Large Basal Cell Carcinoma Research Articles

Additional review of Mohs slides to optimize Mohs micrographic surgery.

One significant risk factor for recurrence after Mohs surgery is misinterpretation of slides. To determine how often pathologists detected incompletely excised basal cell carcinoma (BCC) on Mohs slides and to determine risk factors for incompletely excised BCCs. This retrospective study included 1653 BCCs treated with Mohs surgery in a university hospital between 2007 and 2011. For routine quality assurance, all slides were additionally reviewed by a pathologist within 1 week of the procedure. For this study, all cases that had divergent interpretations were re-evaluated by a Mohs surgeon and a pathologist. Mixed-effects logistic regression models with Mohs surgeon effects as random effects were used to determine risk factors for incompletely excised BCC. Incompletely excised BCCs were detected in 31 cases (2%), in which defects > 20 mm in diameter were an independent risk factor (odds ratio 3.58, 95% confidence interval 1.55-8.28). Other studied variables (i.e. aggressive subtype, previously treated BCC, location on nose and > 2 Mohs stages) did not affect the risk of incompletely excised BCCs. The additional review of Mohs slides might increase accurate interpretation, especially in large BCCs.

Combination Trimodality Therapy Using Vismodegib for Basal Cell Carcinoma of the Face.

Background. For large basal cell carcinomas (BCCs) of the head and neck, definitive surgery often requires extensive resection and reconstruction that may result in prolonged recovery and limited cosmesis. Vismodegib, a small-molecule inhibitor of the hedgehog pathway, is approved for advanced and metastatic BCCs. We present a case of advanced BCC treated with combination of vismodegib, radiotherapy, and local excision resulting in excellent response and cosmesis. Case Presentation. A 64-year-old gentleman presented with a 5-year history of a 7 cm enlarging right cheek mass, with extensive vascularization, central ulceration, and skin, soft tissue, and buccal mucosa involvement. Biopsy revealed BCC, nodular type. Up-front surgical option involved a large resection and reconstruction. After multidisciplinary discussion, we recommended and he opted for combined modality of vismodegib, radiotherapy, and local excision. The patient tolerated vismodegib well and his right cheek lesion decreased significantly in size. He was then treated with radiotherapy followed by local excision that revealed only focal residual BCC. Currently, he is without evidence of disease and has excellent cosmesis. Conclusions. We report a case of locally advanced BCC treated with trimodality therapy with vismodegib, radiotherapy, and local excision, resulting in excellent outcome and facial cosmesis, without requiring extensive resection or reconstructive surgery.

Effective use of Vismodegib as a neoadjuvant prior to Mohs surgery

Importance: Basal Cell Carcinoma (BCC) represents a majority of skin cancers (80%), and can be locally invasive and difficult to treat in patients with Nevoid Basal Cell Carcinoma syndrome (Gorlin syndrome) or in patients with multiple BCCs in high-risk areas. Observations: Long-term use of Vismodegib was tolerated well in the 2 patients in this case series and was able to shrink large BCCs by up to 80.5%. Conclusions and Relevance: In Gorlin syndrome and high risk non-resectable BCCs, vismodegib can provide neoadjuvant treatment. In turn, allowing for Mohs surgery to be a viable option with smaller surgical defects with good cosmetic outcomes.

What is the impact of tumour size on dermoscopic diagnosis of BCC?

The effect of size on diagnostic performance of dermoscopy in basal cell carcinomas (BCCs) is yet to be determined. To investigate the differences in dermoscopic features between small- and large-sized BCCs. A total of 151 BCCs consecutively collected during a 2-year period were analysed. These tumours were evaluated for the presence of various dermoscopic features (colours, structures and vessels) using the contact polarized dermoscopy. Differences in proportions were evaluated by means of chi-squared test and Fisher's exact test, when appropriate. In all, 62 (41.1%) small (≤ 1 cm) and 89 (58.9%) large (>1 cm) BCCs were included. Arborizing vessels, short fine telangiectasias (SFT) and multiple small erosions were significantly (P < 0.05) more frequent in the group of large BCCs. Further analysis of the effect of size on dermoscopic features within the specific groups, nodular, superficial and ulcerated, found significant difference only in the group of nodular BCCs. Structureless hypopigmentation was significantly (P < 0.05) more frequent in the group of large nodular BCCs in comparison with the small ones. Despite determined differences in vascular features and multiple erosions between the small and large BCCs, the results of further investigation within the specific groups indicate that dermoscopy is reliable for the diagnosis of BCC regardless of its size.

Cutaneous basal cell carcinoma with endobronchial metastasis

Although basal cell carcinoma is a very common malignancy, metastasis from this tumour is extremely rare. For this reason, many plastic surgeons, dermatologists and physicians dealing with skin malignancies consider this as a locally invasive malignancy. We present a rare case of metastatic basal cell carcinoma manifested as a bronchial tumour. This case highlights the fact that despite basal cell carcinoma's local invasive potential, the possibility of distant metastasis still exists and clinicians should therefore be cautious about interpreting extracutaneous symptoms. Chest physicians should always consider the possibility of this rare tumour in the lungs in patients with a history of large basal cell carcinomas in the head and neck region.

A phase II, single-armed, multicenter trial of neoadjuvant vismodegib in patients with large and/or recurrent basal cell carcinoma: NICCI.

TPS9116^ Background: Vismodegib is useful to treat locally advanced or metastatic basal cell carcinoma (BCC) but has not been evaluated for use in a neoadjuvant setting to shrink BCCs before surger...

Lichen planopilaris after imiquimod 5% cream for multiple BCC in basal cell naevus syndrome

Basal cell naevus syndrome is an inherited autosomal dominant genetic disorder characterised by multiple basal cell carcinomas (BCC), skeletal, neurological and opthalmological abnormalities. The treatment of choice of the often multiple and large BCC consists of a combined approach including surgery, liquid nitrogen and other topical treatment modalities. Imiquimod 5% cream is an immune-response-modifying drug with antiviral and anti-tumour activity. Recent reports have associated the immune-stimulant properties of imiquimod with the exacerbation of several autoimmune skin diseases, such as eczema, psoriasis, vitiligo and lichenoid dermatitis. Here we report a patient with basal cell naevus syndrome who developed a lichen planopilaris on the same site of the scalp, which had been previously treated with two cycles of imiquimod for multiple BCC.

Unusually large basal cell carcinoma involving ear canal in a German Shepherd dog

A case of unusually large basal cell carcinoma involving ear pinna has been presented. Grossly it was a big ulcerated tumour mass which showed oozing of pus. Cytology revealed only inflammatory growth. Histologically, proliferating basal epidermal tumour cells showed papillary, solid as well as adenoid pattern of growth.

Re: superficial large Basal cell carcinoma over face, reconstructed by v-y plasty.

Re: superficial large Basal cell carcinoma over face, reconstructed by v-y plasty.

Superficial large Basal cell carcinoma over face, reconstructed by v-y plasty.

Superficial large Basal cell carcinoma over face, reconstructed by v-y plasty.

Re: superficial large Basal cell carcinoma over the face, reconstructed by v-y plasty.

Re: superficial large Basal cell carcinoma over the face, reconstructed by v-y plasty.

Oral Smoothened Inhibitor for Advanced Basal Cell Carcinoma of the Hand: A Case Report

Smoothened inhibitors have recently emerged as a nonsurgical, targeted therapy for treating advanced basal cell carcinomas (BCC) [8]. This novel small-molecule drug class suppresses Hedgehog pathway signaling by binding the membrane protein, Smoothened [7, 9]. Dysregulation of Hedgehog signaling is a hallmark of BCCs and is thought to play an integral role in maintaining cancer growth [1]. Treatment of locally advanced and metastatic basal cell carcinomas with the Smoothened inhibitor vismodegib demonstrated a 40–50 % response rate in Phase I and II trials, paving the way for FDA approval in early 2012 [10]. This therapy is most useful in patients for whom surgical resection is difficult or contraindicated due to tumor size, location, recurrence after surgery, or co-morbid medical conditions. Here, we report a case of a 43-year-old man with numerous and large BCCs of the hand that led to significant disability. The extent of disease suggested that surgical treatment might result in unacceptable functional results. There was involvement of a significant portion of the surface of the hand, and surgical excision would have created a large soft tissue defect requiring skin grafting, with the potential for scar formation, contractures with limitation of motion, and poor aesthetic outcome. Management with oral vismodegib resulted in dramatic tumor regression, with good functional and aesthetic results.

The use of forehead flaps in the management of large basal cell carcinomas of the medial canthus/medial lower eyelid in Saudi patients

PurposeBasal cell carcinoma (BCC) is the most common skin cancer worldwide. BCC represents 90–95% of all malignant eyelid tumors with lower eyelid/medial canthus lesions being more common than lower eyelid/lateral canthus lesions. Although various local flaps have been used for the reconstruction of medial canthus/adjacent eyelid defects, we find the forehead flap to be the most suited for these cases. Materials and methodsWe are reporting a clinical series of BCC involving the medial canthus and adjacent medial lower eyelid through a retrospective review of 18 patients who underwent surgical excision of the lesion followed by primary reconstruction using forehead flaps. Patients who underwent reconstruction without forehead flaps were excluded. All cases were Saudis and underwent this type of reconstruction. Indications, results, and complications were reviewed with special emphasis on the acceptance of the obvious forehead donor site scar in Saudi patients. ResultsAll flaps survived completely Follow-up ranged from 2 to 10years (mean of 5years). Tumor recurrence was not seen in any of the patients. Functionally, there was no ectropion and the eyelid margin was well aligned and stable. However, epiphora was evident since lacrimal system reconstruction was not performed. ConclusionWe are presenting the first Saudi series of large medical canthus/lower eyelid defects that underwent reconstruction using forehead flaps. The outcome was satisfactory and there were no cases of tumor recurrence. The only disadvantage is the donor scar which seems to be acceptable in the Saudi population because of their traditional head cover.

Large eyelid basal cell carcinoma with uniform and diffuse melanin deposition

Large eyelid basal cell carcinoma with uniform and diffuse melanin deposition

Double rhomboidal flap for reconstruction of large surgical defect of the labial commissure

Closure of perioral surgical defects involving the oral commissures is highly challenging. We describe a 69-year-old male patient with a large basal cell carcinoma of the right perioral region, extending to the right oral commissure. This lesion was radically excised, and the resulting surgical defect was closed using a homolateral double opposing rhomboidal flap. The final result was esthetically very satisfactory, with total preservation of lip function. Double opposing rhomboidal flaps are viable surgical options for the reconstruction of surgical defects involving the perioral area and oral commissures. In this relatively simple procedure, donor skin is obtained from the nearby cheek and mandibular areas, under low risk of surgical complications, preserving lip function without distortion of the labial anatomy.

Intralesion and Curaderm&amp;lt;sup&amp;gt;BEC5&amp;lt;/sup&amp;gt; Topical Combination Therapies of Solasodine Rhamnosyl Glycosides Derived from the Eggplant or Devil’s Apple Result in Rapid Removal of Large Skin Cancers. Methods of Treatment Compared

Solasodine rhamnosyl glycosides (SRGs) are chemotherapeutic agents for the treatment of cancer. SRGs in a cream formulation, CuradermBEC5, is very effective for the treatment of nonmelanoma skin cancers with excellent cosmetic end results. Intralesion injection of SRGs successfully dispose of very large tumours in animals without any clinical adverse effects. The mode of action of SRGs is by apoptosis. In this study, it is shown that small to large basal cell carcinomas are effectively treated only with topical application of CuradermBEC5. Here it is reported for the first time that combination of intralesion SRG injection and topical application with CuradermBEC5 in humans reduces the treatment time period by more than half when compared with topical application as the sole treatment regime. Two intralesion injections of very low doses of SRGs rapidly and effectively remove a large melanoma on a horse. If rapid removal of large troublesome skin cancers is required then this can be achieved by intralesion and topical treatments. Intralesion or combination therapy with SRGs may have some applications for melanomas in situ such as lentigo maligna.

RETALHO ROMBOIDAL DUPLO PARA ENCERRAMENTO DE DEFEITO CIRÚRGICO DA COMISSURA LABIAL

Os lábios, enquanto estruturas anatómicas móveis da face, apresentam crucial importância em termos funcionais e cosméticos. A abordagem de defeitos cirúrgicos da região perioral é um desafio importante na prática cirúrgica dermatológica, atendendo ao risco de distorção da anatomia local. Apresentamos o caso de um doente do sexo masculino, de 69 anos, com extenso carcinoma basocelular ulcerado da região perioral direita, com envolvi- mento da comissura labial. Foi realizada excisão radical da lesão e encerramento do defeito cirúrgico com retalho romboidal duplo das regiões geniana e mandibular homolaterais. Não houve complicações pós-operatórias e o re- sultado cosmético final foi bastante satisfatório, com preservação da funcionalidade das estruturas labiais. O retalho romboidal duplo é uma alternativa viável para o encerramento de defeitos cirúrgicos da comissura labial, utilizando pele das regiões geniana e mandibular adjacentes. É uma técnica de execução relativamente simples, com baixo risco de complicações, que oferece óptimos resultados funcionais e cosméticos.PALAVRAS-CHAVE – Procedimentos Cirúrgicos Reconstrutivos; Retalhos Cirúrgicos; Comissura Labial; Carcinoma Basocelular; Neoplasias do Lábio.

Successful treatment and management of large superficial basal cell carcinomas with topical imiquimod 5% cream: A case series and review

Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer in the Caucasian population and its incidence is increasing worldwide. Although surgical procedures show a high cure rate with acceptable morbidity, non-surgical, pharmacotherapeutic approaches have been regarded as appropriate alternatives, and/or first-line treatments, in selected cases. Imiquimod (IQ) is a synthetic imidazoquinoline amine that locally enhances, through cytokine induction, both innate and acquired immune pathways, resulting in immunomodulating, antiviral and antitumor effects. Topical IQ 5% cream is approved by the FDA and the European Union for the treatment of small superficial BCCs (<2.0 cm); however, published data highlight the possibility of successful outcomes in larger lesions. We report three patients, each one presenting with a large BCC and successfully treated with IQ 5% cream. Although our cases and those from the literature do not rise to the level of evidence, IQ may be a reliable, efficacious and safe non-surgical option for selected cases of large superficial BCCs. Histological examination should occur at baseline and at the end of treatment along with clinical and dermatoscopic examination at least monthly during the course of the treatment and every 6 months for 2 years following the treatment.

Wound management in a patient with rhinophyma and basal cell carcinoma

To the Editor: Rhinophyma may be the source of great embarrassment, and nasal reshaping can be achieved by using a variety of methods, including electrosurgery and second intention.1 Coexistent tumors may occur with rhinophyma2 and can be difficult to detect because of the anatomical distortion. Since incisional surgical wounds in rhinophymatous skin often heal imperfectly,3 second-intention healing is often the best management option after tumor excision in patients with rhinophyma. We present our management of a man with extensive rhinophyma within which two large basal cell carcinomas (BCCs) had developed.

Photodynamic Therapy for Basal Cell Carcinoma in Recessive Dystrophic Epidermolysis Bullosa

A 22-year-old male with recessive dystrophic epidermolysis bullosa with a large superficial and nodular basal cell carcinoma on his right forehead was treated with photodynamic therapy. The treatment was well tolerated, and the site healed well. Patients with epidermolysis bullosa are at increased risk of developing skin cancers, particularly squamous cell carcinomas. However, basal cell carcinomas are rare in recessive dystrophic epidermolysis bullosa. As patients with epidermolysis bullosa have recurrent blistering and poor wound healing, surgery may not be the optimal choice in treating skin cancers. We present this case to highlight that photodynamic therapy may be a helpful and safe technique in the treatment of superficial skin cancers in patients with epidermolysis bullosa, as an alternative to more radical methods.