Recurrent Basal Cell Carcinoma Research Articles

Pilot Study on High-Intensity Focused Ultrasound (HIFU) for Basal Cell Carcinoma: Effectiveness and Safety.

Background: The rising incidence of Basal Cell Carcinoma (BCC), especially among individuals with significant sun exposure, underscores the need for effective and minimally invasive treatment alternatives. Traditional surgical approaches, while effective, often result in notable cosmetic and functional limitations, particularly for lesions located on the face. This study explores High-Intensity Focused Ultrasound (HIFU) as a promising, non-invasive treatment option that aims to overcome these challenges, potentially revolutionizing BCC treatment by offering a balance between efficacy and cosmetic outcomes. Methods: Our investigation enrolled 8 patients, presenting a total of 15 BCC lesions, treated with a 20 MHz HIFU device. The selection of treatment parameters was precise, utilizing probe depths from 0.8 mm to 2.3 mm and energy settings ranging from 0.7 to 1.3 Joules (J) per pulse, determined by the lesion's infiltration depth as assessed via pre-procedure ultrasonography. A key component of our methodology included dermatoscopic monitoring, which allowed for detailed observation of the lesions' response to treatment over time. Patient-reported outcomes and satisfaction levels were systematically recorded, providing insights into the comparative advantages of HIFU. Results: Initial responses after HIFU treatment included whitening and edema, indicative of successful lesion ablation. Early post-treatment observations revealed minimal discomfort and quick recovery, with crust formation resolving within two weeks for most lesions. Over a period of three to six months, patients reported significant improvement, with lesions becoming lighter and blending into the surrounding skin, demonstrating effective and aesthetically pleasing outcomes. Patient satisfaction surveys conducted six months post-treatment revealed high levels of satisfaction, with 75% of participants reporting very high satisfaction due to minimal scarring and the non-invasive nature of the procedure. No recurrences of BCC were noted, attesting to the efficacy of HIFU as a treatment option. Conclusions: The findings from this study confirm that based on dermoscopy analysis, HIFU is a highly effective and patient-preferred non-invasive treatment modality for Basal Cell Carcinoma. HIFU offers a promising alternative to traditional surgical and non-surgical treatments, reducing the cosmetic and functional repercussions associated with BCC management. Given its efficacy, safety, and favorable patient satisfaction scores, HIFU warrants further investigation and consideration for broader clinical application in the treatment of BCC, potentially setting a new standard in dermatologic oncology care. This work represents a pilot study that is the first to describe the use of HIFU in the treatment of BCC.

Регресс ринофимы на фоне фотодинамической терапии базальноклеточного рака кожи кончика носа

The article describes a case of regression of rhinophyma against the background of photodynamic therapy of basal cell carcinoma of the skin of the nose tip. After a single session of photodynamic therapy using a systemic photosensitizer based on chloride (photoran), there was a significant decrease in the size of the nose (rhinophyma), the disappearance of erythema, puffiness, and the formation of the initial contours of the face of this anatomical area. Despite the marginal recurrence of basal cell carcinoma after six months at the site of previous treatment and a repeat session of photodynamic therapy, after one year of dynamic follow-up, remission of basal cell carcinoma and regression of rhinophyma persist. The described method of treatment is atraumatic, easily reproducible, well tolerated by patients, safe and allows patients with basal cell carcinoma in combination with rhinophyma to achieve complete remission of both diseases.

Results of Mohs' Micrographic Surgery of Periocular Basal Cell Carcinoma: The Swedish Experience.

The Department of Ophthalmology, Sahlgrenska University Hospital, has until recently been the only eye clinic in the Nordic countries to perform Mohs' micrographic surgery of basal cell carcinoma. This has led to the practice of only the most complicated basal cell carcinomas being operated on with this technique. The purpose of this study was to present the results of these surgeries in patients with at least 5 years of follow-up. A retrospective study of all patients operated upon in 2010-2015 was performed. Data were gathered from their medical charts. Primary outcome was recurrence of basal cell carcinoma. One-hundred and sixty-seven patients were operated on. Mohs' micrographic surgery was used for tumours that were judged as highly aggressive on preoperative biopsy, had ill-defined borders, had recurred after previous surgery, or a combination of these factors. Nine recurrences (5.4% of all radical Mohs' micrographic surgeries) were diagnosed after a mean postoperative time of 37 months (4-84 months). Interestingly, all of these 9 recurrences after Mohs' micrographic surgery were in patients who had such surgery because of a recurrent basal cell carcinoma to start with. Good results can be achieved when operating on the most complicated periocular basal cell carcinomas with Mohs' micrographic surgery but special care has to be taken to ensure radical borders when operating on recurring basal cell carcinomas.

[Artículo traducido] Revisión del rol de la cirugía micrográfica con cortes en parafina en el tratamiento de tumores cutáneos

Paraffin-embedded margin-controlled Mohs micrographic surgery (PMMS) includes various procedures such as slow Mohs or deferred Mohs technique, the Muffin and Tübingen techniques, and staged margin excision, or the spaghetti technique. PMMS is a variation of conventional Mohs micrographic surgery (MMS) that allows histopathological examination with delayed margin control. PMMS requires minimum training and may be adopted by any hospital. The setback is that PMMS can require procedures across multiple days. PMMS lowers the rate of recurrence of basal cell carcinoma vs wide local excision in high-risk basal cell carcinoma, and improves the rates of recurrence and survival in lentigo maligna. PMMS can be very useful in high-risk squamous cell carcinoma treatment. Finally, it is a promising technique to treat infrequent skin neoplasms, such as dermatofibrosarcoma protuberans, or extramammary Paget's disease, among others. In this article, we present a literature narrative review on PMMS, describing techniques and indications, and highlighting long-term outcomes.

Long-term results after surgical basal cell carcinoma excision in the eyelid region: revisited.

The aim of the study was to readdress basal cell carcinoma (BCC) in the periocular region to prove the efficacy of histologically controlled surgical treatment and to identify high-risk characteristics.Retrospective analysis of 451 microscopically controlled BCC excisions in the periocular region. Tumor location, tumor size, AJCC 7 classification, and histological results were recorded. The same procedure was followed for recurrences.Arecurrence rate of 5.0% was observed after the first microscopically controlled excision. Recurrent BCCs show ashift from nodular to sclerosing BCC as the primary histological type as well as achange in primary location from lower eyelid to medial canthus. The frequency of BCC with deep extension increased from 7.3% to 24.7%, and 57.1% after the second and third operations, respectively. The recurrence rate increased to 9.5% and 42.9%, after the second and third operations, respectively.In conclusion, we are facing the same challenges in surgical BCC treatment as 30years ago. The distribution of periocular BCC location, histologic subtype and recurrence rates mirror the literature und the general consensus. The recurrence rate increases with every operation needed. Sclerosing BCCs with deep extension at the medial canthus bear the greatest risk for recurrence. In such cases, centers of expertise should be consulted and additional treatment options should be considered.

Review on the Role of Paraffin-embedded Margin-controlled Mohs Micrographic Surgery to Treat Skin Tumors

Paraffin-embedded margin-controlled Mohs micrographic surgery (PMMS) includes various procedures such as slow Mohs or deferred Mohs technique, the Muffin and Tübingen techniques, and staged margin excision, or the spaghetti technique. PMMS is a variation of conventional Mohs micrographic surgery (MMS) that allows histopathological examination with delayed margin control. PMMS requires minimum training and may be adopted by any hospital. The setback is that PMMS can require procedures across multiple days. PMMS lowers the rate of recurrence of basal cell carcinoma vs wide local excision in high-risk basal cell carcinoma, and improves the rates of recurrence and survival in lentigo maligna. PMMS can be very useful in high-risk squamous cell carcinoma treatment. Finally, it is a promising technique to treat infrequent skin neoplasms, such as dermatofibrosarcoma protuberans, or extramammary Paget's disease, among others. In this article, we present a literature narrative review on PMMS, describing techniques and indications, and highlighting long-term outcomes.

Recurrence rates of periocular basal cell carcinoma following intra-operative en-face frozen section margin controlled excision.

To report the margin control process and rate of recurrence of periocular basal cell carcinomas (BCCs) managed by en-face, frozen section margin controlled (FSC), excision by a single surgeon with a 3-year follow-up. A retrospective analysis of all histopathologically proven cases of periocular BCC who underwent surgical excision with intra-operative, en-face, FSC, excision by a single surgeon from 2015 to 2019 was performed. Patients with less than 3-year follow-up were offered a virtual appointment to determine possible recurrence. A total of 88 BCC excisions from 86 patients were reviewed. Minimum 3-year follow-up data is available for 73 patients. The most common location and histological subtype was the lower eyelid and nodular BCC, respectively (47% and 83% of cases). Primary BCC (pBCC) comprised 98% (86/88) of cases and recurrent BCC (rBCC) comprised 2% (2/88) of cases. Negative frozen section margins were achieved in 93% (82/88) of excisions on the day of surgery. The overall recurrence rate during this time was 1.4% (1/73) at minimum 3years. Periocular BCC can be managed effectively by en-face, FSC, excision, with a high cure rate and low recurrence rate comparable to alternative excision techniques such as Moh's micrographic surgery. Advantages of en-face excision include same-day excision and reconstruction and reduced theatre time. Primary nodular BCCs with clear margins can be considered for early discharge with advice to self-monitor.

MOHS MICROGRAPHIC SURGERY FOR BASAL CELL CARCINOMA: A REVIEW OF TREATMENT RESULTS

Objectives: To evaluate the results of Mohs Micrography Surgery (MMS) in the treatment of basal cell carcinoma (BCC). Materials and methods: We used the database of PUBMED and EMBASE to evaluate the results of MMS in treatment of BCC. Results: Nine studies with the total number of 5845 BCC cases were included in this review, the follow-up time varied from 12 to 42 months. The overall cumulative probabilities of recurrence after MMS were 2.4%. The cumulative probability of recurrence for the primary BCC group and the recurrent BCC group was 2.9% and 7.2%, respectively. In the recurrent BCC group, the cumulative probability of recurrence after MMS was lower than after standard surgical excision (SSE) (3.9% vs 13.5%, p < 0.05). In MMS group, 52% of patients required one round of excision to achieve complete removal of BCC, 34% needed two rounds and 14% needed three rounds. The size of final skin defect after MMS was 1.34 times larger than that of the primary tumor (p < 0.05). Conclusion: MMS is superior to SSE in BCC treatment, with lower recurrence rate and better normal skin-sparing. Therefore, MMS is strongly recommended for surgical treatment of BCC, especially in high-risk BCC. Received 28 June 2023Revised 26 September 2023Accepted 29 November 2023

Chernobyl’s Aftermath: Multiple Manifestations of Basalioma in a Patient after Radioactive Contamination in 1986

Background: The Chernobyl nuclear disaster is still considered the worst nuclear accident in history. The particles were dispersed over the former USSR and large parts of Western Europe, leading to radioactive exposure to more than 10 million people. Radioactivity is a risk factor for the development of basal cell carcinoma (BCC), since radiation-induced mutations in both Sonic hedgehog (Shh) signaling pathway genes and TP53 have been described. Methods: We present the case of a patient with a history of radiation exposure following the 1986 Chernobyl accident who presented to our outpatient clinic with recurrent basal cell carcinoma in the facial region. Case: The patient presented to our clinic with two facial lesions suspicious for BCC. Although there were no typical risk factors, 11 BCCs had previously been removed. The patient had been building shelters for the construction workers working on the sarcophagus around the destroyed reactor immediately after the 1986 accident. Staging using an 18F-FDG-PET/CT as well as ultrasound of the abdomen revealed no other tumor manifestations. Diagnostic excision of the two facial lesions was performed, and a histopathological workup revealed BCC at the right temporal region and acanthopapillomatosis with no sign of malignancy at the corner of the mouth. After presentation to the tumor board, complete resection of the BCC was initiated. Conclusions: This case demonstrates the value of early use of 18F-FDG-PET/CT in staging/restaging to visualize BCC location, local spread and potential metastases or secondary tumors and to aid in the decision for therapeutic management.

Récidive des carcinomes basocellulaires palpébraux selon les marges histologiques

Basal cell carcinomas (BCCs) represent 90% of malignant tumors of the eyelids, which can be locally invasive and destructive. The observation of histological safety margins (MHS) allows for the prevention of recurrence while maintaining a fair compromise between aesthetics and functionality. However, to date, there is no consensus or national recommendations concerning the MHS to be observed according to the various histological subtypes of BCCs. Through a retrospective analysis of patient records and corresponding excisional slides, we studied the 6-year recurrence rate of 98 patients who underwent surgery for palpebral BCC. MHS were mostly absent in the excisional specimens of recurrent BCCs and significantly more narrow than in non-recurrent BCCs, on average over 2mm. The results of our study suggest that an average MHS greater than 2mm prevents most recurrences.

Approaches to outpatient cryodestruction as a method of choice for the treatment of recurrent basal cell carcinoma of the scalp

Skin cancer ranks second among the most common types of malignant neoplasms in Russia. Radiation therapy, surgery, and combination therapy are commonly used for the treatment of skin cancer. Unfortunately, the above methods are not always successful. The reason for the incomplete effect of surgical treatment may be insufficient radicality of the intervention due to the surgeon's desire to inflict the least trauma on the surrounding healthy tissues in order to obtain a good cosmetic result. Selective destruction of tumor tissue during cryogenic exposure with minimal damage to surrounding healthy tissues is accompanied by a hemostatic effect, which is especially important in the treatment of both primary and recurrent disintegrating tumor ulcers. The aim was to determine the expediency of cryodestruction as a method of choice for outpatient treatment. The study was controlled and non-randomized. The criterion for inclusion in the study was the diagnosis of recurrent basal cell carcinoma and subsequent cryogenic treatment at the outpatient clinic of the State Budgetary Institution of the Rostov Region «Rostov Oncological Dispensary», Novocherkassk Branch. The patient underwent tumor cryodestruction in several freeze-thaw cycles, lasting 2–3 minutes. The result of this study, i.e. complete recovery, indicates high efficiency of cryodestruction. Subsequently, the patient did not experience continued growth or new relapses. In the presence of recurrent basal cell skin cancer, cryogenic exposure is effective and is the method of choice for treatment on an outpatient basis.

Recurrence of Basal Cell Carcinoma Treated with Surgical Excision and Histopathological Analysis with Frozen Section Technique with Complete Margin Control (CMC-FS): A 15-Year Experience of a Reference Center.

Basal cell carcinoma (BCC) is the most common type of eyelid malignancy and it is considered to be dangerous due to its proximity to functionally essential organs. Early diagnosis and complete excision of the primary lesion are crucial to prevent infiltration and metastasis. The study aims to evaluate the extent of recurrence in subjects affected by BCC of the upper third of the face treated with surgical eradication and the frozen section technique with complete margin control (CMC-FS), in comparison with the gold standard Mohs micrographic surgery (MMS). The study included 111 patients with 111 biopsy-proven eyelid BCCs. On clinical examination, all lesions were removed with 2 mm margins clinically free of neoplasm. Prior to reconstruction, CMC-FS analysis of all surgical margins was performed on each tumor for histopathologic confirmation. Subsequently, all margins were presented for the permanent paraffin sections. There were 69 primary carcinomas and 42 secondary carcinomas among the 111 samples. No recurrence occurred in 109 tumors followed-up for at least 5 years, with a total recurrence rate of 1.8%. The median time between lesion excision and diagnosis of recurrence was 20 months. at 5-year follow-up, CMC-FS guided excision of BCCs of the eyelids resulted in recurrence rates equivalent to MMS. Intraoperative microscopic control of all margins reduced the recurrence rate of the upper third of the facial BCCs, correlating with easier reconstruction with better esthetic and functional outcome.

Prevalence and Risk Factors for Recurrence of Basal Cell Carcinoma Following Surgical Excision in a 5-Year Follow-Up Period

Material And Methods: Observational, descriptive, retrospective study in patients with clinical and histopathological diagnosis of basal cell carcinoma, attended at CMN La Raza in a period of 5 years, to determine the postoperative recurrence of CBC. Clinical and histological variables were included, which were analyzed with descriptive statistics and for the comparison of variables was used chi-square or exact test of Fisher and U of Mann Whitney, subsequently, multiple logistic regression was performed to determine the independent risk factors, with the use of the statistical package SPSS v25. The study was approved by the ethics and research committee of CMN La Raza. Results: We included 280 patients with CBC, with a median age of 72 years. The majority were 211 women (75.4%). CBC recurrence was observed in 115 (41.1%) patients. In the univariate analysis, age, sex, smoking, history of sunburn, facial area, CBC subtype, perineural and vascular involvement were found to be statistically significant (p<0.05). In the regression model, the independent risk factors associated with postoperative recurrence of CBC were age, male sex, and smoking. Conclusions: The clinical-pathological characteristics were similar to those reported in the literature. In our population, it was observed as independent risk factors for recurrence, adjusted to those already mentioned in the literature, were male sex, age and smoking, so it is important to closely monitor these patients to take measures regarding surgical treatment.

DS20 Longevity of patients following Mohs micrographic surgery for the treatment of basal cell carcinomas

Abstract Basal cell carcinomas (BCCs) are slow-growing, nonaggressive skin cancers (metastatic rate < 0.1%). They are common, especially in the elderly population (Sreekantaswamy S, Endo J, Chen A et al. Aging and the treatment of basal cell carcinoma. Clin Dermatol 2019; 37:373–8). Basal cell carcinoma guidelines recommend Mohs micrographic surgery (MMS) for primary high-risk BCCs and high-risk recurrent BCCs suitable for surgery (Mosterd K, Krekels GA, Nieman FH et al. Surgical excision vs. Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncol 2008; 9:1149–56). Mohs micrographic surgery allows for the removal of the tumour in stages with rapid processing of specimens using frozen section analysis. Complete surgical margins are analysed in near real time. It has, compared with other treatments, lower recurrence rates (< 1%) and often better cosmetic outcomes, but it has higher costs and longer operating times (Sreekantaswamy et al.; Mosterd et al.). Factors that need to be considered when deciding on treatment options are comorbidities, performance status and the risk of causing harm if left untreated. The term ‘lag time to benefit’ entails not only looking at how effective a specific treatment is, but also when a treatment will become beneficial in relation to the patient’s life expectancy (Sreekantaswamy et al.). In patients with a limited life expectancy, nonsurgical treatment can be an appropriate and possibly even the preferred choice (Sreekantaswamy et al.). A retrospective single-centre review of all available BCC MMS patient data from January 2011 to December 2017 was performed. Patients from out of area or with tumour syndromes were excluded. Survival rates following MMS were recorded. Of the 2518 patients reviewed, 1905 met the inclusion criteria. In total, 357 (18.7%) were aged ≥ 80 years; at 5 years post-MMS, 24% and 30.7% of the 80–89-year-old females and males had died, respectively, suggesting they had a higher life expectancy than the same general demographic. It would be interesting to compare these results with survival rates following other treatments, such as conventional excision or curettage and cautery. Limitations include missing documentation (n = 258) and not all internal logs being tracked appropriately (19.6% were not tracked, n = 615/3133). We propose a patient-centred, tailored approach to the treatment of BCCs. Based on the fundamental ethical principles, informed and effective shared decision-making is vital; patient values, preferences and experiences should also be considered.

Clinio-pathological study of recurrent basal cell carcinoma in periocular region

To evaluate the prevalence, topographical location and histological type of recurrent basal cell carcinoma in periocular region at tertiary care centre. Clinical and histological data was collected from the patients treated for recurrent basal cell carcinoma (BCC) in periocular region during Jan 2019 to Dec 2021 was analyzed for prevalence, topography, histological type in recurrent cases.280 cases were managed during Jan 2019 to Dec 2021. Out of these 44 were recurrent BCC. In recurrent cases 30 were male and 14 were female. Majority of recurrences about 80% occurred within 3 years of primary excision. Ocular adenexa is most common anatomical site for recurrent basal cell carcinoma. Histologically also more than 80% cases were having of recurrence. Recurrence after incomplete excision is reported to be 20% with 5-9 years of follow-up. Thus, we suggest that all patients who had undergone BCC surgical excision should be re-examined regularly even if surgical margins were negative on histopathology or tumor was indolent in nature.

Recurrent nasal basal cell carcinoma treated with standard surgery excision: evaluation of volume ratio.

Basal cell carcinoma (BCC) is the most common malignant skin tumor. Although it rarely evolves into a metastatic disease, BCC can lead to a significant morbidity due to local invasion. The risk of lesion recurrence depends on clinical and histopathological factors as described by the Nation Comprehensive Cancer Network (NCCN). The surgical excision margins have a well-known role: there is a close relationship between high recurrence rate of BCC and the tumor proximity to the surgical margins. Aim of our study was to assess whether there is a significative correlation between recurring BCC and volume ratio (VRb/t), defined as ratio between excisional biopsy volume and tumor volume, and if VRb/t is a useful parameter to assess the risk of recurrence of BCC. Retrospective case-control study in 80 patients with history of recurrent basal cell carcinoma of the nose (cases), and 43 patients with history of basal cell carcinoma of the nose with no evidence of relapse (controls) in the following 8 years. Surgical excision margins, histological subtype, ulceration, depth of invasion and volume ratio (VRb/t) were evaluated in case and controls. The evaluation of VRb/t evidenced a significant difference between recurrent BCC and non-recurrent BCC. The mean values of VRb/t were 6.17 for cases and 11.94 for controls. The Binomial Logistic Regression has displayed, for values of VRb/t around 7, a probability of 75% to identify BCCs belonging to the recurrent group. Our data show a significant correlation between recurrent BCCs and VRb/t. VRb/t can help in the assessment of recurrence risk, used together with others prognostic factor. For values of VRb/t close to 7 it should be recommended a close follow-up to promptly identify a possible recurrence.

FACIAL BASAL CELL CARCINOMA- CLINICAL VARIANTS, MANAGEMENT AND CLINICAL OUTCOME EXPERIENCE AT OUR CENTRE

Background: Basal cell carcinoma (BCC) is the most common type of skin cancer and it constitutes more than three quarters of skin cancers of the face. Any lesion in the face above the line joining the tragus and the angle of mouth are considered as high risk lesions for recurrence. The gold standard surgical treatment is Mohs micrographic surgery (MMS) or surgical excision with intraoperative histological and margin assessment. Radiation therapy (RT) has always played an essential role in the management of BCC. To retrospectively analyse the presentation, risk Aim: factors, most common histopathology variant, margin status, ap reconstruction, need for adjuvant RT and recurrence of BCC in the face in a tertiary centre. Methods: Retrospective analysis of 16 cases of BCC over the face treated at out centre was done from 2018 to 2020.All were BCC above the line joining tragus to angle of mandible. All cases presented bet Results: ween the age 34 to 67, mean age of 54. Of the total 16 cases, 12 were males and 4 females. 12 cases were primary and 4 were recurrent operated outside. All lesions excised with 2-4mm margin and reconstructed with local faciocutaneous aps in rst setting. All aps healed well with no complictaions except for 2 which had minor wound breakdown. Post op Radiation given in 5 cases (4 recurrent and 1 primary). All patient had acceptable cosmesis after the completion of treatment. All patients were followed up for 2 years. In our experience high risk BCC in the face can be excised wit Conclusion: h negative margins using intraoperative frozen section and ap reconstruction can be done in rst setting only. Those that are recurrent and with high risk features , adjuvant therapy has to be given

Recurrence or de novo? Intradermal Basal Cell Carcinoma of the Scrotum: A Report of Two Cases

Basal cell carcinoma (BCC) is the most common cutaneous malignancy, usually occurring in sun-exposed areas. Although BCC in the scrotal region is uncommon, it carries a higher risk of metastasis than BCC at other sites. Here, we report two cases of BCC that developed in the scrotal region: Case 1 presented as a superficial nodule and Case 2 as a subcutaneous nodule. Histopathologically, both tumors lacked continuity with the surface epidermis and formed an intradermal nodule. In Case 1, BCC occurred for the first time and presumably developed de novo. Case 2 underwent excision of a scrotal BCC 5 years previously, and the histopathological diagnosis at that time was nodular BCC. However, when the original specimen was re-examined, it was determined that, although the tumor had been completely resected, part of the lesion had moved away from the nodular area to represent a micronodular phenotype, an aggressive BCC subtype. We hypothesized that partial evolution from a nodular to a micronodular phenotype may have contributed to the recurrence of BCC in Case 2.

Adequacy of surgical margins, re-excision, and evaluation of factors associated with recurrence: a retrospective study of 769 basal cell carcinomas

BackgroundAchieving adequate surgical margins and preventing recurrence are important in the treatment of basal cell carcinoma (BCC). ObjectivesThe objectives of this study were to evaluate the adequacy of surgical margins and the re-excision rates in patients with primary BCC who underwent standard surgical treatment using our proposed algorithm and to define the risk factors in patients with recurrent BCC. MethodsThe medical records of patients who were histopathologically diagnosed with BCC were reviewed. An algorithm created based on previous literature was used to determine the distribution of optimal surgical margins adequacy and re-excision rates. ResultsStatistically significant differences were observed between the cases with and without recurrence in age at diagnosis (p=0.004), tumor size (p=0.023), tumor location in the H zone of the face (p=0.005), and aggressive histopathological subtype (p=0.000). When the tumors were evaluated for adequacy of deep and lateral surgical margins and re-excision rates, higher rates of adequate excision (457 cases, 68.0%) and re-excision (43 cases, 33.9%) were noted for tumors in the H or M zone. Study limitationsInadequate follow-up of newly diagnosed patients in terms of recurrence and metastasis and the retrospective application of our proposed algorithm are the limitations of the present study. ConclusionsOur results showed that if BCC was detected at an early age and at an early stage, recurrence was lower. The H and M zones were the regions with the highest rates of optimal surgical outcomes.

Basal Cell Carcinoma in Xeroderma Pigmentosa: Reduced CD1a Expression as a Sensitive Predictor of Recurrence.

Xeroderma pigmentosa (XP) is a rare genetic disorder that is characterized by defective DNA repair after ultraviolet induced damage with a great tendency for recurrent cutaneous malignancies including basal cell carcinoma (BCC). BCC is frequently linked to impaired local immune response with a major role played by Langerhans cells (LCs). The current study aims at investigating LCs in BCC specimens of XP and non-XP patients, in a trial to study its possible impact on tumor recurrence. It included 48 retrospective cases of primary facial BCC (18 for XP patients and 30 for non-XP controls). Each group was subdivided, based on the 5 years follow-up data, into recurrent and non-recurrent BCC groups. LCs were assessed immunohistochemically using the sensitive marker; CD1a. Results showed significantly reduced LCs count (intratumoral, peritumoral, and in perilesional epidermis) in XP patients compared with non-XP controls ( P ˂0.001 for all). Intratumoral ( P =0.008), peritumoral ( P =0.005), and perilesional epidermal ( P =0.02) LCs mean values were significantly lower in recurrent versus non-recurrent BCC specimens. Also, within each group (XP and controls), LCs were of significantly lower means in recurrent versus non-recurrent cases ( P ≤0.001 for all). Regarding recurrent BCC cases, peritumoral LCs showed a significant positive correlation with 1ry BCC duration ( P =0.05). Also, intratumoral and peritumoral LCs correlated positively with BCC relapse interval ( P =0.04 for both). Among non-XP controls, periocular tumors had the least LCs count (22.00±3.56), whereas tumors located in the rest of the face had the greatest count (29.00±0.00) ( P =0.02). Sensitivity and specificity of LCs to predict BCC recurrence in XP patients reached 100% in intartumoral area and perilesional epidermis when cutoff points were less than 9.5 and 20.5, respectively. In conclusion; reduced LC count in primary BCC specimens of XP patients and also in normal subjects could help to predict its recurrence. Thus, it might be identified as a risk factor for relapse to apply new strict therapeutic and preventive measures. This presents new avenue for the immunosurveillance against skin cancer relapse. However, being the first study to investigate that link in XP patients recommends further research to confirm.