Forms Of Basal Cell Carcinoma Research Articles

Aggressive and Neglected Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common cutaneous malignancy and usually has a benign coarse. Rarely, examples of aggressive and neglected types of this tumor are seen. To present an interesting and dramatic example of how some people neglect their tumors and how devastating the sequelae can be. We report a 58-year-old man with an extensive BCC and signs of cranial nerve involvement. The patient had a large, infected ulcer on his scalp. He also had skull bone destruction, osteomyelitis, mastoiditis, cranial nerve paralysis, and radiographic features of the skull base and upper cervical soft tissue involvement. Pathologic studies revealed an infiltrating form of BCC. If left untreated and neglected, as in this case, BCC can become inoperable and complicated.

Hair Matrix Differentiation in a Trichogenic Adnexal Neoplasm.

Pilomatricoma is a distinctive tumor characterized by a dual population of proliferating germinative cells and shadow cells and is beleived to derive from the hair matrix. Rarely, benign and malignant adnexal tumors can show pilomaticoma‐like or hair matrix differentiation. We present a 69‐year‐old man with a ruptured cystic nodule of the left cheek. Histology revealed a dermal tumor composed of nests of basaloid cells which manifested peripheral palisading and abortive hair papilla formation with a modified stroma and pilomatricoma‐like areas. This lesion shares features of a trichogenic adnexal neoplasm with those of a tumor having hair matrical differentiation, and has been rarely reported under the designation “follicular” basal cell carcinoma (BCC). This case illustrates an example of this unusual occurrence of hair matrix differentiation in a benign basaloid adnexal neoplasm as characterized by the presence of basaloid and shadow cells; the absence of individual cell necrosis and mitotic activity prompts us to doubt that it represents a form of nodular BCC, but rather it more likely reflects a hamartoma of the follicular anlage.

Polarization-sensitive optical coherence tomography of invasive basal cell carcinoma

Skin cancer is the most common human malignancy, with basal cell carcinoma (BCC) the most frequent type. Aggressive forms of BCC are associated with extensive dermal invasion and destruction of collagen. Surgery is the most common treatment, but identification of tumor borders is a challenge. Polarization-sensitive optical coherence tomography (PS-OCT) is an optical method to examine collagen birefringence. To date, it has not been exploited for cancer management. As part of a pilot exploratory study to examine the use of OCT in skin cancer, we examined several tumors that pose a challenge to the surgeon due to their large size and histological subtype. In normal perilesional skin, OCT identifies epidermal and dermal structure; PS-OCT identified dermal birefringence. In BCC, tumors lost normal structure and gained the appearance of lobular impressions. PS-OCT identified an alteration of dermal birefringence. Examination of a border area revealed a gradual transition from more normal appearing image to frank tumor. These results indicate that PS-OCT can identify features that distinguish normal skin from tumor and may have the potential to guide surgeons in the treatment of aggressive skin cancer.

Expression of basic fibroblast growth factor, vascular endothelial growth factor, and thrombospondin-1 related to microvessel density in nonaggressive and aggressive basal cell carcinomas.

The aggressive forms of basal cell carcinoma (BCC) are biologically different in a number of features from their nonaggressive counterparts. The expression of basic Fibroblast Growth Factor (bFGF), Vascular Endothelial Growth Factor (VEGF), and Thrombospondin-1 (TSP-1) was examined in primary culture samples of nonaggressive and aggressive BCCs. We studied the relationship between neoangiogenesis by counting microvessels, tumor aggressiveness, and the expression of three different angiogenic factors. bFGF mRNA was detectable in all BCC samples, but there was no significant difference in the levels of expression between the two types. VEGF mRNA was also detectable in all BCC samples. VEGF expression in the aggressive type was approximately 3.5-fold higher than in the nonaggressive type. TSP-1 expression was variable and not related to the type of BCC. The mean value of microvessel density (MVD) was significantly higher for the aggressive type than for the nonaggressive type. There was a significant correlation between VEGF levels and MVD. No significant relationships were found between bFGF, TSP-1 mRNA expression, and MVD. In conclusion, the results of present study suggest that VEGF expression and angiogenesis might play important roles in the progression to aggressive BCC.

Basal Cell Carcinoma

The incidence of basal cell carcinoma is rapidly increasing and a number of treatment modalities are available. Treatment of basal cell carcinoma includes both surgical and nonsurgical approaches, some of which are traditional, and others experimental. The treatment modality utilized is dependent on both the tumor type and the patient. In order to choose between therapies, evidence-based research is necessary. In an extensive review of the literature concerning treatment options for patients with basal cell carcinoma, we found that there are a limited number of comparative, prospective, randomized, long-term follow-up studies. Based on the results of the available studies, surgical excision, Mohs surgery and cryosurgery are the three standard therapies of choice. Other treatment modalities should be considered secondary choices. There are also promising new treatment options, such as photodynamic therapy, which need further investigation. Special attention is needed when treating the more aggressive subtypes of the disease, such as the micronodular, infiltrative, adenoid and morpheic forms of basal cell carcinoma, as well as bigger basal cell carcinomas and basal cell carcinoma recurrences.

The role of hedgehog signalling in tumorigenesis

It has long been known from work in both Drosophila and vertebrate systems that the hedgehog signalling pathway is pivotal to embryonic development, but the past 5 years has seen an increase in our understanding of how members of this pathway are crucial to the processes of tumorigenesis. This important link was firmly established with the discovery that mutations in the gene encoding the hedgehog receptor molecule patched are responsible for both familial and sporadic forms of basal cell carcinoma (BCC), as well as a number of other tumour types. It is now known that a number of key members of the hedgehog cascade are involved in tumorigenesis, and dysregulation of this pathway appears to be a key element in the aetiology of a range of tumours.

A study of secondary cutaneous amyloidosis in basal cell carcinoma in Chinese patients: lack of correlation with bcl-2 or p53 protein expression.

Pigmented basal cell carcinoma (BCC) is an uncommon form of BCC among Caucasians. In contrast, the majority of BCC in Orientals are pigmented BCC. To assess the occurrence of secondary amyloid deposits in BCC among Chinese patients, a retrospective study was conducted on 53 BCC specimens. We used a terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling method for detecting the apoptotic cells. In addition, immunohistochemical staining was performed to examine the expression of the B-cell leukemia/lymphoma-2 gene (bcl-2) and p53 protein. Of the 53 BCC specimens, 37 (69.8%) were pigmented BCC and 31 (58.5%) showed amyloid deposits in the stroma of the tumor cells. The mean percentage of apoptotic tumor cells was 0.29%. Immunostaining of bcl-2 and p53 was detected in 33 BCCs (62.3%) and 19 BCCs (35.8%), respectively. No relationship between amyloid deposition and the number of apoptotic cells was found. In addition, there was no correlation between amyloid deposition and bcl-2 protein expression or between amyloid deposition and p53 protein expression. Our results indicate that the frequency of secondary amyloidosis in BCC among Chinese patients is not higher than that reported in the West. Although no correlation could be detected between amyloid deposition and bcl-2/p53 protein expression, the possible role of apoptosis in the pathogenesis of amyloid deposition in BCC still needs further investigation.

BASAL CELL CARCINOMA OF THE SCROTUM

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 Mar 2000BASAL CELL CARCINOMA OF THE SCROTUM E. VANDEWEYER and R. DERAEMAECKER E. VANDEWEYERE. VANDEWEYER More articles by this author and R. DERAEMAECKERR. DERAEMAECKER More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67840-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "BASAL CELL CARCINOMA OF THE SCROTUM." The Journal of Urology, 163(3), p. 914 References 1 : Basal cell carcinoma of the scrotum. Report of three cases and review of the literature. J Am Acad Dermatol1992; 26: 574. Google Scholar 2 : Fifteen-year experience of carcinoma of the scrotum. Br J Urol1991; 68: 414. Crossref, Medline, Google Scholar 3 : Basal cell carcinoma of the scrotum: a case report and literature review. J Urol1982; 127: 145. Link, Google Scholar From the Plastic and Reconstructive Surgery Department, Jules Bordet Institute, Brussels, Belgium© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 163Issue 3March 2000Page: 914 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordscarcinoma, basal cellskin diseasesscrotumMetricsAuthor Information E. VANDEWEYER More articles by this author R. DERAEMAECKER More articles by this author Expand All Advertisement PDF downloadLoading ...

The hedgehog signalling pathway in tumorigenesis and development.

The hedgehog signalling pathway is responsible for the embryonic patterning of a range of tissues, and it is now known that dysregulation of this pathway can result in the formation of several tumour types. This cascade is regulated at the cell surface by the opposing actions of the patched and smoothened molecules which together form a receptor complex for hedgehog. The discovery that inactivation of the human patched gene is responsible for familial and sporadic forms of basal cell carcinoma firmly established a role for dysregulation of hedgehog signalling in tumorigenesis. Other key members of this pathway have also been shown to be involved in tumour formation, as have more distal downstream targets of hedgehog signalling. Since it appears that tumorigenesis results from constitutive activation of hedgehog responsive genes, the identification of novel downstream targets of hedgehog signalling in given cell types is likely to increase our understanding of the molecular processes underlying tumour formation.

Hemidesmosomes, Collagen VII, and Intermediate Filaments in Basal Cell Carcinoma

We have undertaken an analysis of hemidesmosomes (HD) and their associated structures, intermediate filaments (IF) and anchoring fibrils (AF), in various types of basal cell carcinoma (BCC). Using a combination of electron microscopy and immunofluorescence microscopy we show that there is a correlation between the loss of HD and tumor type (i.e., in solid and infiltrative BCC hemidesmosomes are present, sometimes in reduced numbers), while there appears to be a lack of hemidesmosomes in cells of sclerosing specimens. Moreover, even though there is a loss of cytoplasmic constituents of the HD in sclerosing forms of BCC, this is not the case with regard to collagen VII, a component of AF, which are normally associated with the extracellular side of the HD. Collagen VII is localized to the basement membrane zone of tumor cells in the absence of the cytoplasmic constituents of HD. Furthermore, deposits of collagen VII occur in the connective tissue close to tumor cell populations in all but one of the BCC specimens we analyzed. In addition to modifications in HD and AF in BCC tissue, there are changes in the cytoskeletal elements of both tumor cells and the normal appearing epidermis that overlies tumor areas. In sclerosing BCC microfilaments are commonly observed along the basal portions of tumor cells where they abut the connective tissue. IF are often found interacting with these microfilaments. Indirect immunofluorescence analysis of tumor tissue using a monoclonal keratin antibody preparation, AE1, which in normal epidermis stains basal cells, reveals that AE1 antibodies only weakly stain tumor cells. Moreover, in the epidermis that overlies tumor cell regions AE1 antibodies stain suprabasal cells and not basal cells. This change in staining pattern generated by AE1 antibodies appears to depend upon the proximity of tumor cells. These results are discussed in relation to the organization of the HD and its associated AF and IF. The possibility that HD, IF, and AF antibody preparations may be of diagnostic use is raised.

Basal cell carcinoma with follicular differentiation.

A distinctive form of basal cell carcinoma with follicular differentiation was studied in 15 biopsy specimens. The neoplasms differ from other variants of basal cell carcinoma by being situated on the face only, being small and well circumscribed, and having signs of follicular differentiation, namely, numerous tiny infundibular cyst-like structures and aggregations of neoplastic cells that resemble hair follicles in telogen. The diagnostic features of basal cell carcinomas with follicular differentiation are enumerated and illustrated.

Nevoid basal cell carcinoma syndrome: Profile of genetic and environmental factors in oncogenesis

Nevoid basal cell carcinomas (NBCCs) are a prototype of a genetic form of basal cell carcinoma. These basal cell cancers, rather than being caused by genetic factors alone, are most likely the product of genetic and environmental factors. The NBCC syndrome provides a model for studying tumors induced by ionizing radiation and for viewing carcinogenesis as a multistage process explaininable by a minimum of two steps. The interaction of genetic and environmental factors in producing tumors to which an individual is predisposed can be studied in patients with the NBCC syndrome and childhood medulloblastoma that was treated by radiation therapy. Individuals with the NBCC syndrome represent a special subgroup with a hereditary predisposition to basal cell carcinoma in whom ionizing radiation may supply the subsequent mutation necessary for tumor development. The genetically altered epidermis underlying the palm and sole pits found in patients with the syndrome represents basal cell carcinoma in situ from which basal cell carcinomas develop, albeit infrequently. The restrained biologic behavior of most of these tumors contrasts with the usual destructive behavior of the NBCCs of the head and neck in the same patient.

Aggressive Basal Cell Carcinoma of the Scalp

Three examples of an unusually aggressive form of basal cell carcinoma in the skin of the scalp were treated surgically. The extent of each tumor was verified with gross and microscopic examination. The tumors invaded fat, muscle, fascia, and bone. Dural involvement was seen in one case. Light microscopy showed a marked variation in growth patterns and cytologic types from one portion of the tumor to another. Characteristics included a diffusely infiltrating pattern with a fibrotic stromal response, rare intraepidermal tumor nests, formation of occasional duct-like structures, poor cellular cohesion with single-life invasion through dermal collagen, perineural invasion, and pleomorphism with varying nuclear cytoplasmic ratios. Basaloid populations with peripheral palisading were seen in each tumor. These malignancies may be representative of an unusual basal cell carcinoma variant unique to the scalp.