular form of BCC.

Scalp basal cell carcinoma: A different entity?

Basal cell carcinoma is the most frequent malignant neoplasm in white-skinned individuals. It develops in different body areas, including in the scalp, which is a unique anatomical region due to the high number of pilosebaceous follicles; the scalp is protected from UV exposure, a main risk factor for basal cell carcinoma development. Moreover, scalp basal cell carcinoma has been described as more aggressive and difficult to treat than other forms of basal cell carcinoma. In this study, we reviewed the clinical and pathological characteristics, risk factors, genetics, and treatment options for scalp basal cell carcinoma to better understand this special type of cancer. Even though it is not yet clear whether scalp basal cell carcinomas represent a different entity, it seems important to give them special attention due to their potential aggressiveness, invasion capacities, tendency to relapse, and treatment difficulties.

Basal Cell Carcinoma Pathology Requests and Reports Are Lacking Important Information.

Introduction Basal cell carcinoma (BCC) is the most common cancer affecting humans. Luckily it has negligible risk for metastasis; however it can be locally destructive to surrounding tissue. The diagnosis of this tumor relies on clinical and dermoscopic features; however confirmation requires biopsy and histologic examination. Based on clinical and pathologic findings, BCC is classified as low or high risk subtype. The clinician requesting pathology examination for BCC should provide the pathologist with detailed information including patient details, relevant clinical and medical history, site and type of the biopsy, and whether this is a primary or recurrent lesion. The pathologist on the other hand should write an adequate report containing a minimum of core set of parameters including type of BCC, depth of invasion, presence of lymphovascular or perineural invasion, and the excision margins. ObjectivesThe objective of this study is to evaluate whether requests by clinicians and pathology reports of BCC are adequate. MethodsThis is a retrospective analysis done at the dermatology department, faculty of medicine at Jordan University of Science and Technology, Irbid, Jordan. Reports for the period from January 2003 to December 2017 were retrieved and analyzed for data completeness. ResultsMost clinical request forms of BCC provided by clinicians are inadequate and lack important relevant information especially in regard to lesion history, patient medical history, and whether BCC is a primary or a recurrent one. Pathology reports for BCC cases also have significant deficiency especially in describing the histologic subtype, depth of invasion, and presence of lymphovascular and perineural invasion. However, the tumor excision margins are adequately described in almost all reports. ConclusionsThe study shows that clinicians do not provide adequate clinical information when submitting a request for histopathologic examination of BCC. Similarly, pathologists write incomplete reports that lack important pathologic features. Having pre-set forms (electronic proforma) can help overcome missing information.

Giant Basal Cell Carcinoma: A Case Report

Abstract Basal cell carcinoma (BCC) is the most common type of skin cancer and the most common type of tumor in the human population in general. Clinical variants of BCC include nodular, superficial, pigmented, morpheaform, cystic, metatypical types and fibroepithelioma of Pinkus. Giant BCC is a rare type of carcinoma, accounting for less than 1% of all cases of BCC. Most often they occur on the trunk. BCC belongs to the group of aggressive tumors, leading to the invasion of deeper tissues, and examples of metastasis of this type of tumor can be found in the reference literature. In this case report, we present a case of a 76-year-old female patient with a giant ulcerous form of basal cell carcinoma on the back.

FLUORESCENT DIAGNOSTICS OF MALIGNANT SKIN TUMORS WITH CHLORIN SERIES PHOTOSENSITIZERS

The article shows possibilities in fluorescence imaging of malignant skin tumors with chlorin series photosensitizers (PS) photolon and fotoditazin. The regularities of photosensitizer accumulation from the data of local fluorescence spectroscopy depending on the PS and its dose, the clinical picture and the histological form of the malignant skin neoplasm is investigated. It is shown that the level and selectivity of PS accumulation in the tumor focus depends on the PS dose. In studies on 10 patients with basal cell skin cancer after the introduction of fotoditazin at a dose less than 1 mg/kg, fluorescent contrast between tumor and healthy tissue varied between 1.3 and 9.5, the average was 2.8±0.3; for patients who had the administered fotoditazin dose of 1 mg/kg, fluorescent contrast was 2.9±0.4, varying from 1.4 to 5. In a study with 127 patients after the introduction of photolon in the dose of 0.7-1 mg/kg, the average value of the fluorescence intensity in relative units in the intact skin was 6.9±0.3 (min 4.6, max 12.2), at a dose of 1.1 to 1.4 mg/kg – 8.0±0.3 (min 4.6, max 12.5), at a dose of 1.5-2 mg/kg – 9.9±0.7 (min 5.7, max 20.3). It is also shown that fluorescence intensity of malignant neoplasm of the skin with the same dose of the photosensitizer depends on the neoplasm’s clinical and histological forms. So, 3 hours after the introduction of photolon at a dose of 1.3 mg/kg the average fluorescent contrast in the surface type of skin cancer was 2.7±0.5, in the nodal form – 2.3±0.2, in erosive-ulcerative form – 3.6±0.3. In patients with nodular form of squamous skin cancer after the introduction of photolon at a dose of 1.3 mg/kg fluorescent contrast was significantly higher (p<0.05) (average of 2.8±0.2) than in the nodular form of basal cell carcinoma after the introduction of photolon at the same dose (average of 2.1±0.2).

SURFACE FORM OF BASAL CELL CARCINOMA OF THE SKIN: BIOLOGICAL BEHAVIOR, MORPHOLOGY AND CLINICAL VARIANTS

The superficial form of basal cell carcinoma (BCC) is a malignant skin epithelial tumor with the most favorable flow profile and the least aggressive morphological structure among all known forms of BCC. Surface variants of BCC are characterized by a long and more benign course, slow, long-term growth. However, in the late stages of development, some researchers note the appearance of severe infiltration and destructive changes, ulceration of the BCC foci. Despite the fact that the surface form of the BCC is characterized by a long-term benign course, data have been obtained according to which the histologically confirmed surface multicentric form of BCC initially localized on the trunk increases the number of foci considerably faster than other localization and histological pattern. Objective: To study clinical and morphological features of the surface form of basal cell carcinoma based on monitoring 2500 cases of basal cell carcinoma. Material and methods. The authors analyzed literature sources and their own clinical and morphological data for 2500 clinical observations of patients with different clinical variants of BCC. Results. 2500 cases of BCC were analyzed. Among them 522 cases of clinical variants of surface form of BCC were revealed. Clinical and morphological monitoring was carried out taking into account the sex and age of patients, the variety and the primary localization of the disease, as well as the number and size of lesions. According to our monitoring data, 2500 cases of BCC registered in Moscow and the Moscow Region over the past 10 years, the frequency of the surface form in the overall structure of all BCC cases is 22.3% (557.5 cases), which is generally consistent with the reports of other authors. According to our data, the surface form of the BCC is localized mainly on the skin of trunk, extremities and much less often on the face. Women suffer from this form of BCC 2 times more often than men (371.6 and 185.8, respectively). We have not received convincing data on the predominant morbidity of this type of BCC of younger age groups, which, however, can be explained by the peculiarities of the patients’ mentality (often long unsuccessful self-treatment, rare medical attention), as well as the long practically asymptomatic course of the disease. The majority (80.3%) of the tumors corresponded to the TIN0M0 characteristic. On the body and limbs, the foci are more localized in men than in women (38.8 and 27.3%, respectively), while in the head (face, neck) - in women (72.7 and 61.2%, respectively). A rare type of surface form is a self-scaring BCC (Pejetoid epithelioma of Little). It is characterized by pronounced centrifugal growth. It is possible to transform the surface form of BCC into a more aggressive - nodular form.

Macrophage subtypes in recurrent nodular basal cell carcinoma after Mohs micrographic surgery.

The macrophages associated with solid tumors are related to the progression or regression of tumors, depending on the differentiation in M1 or M2. M2 subtype promotes angiogenesis, remodeling, and tissue repair (tumor proliferation). In contrast, M1 produces toxic mediators and presents antigens, destroying microorganisms and tumor cells. The microenvironment of most aggressive forms of basal cell carcinoma (BCC) shows an increase in macrophages due to M2 phenotype compared to noninvasive forms. The treatment of nodular BCC by Mohs micrographic surgery (MMS) provides high cure rates, but relapses can occur. To compare the total population of macrophages and their subpopulations M1 and M2 in cases of recurrent and nonrecurrent nodular BCC after excision by MMS. Histological sections obtained from paraffin blocks of nine cases of recurrent nodular BCC after MMS and 18 cases of nonrecurrent nodular BCC operated by MMS were immunostained for iNOS, CD204, CD163, and CD68. The expression of these markers was analyzed by image analysis. No significant differences were found between the groups in relation to the average percentage of M1 cells, M2 cells, and total cells. A relationship was not seen between tumor-associated macrophages (TAM) and tumor recurrence.