Metatypical Basal Cell Carcinoma Research Articles

Use of HSP105 in the Differential Diagnosis of Basaloid Skin Tumors: A Study of 73 Cases

Background: Basaloid skin tumors include subtypes of basal cell carcinoma (BCC) and the basaloid variant of squamous cell carcinoma (SCC). Due to their similarity in pathology and clinical presentation, their diagnosis is not straightforward. The aim of this study was to analyze the immunohistochemical expression of HSP105 in basaloid skin tumors, which include BCC, basosquamous carcinoma (BSC), metatypical basal cell carcinoma (MBCC), basaloid squamous cell carcinoma (BSCC), BCC with squamous differentiation as well as conventional SCC. Methods: This retrospective study included 17 cases of BCC, 11 cases of BSC, 8 instances of MBCC, 10 cases of BCC with squamous differentiation, 8 cases of BSCC, and 19 cases of SCC. Their clinical characteristics were summarized, and the paraffin blocks of tumor biopsy specimens were collected for HSP105 immunostaining. Results: In contrast to the BCC group, which stained predominantly negative, SCC stained diffusely positive for HSP105. BSCs showed some areas of HSP105 positivity with a transitional expression signature. HSP105 was only weakly positive in a few cases of MBCC. Although BSCC was stained positive for HSP105, the HSCORE was significantly lower than that of the classic SCC. In BCC with squamous differentiation, focal staining for HSP105 was only seen in the area of squamous differentiation. Conclusion: There was a difference in immunohistochemical staining of HSP105 in basaloid skin tumors which helps in differential diagnosis. Differentiation between BCC, SCC, BSCC, MBCC, and BCC with squamous differentiation can be aided by immunohistochemistry using HSP105.

Metatypical BCC of The Ear: Partial Amputation of The Auricle as Adequate Dermatosurgical Approach

Non-melanoma skin cancer is the most common cancer in the world (1). Basal cell carcinoma (BCC) is the most common malignant neoplasia of the skin, accounting for approximately 80% of all cutaneous tumors (2). High cumulative ultraviolet (UV) light exposure and the presence of Fitzpatrick skin phototype I or II are pathogenetic risk factors (3). UV radiation induces mutations in the tumor suppressor PTCH1 gene, leading to increased Hedgehog (XX/Hh) signaling pathway activity (4). Dysfunction or abnormal activation of the Hedgehog signaling pathway is associated with disorders of embryonic development and the development of cancers such as Goltz–Gorlin syndrome for example (5). BCC has the characteristics of a locally invasive, slow-growing skin cancer, with a metastatic incidence between 0.0028-0.5%, with areas in the head and neck most commonly affected (6). Metatypical basal cell carcinoma (MTBCC) is a rare variant of BCC that has histopathological characteristics of both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) (7).

Mohs micrographic surgery in rare cutaneous tumors: a retrospective study at a Brazilian tertiary university hospital

BackgroundMohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique. ObjectiveTo study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors. MethodsThis was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021. ResultsDuring the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up. Study limitationsThis is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn’t widely available in the public service. ConclusionThis retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.

Metatypical basal cell carcinoma invasion of the central nervous system

Metatypical basal cell carcinoma is a rare skin cancer. Compared to basal cell carcinoma, this tumor type is more aggressive and has higher incidence of metastasis. We present the case of a 45-year-old female with metatypical basal cell carcinoma of the scalp with invasion of the central nervous system.

Reappraising basosquamous carcinoma: a summary of histologic features, diagnosis, and treatment

Basosquamous carcinoma (BSC) is a malignant and aggressive neoplasm with unclear molecular etiology. It is often misdiagnosed as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) on biopsy as there are unclear histologic criteria for this neoplasm. It has been interchangeably referred to as metatypical BCC and collision tumor, although these entities are different. On histology, BSC consists of basal cells with areas with nests of squamous cells and an intermediate transition zone. The nature of this transition zone is not clearly defined in literature; however, Ber-EP4 staining is diagnostic for BSC. A gradation of Ber-EP4 staining from strongly positive in basaloid areas to weakly positive in an intermediate zone is demonstrated (no staining of squamous areas). Treatment with an array of modalities including wide local excision, Mohs surgery, radiotherapy, and palliative chemotherapy has been performed. We recommend further molecular studies in understanding the genetic mechanisms leading to BSC. For the purpose of good clinical practice, multiple biopsies and immunohistochemical studies should be performed to avoid samplingerror that can lead to a misdiagnosis of BSC.

Extensive bony metastases from facial metatypical basal cell carcinoma: a case report

Metastatic basal cell carcinoma (BCC) is rare. We treated a 44-year-old woman with an extended facial metatypical BCC in whom staging showed no local or distant metastases, but one year after resection, we diagnosed a local recurrence. Re-staging, using a fludeoxyglucose positron emission tomography-computed tomogram, (FDG PET-CT) showed suspected accumulations of FDG in the whole axial skeleton. Bone punch biopsy examination confirmed extensive bony metastases, and after resection of the relapse, we began her on a systemic treatment with a Hedgehog-pathway inhibitor (vismodegib), which resulted in partial remission.

Ulcerated Metatypical Basal Cell Carcinoma of the Forehead.

An 81-year-old male presented with an ulcerated lesion on the frontal area. The lesion had started three years before with a small ulceration and was initially treated with a cream of betamethasone and fusidic acid twice daily for several months. The clinical impression was ulcerated basal cell carcinoma (BCC). The histopathological findings after surgical excision were consistent with metatypical or basosquamous carcinoma. The importance of metatypical and basosquamous carcinomas is their potential for a more aggressive behaviour than conventional BCC, both regarding local recurrences and metastatic disease. Clinicians should be aware of the more aggressive behaviour of metatypical BCC since it may influence the protocols of follow-up of these patients to timely detect local recurrences and/or metastatic disease.

Basosquamous Carcinoma: Controversy, Advances, and Future Directions

Basosquamous carcinoma is a rare cutaneous neoplasm that has caused considerable controversy as to its classification, pathogenesis, and management. To review and summarize current literature on the definition, pathogenesis, incidence, and management of basosquamous carcinoma. Through December 2015, an electronic search of the Pubmed database was performed using combinations of basosquamous carcinoma and metatypical basal cell carcinoma as search terms. A selection of 39 publications including case reports and series, retrospective studies, and systematic reviews of the literature were included. Descriptions of the definition of basosquamous carcinoma, clinical behavior, histopathological characteristics, current treatment therapies, and future advances are summarized. This systematic review provides a comprehensive overview of the current understanding of basosquamous carcinoma. Further study is required to elucidate the mechanisms driving the formation of this aggressive tumor.

Metatypical basal cell carcinoma in young man

Malignant epithelial skin tumors are leading among oncological diseases worldwide. In most cases epithelial skin tumors affect areas, susceptible to the action of adverse environmental factors. Metatypical basal cell carcinoma is a variant of basal cell carcinoma that combines the features of basal cell and squamous cell carcinomas. It characterized by infiltrative growth and the destruction of the underlying tissues, pain, bleeding, formation of distant metastases and frequent relapses. Metatypical basal cell carcinoma is more common in women, with the average age is 70.5 years. Historical data, the results of own clinical investigations, rare case of metatypical basal cell carcinoma of the young man, who was successfully treated with recombinant interferon-a2 and prospidinum are presented.

Pigmented Squamous Cell Carcinoma of the Lower Back Skin: A Case Report and Review of the Literature

Pigmented squamous cell carcinoma is a rare neoplasm arising mostly in mucous membranes or in sun-exposed skin. We describe a case of this tumor in a 70 year-old man who presented with a pigmented ulcerated nodule on his lower back. Microscopic examination revealed a squamous cell carcinoma (SCC) with atypical proliferation of cells with individual cell keratisation and keratin pearls’ formation. Apart from the squamous cell carcinoma a population of cytologically bland dendritic melanocytes was also present, a process that has been described as tumor cell colonization. Differential diagnosis of pigmented SCC includes melanoma with pseudoepitheliomatous hyperplasia, pigmented metatypical basal cell carcinoma and squamomelanocytic tumor, a recently described combined tumor. A small number of cases of pigmented SCC have been referred in the literature mainly located in mucosal surfaces such as the oral and nasal cavity and the conjunctiva but also in sun-exposed cutaneous sites especially at the skin of the head. In the present study, a case of pigmented SCC arising in sun protected skin is described. The authors review the published literature and discuss the histologic differential diagnosis of pigmented SCC as well as the possible mechanisms of melanocytes’ colonization in pigmented non-melanocytic malignant neoplasms.

Basosquamous carcinoma and metatypical basal cell carcinoma: a review of treatment with Mohs micrographic surgery.

Basosquamous carcinoma (BSC) and metatypical basal cell carcinoma (MBCC) are uncommon tumors poorly defined in the literature. Available studies suggest these tumors carry a greater risk of recurrence and metastases than basal cell carcinomas (BCCs) and, in some studies, squamous cell carcinomas. Formal treatment recommendations are not fully established. To analyze BSC and MBCC separately, evaluate whether they are distinct tumor subtypes, and analyze Mohs micrographic surgery (MMS) efficacy for BSC and MBCC. Retrospective review of medical records and histologic specimens was conducted for 293 patients with 303 biopsy-proven BSCs or MBCCs treated with MMS between 1996 and 2004. In total, 32 BSCs and 128 MBCCs were identified. Surgical and follow-up data were analyzed. Kaplan-Meier estimates of recurrence-free survival after MMS were 100% at oneyear for both tumor subtypes and were 100% for BSC and 93.8% for MBCC at 5years. Initial mean sizes were 1.5cm for BSC and 1.3cm for MBCC. Approximately 7% represented recurrent tumors at surgery. Of six patients with recurrences, none had known metastatic disease. Limitations include retrospective design, analysis of only head and neck sites, and small sample sizes. BSC and MBCC showed no significant distinguishing characteristics to separate them into two BCC subtypes. Reported recurrence rates for BSC and MBCC are 12-45% with wide local excision; estimated recurrence rates are 4.1% with MMS. Our study showed recurrence-free survival of 95.1% at fiveyears. Hence, MMS is effective in treating these BCC subtypes.

Metatypical Basal Cell Carcinoma: Histopathological Features in Aggressive Tumors

Objectives: The incidence and histological characteristics of metatypical basal cell carcinoma (MBCC) are divergent in the literature, especially in large dimension lesions. Retrospective studies suggest that this neoplasm represents from 1.2% to 2.7% of all BCCs, with a particular behavior that is prone to metastasis. The purpose of this study is to compare the demographics and histopathological features of cervicofacial MBCC with other BCCs treated by head and neck surgery. Methods: Data from 354 basal cell carcinomas were reviewed (1994-2012). Sex, age, histological subtype, localization, size, perineural and angiolymphatic invasions were analyzed, comparing MBCC with other basal cell carcinoma subtypes. Results: MBCC was found in 35 cases (10.77%), either as principal or associated subtype. Average age of MBCC was 64.8 ± 12.8, and 65.1 ± 14.2 years in the other group ( P = 0.89). There was no statistical difference in the items sex and angiolymphathic invasion. Zone H tumors were in 75.6% of MBCC and 89.7% of the negative group ( P = 0.02). Median size was 4.18 cm in MBCC and 2.67 cm in the negative group ( P < 0.01). Perineural invasion was observed in 47.2% in MBCC, while the frequency in the general BCC group was 20.8% ( P < 0.01). Conclusions: MBCC lesions with large dimensions, described as more aggressive behavior, present with bigger size, higher frequency of perineural invasion, and lower location in Zone H.

Features of biopsy in diagnosis of metatypical basal cell carcinoma (Basosquamous Carcinoma) of head and neck

Metatypical Basal Cell Carcinoma, also known as Basosquamous Carcinoma is a subtype of Basal Cell Carcinoma. It is similar to Basal Cell Carcinoma for the gross aspect and regional recurrences, but it has the capacity to spread and develop metastasis. This terrible characteristic endangers the life of the patient if it is not readily recognized by the physicians. Herein we present a report of two patients affected by BSC originating in the nasal region and external ear that after a series of devastating local recurrences metastasized to the lung and bones in one case. The true incidence of Basoquamous Carcinoma may be higher, with underreporting arising because of rarity of diagnosis and lack of awareness on the part of clinicians. Our experience suggests that a deep biopsy is often necessary to discover a BSC that appears as BCC but with local aggressive features.

Lung metastases in a case of metatypical basal cell carcinoma of the eyelid: an illustrative case and literature review to heighten vigilance of its metastatic potential

Basal cell carcinoma (BCC) is an extremely common malignancy; however, unlike other skin cancers, they very rarely metastasize. Here we present an unusual case of metatypical BCC of the eyelid which metastasized to the lung nine years after initial surgical treatment. We include a review of the literature regarding metastatic BCC and suggest that metatypical features in primary BCC should prompt careful patient monitoring and consideration of adjuvant treatment at the time of diagnosis.

Metatypical Basal Cell Carcinoma of the Nose

We report a case of metatypical basal cell carcinoma on the nose of a 79-year-old woman with a brief review of the literature.

Carcinoma of the skin metastatic to parotid area lymph nodes

This is a retrospective analysis of 60 patients with previously untreated metatypical basal cell (3 patients) or squamous cell (57 patients) carcinoma of the skin, metastatic to the parotid area. All patients had a minimum 2-year follow-up, and 43% had a minimum 5-year follow-up. Treatment was surgery alone (8 patients), irradiation alone (16 patients), or planned combined surgery and irradiation (36 patients). The ultimate rates of control of disease in the parotid area were surgery alone, 5 of 8 (63%); irradiation alone, 6 of 13 (46%); planned combined surgery and irradiation, 32 of 36 (89%). In the combined-treated group, all 4 recurrences were in patients who had positive surgical margins and gross involvement of the facial nerve. In patients with negative surgical margins, without involvement of the facial nerve, who had combined treatment, the control rate was 100%. Of the surgery-alone group, only 1 patient ultimately had the disease controlled and retained a functioning facial nerve.

Metastatic basal cell carcinoma: a clinicopathologic study of seventeen cases.

Basal cell carcinoma is a common cutaneous neoplasm that rarely metastasizes. We studied the clinical and pathologic features of 17 patients with metastatic basal cell carcinoma as recorded in the files of the Armed Forces Institute of Pathology (AFIP). Sixteen of the patients were male, and as far as it could be determined, all were white. The most frequent site of metastasis was lung (9 cases), followed by bone (5), lymph nodes (4), liver (3), spleen (1), and adrenal gland (1). Thirteen of the patients had metastatic lesions involving only one organ system. Mean survival time after metastasis was 1.6 years. Features of metatypical (basosquamous) basal cell carcinoma were common in the primary and recurrent tumors, and metastatic lesions generally had a metatypical or adenoid pattern. Two of the five bony metastases demonstrated shadow cells characteristic of pilomatrixoma. The metatypical pattern of a basal cell carcinoma is a feature of an aggressive lesion with the ability to metastasize.

Basal cell carcinoma in children

Clinical and pathologic features of 22 cases of basal cell carcinoma (BCC) in children, unassociated with xeroderma pigmentosum, nevus sebaceus, or nevoid BCC syndrome, and a review of the 25 cases previously cited in the literature are given. In our series, the patients ranged from 7 to 15 years in age, and each had a single lesion. Histologic features resembled those seen in BCC occurring in older age groups, except that fibroblastic proliferation of the surrounding stroma was prominent in many lesions. Most tumors were comprised of combinations of solid, adenoid, and cystic patterns. There were two fibrosing BCCs and one metatypical BCC. Isolated BCC in children can be distinguished from nevoid BCC only by careful clinical examination and follow-up. Trichoepithelioma may be misdiagnosed histologically as BCC.

Basal Cell Carcinoma in Children

Clinical and pathologic features of 22 cases of basal cell carcinoma (BCC) in children, unassociated with xeroderma pigmentosum, nevus sebaceus, or nevoid BCC syndrome, and a review of the 25 cases previously cited in the literature are given. In our series, the patients ranged from 7 to 15 years in age, and each had a single lesion. Histologic features resembled those seen in BCC occurring in older age groups, except that fibroblastic proliferation of the surrounding stroma was prominent in many lesions. Most tumors were comprised of combinations of solid, adenoid, and cystic patterns. There were two fibrosing BCCs and one metatypical BCC. Isolated BCC in children can be distinguished from nevoid BCC only by careful clinical examination and follow-up. Trichoepithelioma may be misdiagnosed histologically as BCC.