Nodular Basal Cell Carcinoma Research Articles

632 UVB induced EMT-like phenotype in keratinocytes is mediated by TLR3 activation

Risk factors for non-melanoma skin cancer (NMSC) include UVB exposure, genetic mutations, immunosuppression, and chronic inflammation. Activation of Toll-Like-Receptor 3 (TLR3), which recognizes dsRNA, leads to downstream activation of NF-κB and an upregulation of inflammatory cytokines. TLR3 protein expression is higher in moderately differentiated squamous cell carcinomas (SCCs) and infiltrative basal cell carcinomas (BCCs) compared to well-differentiated SCCs by immunohistochemistry (n > 6) suggesting TLR3 expression correlates with more aggressive NMSCs.

Topical Imiquimod as a Treatment Option for Nodular Basal Cell Carcinoma: A Systematic Review.

Surgical excision is considered standard treatment for nodular basal cell carcinoma (nBCC). However, patients who reject or are unsuited for surgery may benefit from imiquimod (IMQ) 5% cream as an alternative treatment. The objective of this study was to conduct a systematic review on the efficacy and safety of IMQ for the treatment of nBCC. The terms basal cell carcinoma AND imiquimod OR Aldara were searched on Ovid-MEDLINE, EMBASE, and Cochrane Library databases. Articles were included if they reported the efficacy or side effects of IMQ for nBCC. Primary outcomes included clearance (clinical and histological), recurrence rates, and adverse events. Number of lesions/subjects, treatment regimens, length of treatment, and time to recurrence were secondary outcomes. Thirty-nine publications, totaling 738 lesions, revealed a 77.4% (335/433 lesions) clinical and 72.9% (390/535 lesions) histological clearance rate. Regimens ranged from once daily 2 days a week to twice daily 7 days a week. Average treatment duration was 8.81 (±3.49) weeks. There was a 1.80% recurrence rate after an average follow-up period of 13.03 (±15.09) months. Common adverse effects included erythema (77.2%), crusting (50.5%), pruritus (34.1%), tenderness/irritation (27.3%), ulceration (25.4%), burning (22.1%), and erosion (21.7%). Unforeseen side effects included conjunctivitis, keratitis, depigmentation, comedone formation, and ruptured epidermoid cysts. Imiquimod showed clinical and histological clearance rates of over 70% for nBCC, with a recurrence rate of 1.80%. Although clearance rates are lower than surgery, IMQ can be considered as a treatment option for nBCC in those who decline or are unfit for surgical intervention.

Sclerodermiform basal cell carcinomas vs. other histotypes: analysis of specific demographic, clinical and dermatoscopic features.

Among the various types of basal cell carcinoma, the sclerodermiform variant has a high risk of recurrence and local invasiveness. A systematic description of the dermatoscopic features associated with specific body localization is lacking. To describe the clinical and dermoscopic features of sclerodermiform basal cell carcinoma (BCC) according to localization in the body confronting with superficial and nodular types. Clinical and dermoscopic images of sclerodermiform, nodular and superficial BCCs were retrospectively evaluated to study the location in the various body districts, maximum diameter, clinical appearance of the lesion, features of edges and presence or absence of specific dermatoscopic criteria of BCCs. We examined 291 histopathologically proven BCCs showing that in nodular BCCs, classical arborizing vessels were more frequently found in the body macro-area (trunk and limbs; n=46, 97.9%) than in the head/neck area (n=43, 82.7%); within sclerodermiform BCCs, short arborizing vessels were found more frequently in the head/neck district (n=35, 49.3%) than in the body (n=6, 23.1%; P-value 0.02); within nodular BCCs, multiple blue-grey dots and globules were more frequently found on the trunk (n=23, 48.9%) than in the head/neck district (n=12, 23.1%; P-value 0.01). In sclerodermiform BCCs, ulceration was found more frequently in the head/neck district (n=38, 53.5%) than in the body (n=4, 15.4%; P-value>0.01), and in superficial BCCs, ulceration was found more frequently in the head/neck district (n=5, 38.5%) than in the body (n=8, 9.8%; P-value 0.02). Our study shows that superficial BCC are found frequently in the head/neck district dermoscopically characterized by ulceration and arborizing vessels; nodular BCCs are more frequently found in the body than in the head/neck district, and the dermoscopic pattern is characterized by the combination of three features: (i) classical arborizing vessels, (ii) multiple blue-grey dots and (iii) globules. Instead, sclerodermiform BCC is preferentially located in areas at high-moderate risk of recurrence; if pink-white areas and/or fine arborizing vessels are seen, clinicians should consider this diagnosis. Furthermore, location-specific dermatoscopic criteria have been described.

Long-term outcome of 117 patients with Erdheim-Chester disease and mixed histiocytosis receiving targeted therapies (BRAF and MEK inhibitors): A monocentric experience.

7560 Background: Erdheim–Chester disease (ECD), an inflammatory myeloid neoplasm from the L group, is an histiocytosis associated with multisystem infiltration. Around 1500 cases have been reported worldwide since 1930. In 15% of cases, ECD is associated with another histiocytosis corresponding to mixed histiocytosis. Before 2004, 60% of patients died within 3 years after diagnosis. The targetable BRAFV600Emutation is present in as much as 70% of all ECD cases. Targeted therapies (BRAF inhibitors in April 2012, followed by MEK inhibitors after 2015) have revolutionized the therapeutic options and prognosis of refractory ECD and mixed histiocytosis. Methods: This retrospective study was conducted between April 2012 and December 2019 on 117 ECD patients who received targeted therapies in the French National Referral Center for Histiocytosis at Pitié-Salpêtrière Hospital in Paris, France. 28 patients (pts) (24%) had a mixed histiocytosis. Results: 43 (36.7%) pts were female and 95/116 exploitable pts (81.9%) had a BRAF V600E mutation. 12 (10.3%) pts had a co-ocurring hemopathy (myeloproliferative neoplasm or myelodysplastic syndrom). Age at diagnosis was 57.2 yr (+/- 13.8). The main sites of involvement were: vascular (“coated aorta”) in 85 pts (73%), heart in 83 pts (71%), xanthelasma in 30 pts (26%), central nervous system in 56 pts (48%) and peri-renal (“hairy kidney”) in 84 pts (72%). 34 pts (29%) had previously received corticosteroids, and 63 pts (54%) interferon alpha regimen (mainly PEG interferon). 86 (74%) pts received the BRAF inhibitor vemurafenib, and 42 (36%) pts the MEK inhibitor cobimetinib (some patients receiving both). 25 pts died during follow-up. The median survival of patients with targeted therapies in december 2019 was undefined, whereas the patients with no targeted therapies had a median survival of 133 months (HR 0.64 (0.42-0.99); p = 0.04). Among the 117 pts, only 2 had a progression of VAF of mutations within genes frequently mutated in myeloid neoplasms. The most serious adverse events were cutaneous (squamous cell carcinoma, basocellular carcinoma, DRESS) and acute pancreatitis with BRAF inhibitors, whereas chorioretinitis and left ventricular dysfunction were seen with MEK inhibitors. None of the patients receiving targeted therapies progressed. Conclusions: Targeted therapies (BRAF and/or MEK inhibitors) were found dramatically efficacious in 117 patients with severe and refractory ECD and mixed histiocytosis, improving survival of patients.

Clinical Management of Locally Advanced Basal-Cell Carcinomas and Future Therapeutic Directions.

Treatment of choice for nodular basal-cell carcinomas (BCCs) is complete excision, implying that small lesions are of minor concern. Metastasis is very rare (< 1%). However, locally advanced basal-cell carcinomas (laBCCs), which are ineligible for surgery or radiation, are a therapeutic challenge. First-generation Smoothened (SMO) inhibitors (vismodegib, sonidegib) have been approved for treatment, but common side effects limit their use. Numerous new compounds are being investigated in clinical trials as potential therapeutic alternatives, among them second-generation SMO inhibitors, other Hedgehog signaling pathway inhibitors, immune-checkpoint inhibitors and intralesional modalities such as oncolytic viruses. Neoadjuvant treatment regimens open another field. This article deals with the clinical management of laBCCs, based on the description of an illustrative case from our department featuring multiple extensive lesions of the scalp. In this short review we will discuss therapeutic options and implications for the future. Some of the new strategies might potentially evolve as alternatives in the management of genodermatoses such as basal-cell carcinoma syndrome, if proven effective and safe.

CD73 Is Enriched in Cutaneous Carcinomas That Invade the Orbit.

To compare the expression of CD73 in indolent nodular basal cell carcinomas and cutaneous lesions that invade the orbit. Immunohistochemical staining for CD73 was performed on nodular basal cell carcinomas and invasive basal cell carcinomas. The numbers of positively staining cells were counted across 5 consecutive ×40 microscopic fields, and a statistical comparison was performed via a dedicated computerized software package. Ten control specimens and 11 invasive tumors were analyzed. In nodular basal cell carcinomas, the mean number of positively staining cells was 0.72/×40 field (standard deviation = 0.80 cells/×40 field), whereas invasive tumors demonstrated a mean of 6.53 positive staining cells/×40 field (standard deviation = 3.33 cells/×40 field). This difference was statistically significant (p = 0.0002). CD73 is enriched in orbital invasion of cutaneous carcinomas. This checkpoint may represent an important target for therapeutic management of these lesions. Immunotherapeutic agents that have been designed to treat other neoplasms may decrease the requirement for orbital exenteration in this clinical scenario.

Diagnosis and Management of Nonmelanoma Skin Cancer

Nonmelanoma skin cancer (NMSC) is the most common cancer in the world. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common types. SCC lesions are more likely to metastasize when compared to BCC, but due to low risk for metastasis, prognosis for NMSC is excellent. Ultraviolet radiation exposure is the main risk factor for developing NMSC. Merkel cell carcinoma and dermatofibrosarcoma protuberans are rare forms of NMSC. The most common BCC lesions types are nodular, superficial, and sclerosing. Nodular BCC typically consists of papular lesions with a pearly border. Superficial BCC lesions are flat or slightly raised, often red to brown. Sclerosing BCC lesions usually have nondiscrete margins. The gross appearance of SCC is that of an erythematous plaque with scale and/or ulceration. The diagnosis of NMSC starts with gross examination, followed by biopsy. Recommended biopsy techniques include punch, shave, and excisional biopsy. Dermatoscopy should also be used to aid in the evaluation of suspected NMSC and other skin cancers, as it greatly enhances the point-of-care diagnosis of skin malignancies. For low-risk lesions, surgical excision is the cornerstone of treatment, although depending on the clinical situation, curettage and electrodessication or non-surgical modalities may be used. Cryotherapy, topical treatments, photodynamic therapy, or radiation treatment can be used to treat BCC and SCC, but cure rates are lower than with surgical excision. High-risk lesions require specialist referral. All patients treated for NMSC should undergo regular complete skin exams, and counseling on the use of sun protection and avoidance.

Surgery versus combined treatment with curettage and imiquimod for nodular basal cell carcinoma: One-year results of a noninferiority, randomized, controlled trial

Nodular basal cell carcinoma (nBCC) is mostly treated with surgical excision. Interest in minimally invasive treatment of these low-risk tumors is increasing. We assessed the effectiveness of nBCC treatment with curettage and imiquimod cream compared with surgical excision. Patients with nBCC included in this randomized, controlled noninferiority trial were randomly assigned to either a curettage and imiquimod cream group or a surgical excision group. The primary endpoint was the proportion of patients free from treatment failure 1year after the end of treatment. A prespecified noninferiority margin of 8% was used. A modified intention-to-treat and a per-protocol analysis was performed (ClinicalTrials.gov identifier NCT02242929). One hundred forty-five patients were randomized: 73 to the curettage and imiquimod cream group and 72 to the surgical excision group. The proportion of patients free of recurrence after 12months was 86.3% (63/73) for the curettage and imiquimod group and 100% (72/72) for the surgical excision group. The difference in efficacy was -13.7% (95% confidence interval -21.6% to -5.8%; 1-sided P=.0004) favoring surgical excision. Noninferiority of curettage and imiquimod cream cannot be concluded. Given the still high efficacy of curettage and imiquimod cream and the indolent growth pattern of nBCC, curettage and imiquimod could still be a valuable treatment option with the possibility to prevent overuse of excisions. However, it cannot replace surgical excision.

Surgical treatment of basal cell carcinoma: a case series on factors influencing the risk of an incomplete primary excision.

Basal cell carcinoma (BCC) is the most common skin cancer form, and one first-line treatment is surgical excision. Complete excision is vital to minimize risk of recurrence. Studies on occurrence of incomplete excisions have given diverse results and seldom include large populations from a dermatological setting. The rate of positive surgical margins in primary surgery of BCC at a tertiary dermatology clinic is studied. Factors associated with an incomplete primary excision are analysed. Patients scheduled for standard excision, without perioperative margin control, of BCC during the years 2008-2015 were prospectively enrolled in the study. Tumour-specific factors, including histopathologic subtype, as well as postoperative outcome were registered. Incomplete excisions were analysed in relation to patient- and tumour-related factors. In total, 4.6% of 3911 BCC tumours were incompletely excised. The rate of incomplete excisions was higher for facial tumours and among tumours with an aggressive histological subtype. Morpheiform BCC on the nose or ear had the highest rate of an incomplete excision, 61.5% and 50%, respectively. Most BCCs, irrespective of subtype, were completely excised during the primary excision. Tumour sites nose and ears were associated with the highest rate of positive primary surgical margins, especially for infiltrative or morpheiform BCCs. Surgery with perioperative examination of margins is strongly recommended for these tumours.

Surgical margins required for basal cell carcinomas treated with Mohs micrographic surgery according to tumor features

Basal cell carcinomas (BCCs) with high-risk features are preferably treated by Mohs micrographic surgery. Studies have shown clinicopathologic characteristics that may predict more stages required for clearance. However, few studies have correlated such factors with the number of millimeters removed per stage. To determine margins necessary for BCC clearance according to tumor features, especially for tumors less than 6mm, and to suggest initial margins for Mohs micrographic surgery and margins for wide local excision. Retrospective analysis of 295 consecutive Mohs micrographic surgeries for primary BCCs. Variables analyzed included patient age, sex, immunostatus, lesion size, location, histologic subtype, borders, stage number, and millimeters excised per stage. BCCs less than 6mm had a clearance rate of 96% with 3-mm margins. In adjusted multivariable analysis, superficial, micronodular, infiltrative, and morpheaform subtypes were associated with larger margins, whereas clinically well-defined tumors were associated with smaller margins. Because of the limited sample of certain subtypes, a 3-mm margin is better suited for nodular tumors. These data help guide initial Mohs micrographic surgery and wide local excision margins required for tumor clearance according to tumor features. Nodular BCCs less than 6mm may be cleared with 3-mm margins instead of the current 4-mm margin recommendation.

Crateriform Nodule over a Scar

Keratoacanthoma is a low-grade epithelial neoplasm that originates from the pilosebaceous unit. The exact etiopathogenesis of keratoacanthoma is not known. It may arise secondary to other skin lesions such as psoriasis, herpes zoster, lichen planus. Clinically, it is characterized by rapidly growing, dome-shaped crateriform nodule with central keratotic core. The classic lesion shows rapid progression followed by spontaneous involution with a depressed, hypopigmented scar. Clinically differential diagnosis of keratoacanthoma includes squamous cell carcinoma, nodular basal cell carcinoma, nodular Kaposi sarcoma, and metastatic lesion to the skin. In contrast to these malignancies, keratoacanthoma undergo spontaneous resolution and it rarely spread through lymphatic, venous, or perineural routes. Surgical excision is the gold standard for the treatment of keratoacanthoma. Here, we describe a case of keratoacanthoma developing over a pre-existing scar following lichen planus hypertrophicus. High index of suspicion of keratoacanthoma is required while encountering rapidly growing nodule over a scar and histopathological examination is mandatory to rule out other malignancy.

Carcinoma basocelular como debut por exposición al sol.

Introducción: Es reconocida la importancia de la luz solar para la evolución de la vida en la tierra y su papel en el desarrollo humano. Sin embargo, todos los humanos, especialmente las personas cuya piel no está tan pigmentada o cuya ocupación o estilo de vida los expone a cantidades excesivas de luz solar, son potencialmente susceptibles a sus efectos nocivos. Es indiscutible el vínculo entre la exposición crónica al sol de la piel humana y las consecuencias clínicas nocivas como el fotoenvejecimiento y los cánceres de piel, como es el carcinoma basocelular.&#x0D; Objetivo: Describir el efecto que tiene la exposición prolongada al sol como factor de riesgo para desarrollar Carcinoma Basocelular.&#x0D; Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico de Carcinoma Basocelular por exposición al sol&#x0D; Resultados: Existieuna asociación entre la exposición excesiva a radiaciones solares por el paciente y la aparición de un carcinoma basocelular en la piel.&#x0D; Conclusiones: El Carcinoma Basocelular representa la neoplasia cutánea más frecuente, por lo cual se hace imprescindible para lograr el correcto diagnóstico y tratamiento, conocer su comportamiento clínico y evolución de la lesión. El factor de riesgo más importante a considerar es el tiempo de exposición a los rayos solares.

Local recurrence of clinically observed basal cell carcinomas following complete saucerization or punch removal with negative margins: Retrospective case series from 2010 to 2020

Local recurrence of clinically observed basal cell carcinomas following complete saucerization or punch removal with negative margins: Retrospective case series from 2010 to 2020

Multispectral autofluorescence dermoscope for skin lesion assessment.

Basal cell carcinoma (BCC) is the most common type of skin cancer. Diagnosis and edge assessment of BCC lesions are based on clinical and dermoscopy evaluation, which are strongly dependent on the expertise and training of the physician. There is a high rate of underdiagnosis because BCC is frequently confused with certain common benign lesions and is often indistinguishable from the surrounding healthy tissue. In the present study, a multispectral fluorescence lifetime imaging (FLIm) dermoscopy system, designed for imaging and analyzing the autofluorescence emission of skin tissue, was used to image thirty-eight patients with diagnosed nodular BCC (nBCC) lesions, using clinically acceptable levels of excitation light exposure. With this system, skin autofluorescence was imaged simultaneously using three emission bands: 390 ± 20 nm, 452 ± 22 nm, and >496 nm, preferentially targeting collagen, NADH, and FAD autofluorescence, respectively. Statistical classifiers based on FLIm features developed to discriminate BCC from healthy tissue showed promising performance (ROC area-under-the-curve of 0.82). This study demonstrates the feasibility of clinically performing multispectral endogenous FLIm dermoscopy providing baseline results indicating the potential of this technology as an image-guided tool to improve the delineation of nBCC during surgical lesion resection.

The Follicular Benignancy- Desmoplastic Trichoepithelioma

Trichoepithelioma is a benign, cutaneous neoplasm originating from the hair follicle and is categorized into singular trichoepithelioma, multiple trichoepithelioma and desmoplastic trichoepithelioma wherein desmoplastic trichoepithelioma is cogitated as an exceptional, cutaneous adnexal tumour. Desmoplastic trichoepithelioma was initially scripted by Hartzell in 1904 wherein the lesion was described as a benign, cystic epithelioma. Desmoplastic trichoepithelioma can be additionally nomenclated as epithelioma adenoides cysticum, morphea - like epithelioma or sclerosing epithelial hamartoma 1. Familial instances of desmoplastic trichoepithelioma are infrequent and can be misdiagnosed on account of adjunctive benign, cutaneous, adnexal neoplasms depicting subtle clinical features, excepting a nodular basal cell carcinoma. Cogent clinical and histological features can assist the diagnosis of desmoplastic trichoepithelioma 1, 2.

2-mm surgical margins are adequate for most basal cell carcinomas in Japanese: a retrospective multicentre study on 1000 basal cell carcinomas.

Surgery is the gold standard for basal cell carcinomas (BCC). Current recommended surgical margins for BCCs are determined from studies in Caucasian populations. However, the appropriate surgical margins for BCCs in non-white races are unclear. To investigate the accuracy of preoperative determination of clinical tumour borders and appropriate surgical margins in Japanese patients with BCC. The maximum calculated differences in distance between the preoperatively determined surgical margins and the actual histologic tumour side margins were considered as 'accuracy gaps' of clinical tumour borders. Estimated side margin positivity rates (ESMPRs) with narrower (2 and 3mm) surgical margins were calculated on the basis of the accuracy gaps. Overall, 1000 surgically excised BCCs from 980 Japanese patients were included. The most frequent histologic subtype was nodular BCC (67%). The median accuracy gap was 0.3mm [interquartile range (IQR): -0.5 to +1mm]. The ESMPRs with 2- and 3-mm surgical margins were 3.8% and 1.4%, respectively. Only the ESMPRs between the well-defined (n=921) and poorly defined clinical tumour border groups (n=79) showed statistical difference [2-mm margin: 3.1% vs. 11.7%, OR: 3.89, 95% confidential interval (CI): 1.41-10.71, P <0.01; 3-mm margin: 0.97% vs. 6.3%, OR: 6.58, 95% CI: 1.67-25.99, P <0.01]. No significant differences in ESMPRs were noted in other subgroups including risk classifications. The determined clinical tumour border accuracy gaps in this Japanese cohort were negligible. Dermatologic surgeons may use narrower surgical margins with acceptable margin positivity rates. The clarity of clinical tumour borders could be an appropriate guide for selection of different surgical margins in the Japanese cohort.

Basal cell carcinoma with intravascular invasion

Summary: We report the case of a 59-year-old Caucasian male with a primary infiltrative basal cell carcinoma (BCC) with vascular invasion on the right temple. An excision biopsy was taken and histology confirmed a BCC, 2.5mm thick, invading into the reticular dermis. The patient underwent a scar excision which demonstrated no further malignancy. The patient showed no clinical signs of recurrence 2 years after diagnosis. Relevance: BCC is the most common human malignancy and its incidence is increasing. Less than 1% of BCCs metastasize and very few cases of intravascular invasion by a primary BCC have been reported. This report discusses the clinical features of a BCC, the population at risk and summarises all known cases of BCC with vascular invasion in the literature. Take Home Messages: Due to the rarity of BCC with vascular invasion, there is a poor understanding of the disease process and the metastatic potential, resulting in uncertainty for clinician and patient regarding appropriate management.

Trichoblastic Carcinoma of the Scalp: a Case Report on a Rare Condition

Trichoblastic carcinoma is a rare malignant adnexal tumor arising from the hair follicle. It is often difficult to differentiate it from basal cell carcinoma given its similarities on histopathology. However, it is important to arrive at a definitive diagnosis given its tremendous potential to metastasize as compared with basal cell carcinoma. Here we report a case of a 52-year-old man with an indolent scalp swelling. A surgical excision followed by a histological study showed trichoblastic carcinoma. A revision surgery was done later with adequate margins which were tumor free on histology. Very few cases of such diagnosis are available at our disposal.

Photodynamic therapy with methyl-5-aminolevulinate for basal cell carcinoma: A systematic review and meta-analysis

Basal cell carcinoma (BCC) is the most common type of non-melanoma skin cancer worldwide. Methyl-5-aminolevulinate (MAL) photodynamic therapy (PDT) is an effective and acceptable treatment for BCC. The purpose of this analysis was to compare the benefit and tolerability of MAL-PDT with other modalities for the treatment of BCC. PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched from inception until 5 August 2019. Eligible studies were prospective and retrospective clinical trials of MAL-PDT for superficial and nodular BCC. At least one of the following outcomes were reported: complete response (CR) at 3 months and sustained at 12 months; recurrence at 12 months and sustained at 5 years; cosmetic outcome at ≥ 3 months; adverse events. From 427 search results, 11 articles including seven randomized controlled trials (1339 patients; 1568 lesions) and one retrospective study (108 lesions) were eligible. CR was inferior with MAL-PDT versus surgery (3 months: Risk Ratio [RR]: 0.93, 95 % confidence interval [CI] 0.89-0.97, p = 0.002; 12 months: RR: 0.90, 95 % CI 0.85-0.95, p = 0.0002). Moreover, MAL-PDT had higher 12 months recurrence rate (RR: 10.43, 95 % CI 1.98-55.03, p = 0.006) and more toxicities (RR: 2.12, 95 % CI 1.46-3.09, p < 0.0001) in comparison with surgery. However, MAL-PDT cosmesis was superior to excisional surgery (RR: 1.99, 95 % CI 1.50-2.63, p < 0.00001). Additionally, MAL-PDT was associated with similar CR in comparison with 5-aminolaevulinic acid (ALA)-PDT and ALA nanoemulsion (BF-200 ALA)-PDT, but had higher recurrence rate at 12 months and worse cosmesis compared with BF-200 ALA-PDT, even though the differences were not statistically significant. MAL-PDT might not be the best first-line treatment option for BCC, although cosmetic outcome could be good-to-excellent.

Periocular basal cell carcinoma: 20-years experience at a tertiary eye care center of South India

PURPOSE: To study the clinical profile and management outcomes of periocular basal cell carcinoma (BCC).MATERIALS AND METHODS: A retrospective analysis of all histopathologically proven cases of BCC between 1995 and 2015 was done. The demographic data, clinical presentation, histopathological subtype, and management outcomes were analyzed.RESULTS: We had a total of 185 malignant eyelid tumors during the study period, out of which 37 (20%) were BCC. Thirty-two (86.5%) out of 37 cases were primary BCC. The mean age was 63.3 years. Pigmented ulcerative lesion (14, 38%), lower eyelid (19, 51%), and nodular BCC (15, 40%) were the most common presentation, periocular site, and histological subtype, respectively. 28 patients underwent excision under frozen section with an average tumor-free margin of 3.5 mm. Mean follow-up period was 18.78 months. Recurrence rate of 0% and 3.1% was noted in primary and recurrent BCC, respectively.CONCLUSION: Periocular BCC commonly presents as pigmented ulcerative lesion in the lower lid. Excision biopsy under frozen section with an average tumor-free margin of 3.5 mm offers cure in most cases.