Small Basal Cell Carcinoma Research Articles

Dermoscopy of very small basal cell carcinoma (≤3 mm)

BackgroundBasal cell carcinoma (BCC) dermoscopy is key to lower the biopsy threshold of suspicious lesions. There is a scarcity of published data on the dermoscopy of very small BCC (≤3mm) and its differences from larger BCCs. ObjectiveTo describe and compare dermoscopic features of BCCs measuring ≤3mm, with those from 3 to 10mm. MethodsAn analytical cross-sectional study, included biopsy-proven BCCs that had dermoscopic photographic images, between January 2017 and December 2022 in a Skin Cancer Center in Medellín, Colombia. Demographic, clinic-pathological and dermoscopic features were compared between very small BCCs (vsBCCs) and a reference group. ResultsA total of 326 BCCs in 196 patients were included, of whom 60% were male. The most common Fitzpatrick phototype was III. vsBCCs accounted for 25% of the lesions (81/326). Face and neck were the most frequent locations (53%), especially in very small tumors. The nodular type was more common in very small tumors than in larger lesions, the superficial type was less frequent, and aggressive types were equally prevalent in both groups. On dermoscopy, very small tumors were statistically more likely to present pigmented structures than reference lesions, especially blue-gray dots (67% vs. 54%), vessels were less frequent, particularly short-fine telangiectasias (SFT) (52% vs. 66%), as were other structures such as shiny white structures (SWS), ulceration, micro-erosions, and scales. Study limitationsLatin-American sample, lacks information on dark phototypes ConclusionsPigmented structures, especially blue-gray dots, were most common in vsBCCs when compared to larger lesions; SFT, SWS and other findings were less prevalent.

Dermatoscopically narrowed surgical margins for head and neck basal cell carcinoma: A retrospective case-control study.

SummaryBackgroundBasal cell carcinoma (BCC) can cause extensive tissue damage if untreated. Complete surgical excision is the treatment of choice, but especially in the head‐and neck area, defining both radical and healthy skin sparing surgical margins is complex.Materials and methodsExcised, small (≤ 1 cm), BCCs of the head and neck were retrospectively analyzed, comparing histological properness of surgical margins after clinical‐dermatoscopical preoperative evaluation (cases), vs. clinical evaluation only (controls) and recurrences.ResultsOf 281 BCCs: 6 % (8/139) of cases and 8 % (12/142) of controls had unproper deep margins; 4 % (5/139) of cases, 20 % (29/142) of controls had unproper lateral margins (P < 0.001). Surgical 3 mm lateral margins were unproper in 0 % (15/66) of cases, 15 % (10/66) of controls (P > 0.005); surgical 1–2 mm lateral margins were unproper in 7 % (5/73) of cases, 25 % (19/76) of controls (P < 0.01). Of cases excised at 3 mm, 1–2 mm, and controls, 1.5 %, 0 %, and 7.7 % recurred, respectively.ConclusionsBCC excision at 3 mm may be appropriate in the head and neck for small, dermatoscopically well‐defined and non‐aggressive BCCs, attaining surgical cure rates of 100 % and 1.5 % recurrences. Excision at 1–2 mm should be reserved only for BCCs in very difficult‐to‐treat areas, as the surgical cure rate was only 93 %.

Non-invasive characterization of different types of basal cell carcinomas (BCCs) using vibrational optical coherence tomography (VOCT): Can early lesions as small as 0.05 mm be identified by VOCT?

Vibrational optical coherence tomography (VOCT) has been used to non-invasively measure the resonant frequency and elastic modulus of different types of BCCs to compare the physical biomarker characteristics of each of these lesions. The results suggest that in very small lesions (about 0.05 mm in diameter) new 80Hz and 130Hz resonant frequency peaks are seen not present in normal skin or in healing wounds. In all other BCCs, new 80Hz, 130Hz and 260Hz resonant frequency peaks are found like those found in other carcinomas including SCC and melanoma. Small BCCS are characterized by new 80Hz and 130Hz in the absence of a significant 50Hz peak unlike actinic keratoses that are characterized by 50Hz, 80Hz and 130Hz peaks. In the absence of the 260Hz peak, small BCCs appear to be a precursor to larger BCCs. Pigmented BCCs exhibit a larger ratio of the 50Hz/80Hz peaks compared to the other BCC types in addition to peaks at 130Hz and 260Hz suggesting that benign melanocyte lesions contribute to the 50 Hz peak. Further studies are needed to understand the factors that drive differences in shape and invasiveness of cancerous BCCs. While all BCCs were found to contain new cell and blood vessel resonant frequencies that coincide with fibrotic tissue encapsulating the tumors in the papillary dermis, other factors must drive differences in the shape and invasiveness of the different BCCs. It is hypothesized that the new cells and blood vessels formed lead to the deposition of fibrous tissue in all BCCs and is partially driven by an epithelial-mesenchyme transition. It is concluded that fibrotic tissue is found encapsulating all cancerous BCCs and that this layer of tissue may limit invasiveness and metastatic behavior of this tumor type. In general, tumor shape and invasiveness are likely influenced by the exact cellular mutations in each lesion type and the extent of UV light damage experienced by the surrounding extracellular matrix.

Photodynamic therapy as a treatment option for multiple pigmented basal cell carcinoma: Long-term follow-up results.

Photodynamic therapy (PDT) has been used worldwide as a non-surgical option for the treatment of basal cell carcinoma (BCC). PDT treatment for pigmented BCC is not frequently performed because of poorer results, which are explained by lower penetration of the light, possibly related to the melanin absorption in the visible range wavelengths. However, there is evidence for an increase in PDT cure rates with prior debulking of the lesion. In this study, we reported a complete clearance of 30 pigmented basal cell carcinomas in 2 patients. PDT was performed in a single visit protocol, which consists of two illumination sessions performed on the same day (125 mW/cm² of irradiance and 150 J/cm² of fluence). Imediately after the debulking of the BCC, a 20 % methyl aminolevulinate cream was applied and occluded for 3 h in the first session and 1.5 h in the second. After 30 days of the treatment, all regions were evaluated clinically and histologically, showing no residual BCC. Even with long-term follow-up (mean of 24 months), no recurrence was detected.. This PDT protocol achieved 100 % control for pigmented BCC. Therefore, it was demonstrated that PDT may be a successful treatment option for small and multiple pigmented BCC.

How Wide Should the Excision Margins for Facial Small Aggressive Basal Cell Carcinoma Be? Experience With 306 Cases.

Subclinical extension (SCE) of basal cell carcinomas (BCCs) may be responsible for incomplete resection of the tumor. The aggressive histological patterns (micronodular, infiltrative, and morpheaform) have greater tendencies toward invading surrounding tissues in an irregular pattern. To determine the SCE of small facial aggressive BCCs excised using Mohs micrographic surgery (MMS). An observational case series study. Data of patients with facial BCCs with aggressive histological patterns, less than or equal to 6 mm in diameter in high risk site (H zone), and 10 mm in intermediate risk site (M zone), treated with MMS between January 2008 and December 2016, were included. This study included 306 histologically confirmed lesions retrieved from 1,196 clinical records reviewed. Median size of tumors was 5.7 mm (interquartile range: 5-6 mm). Resection of the tumors using 2, 3, and 4 mm margins achieves complete excision of the lesion including the subclinical extension area in 73.9%, 94.4%, and 99% of cases, respectively. The present study demonstrated that a 4-mm resection margin was enough to eradicate the lesion completely in 99% of cases of primary small facial BCCs with aggressive histological patterns.

Alternative treatment options for periorbital basal cell carcinoma

Latest developments as well as established procedures offer alternative treatment approaches to basal cell carcinoma (BCC) when micrographically controlled surgical removal is not avalid option. Alternative treatment options for periorbital BCC are presented. A literature search was carried out and a structured display and analysis of the results are given. Micrographically controlled surgical removal represents the gold standard in treatment of BCC. When for various reasons surgical removal is not avalid option, other procedures are required. The alternative treatment options can be divided into three main groups: treatment options for locally advanced or metastasized BCC, topical approaches for small and superficial BCC and prophylactic measures. While radiotherapy and systemic therapy are suitable for locally advanced BCC and are discussed in a tumor board, small and superficial BCC can be treated by topical medication. In cases of aprevious BCC history, aprophylactic treatment can be considered. Combinations of systemic treatment and also neoadjuvant or adjuvant approaches before and after surgery are promising options for a successful outcome, which can further improve the standard treatment for locally advanced BCC. Alternative treatment options for periocular BCC are available; however, the use is only indicated when microscopically controlled excision with subsequent oculoplastic reconstruction is not possible. According to the national guidelines a prior presentation to a suitable tumor board is practically compulsory.

Factors predictive of recurrence, metastasis, and death from primary basal cell carcinoma 2 cm or larger in diameter

Basal cell carcinoma (BCC) recurrence and metastatic rates are known to be very low. The risk factors for these rare outcomes are subsequently not well studied. To identify risk factors independently associated with local recurrence (LR) and metastasis and/or death (M/D) in large (≥2cm) BCC. BCCs histologically confirmed between 2000 and 2009 were retrospectively screened for tumor diameter at 2 academic centers. Medical records of all large BCCs and an equal number of randomly selected small BCCs were reviewed for LR and M/D. Included were 248 large BCC and 248 small BCC tumors. Large BCCs had a significantly higher risk of LR and M/D than small BCCs (LR: 8.9% vs 0.8%, P<.001; M/D: 6.5% vs. 0%, P<.001). Because the risks were so low in small BCCs, they were excluded from further analysis. On multivariable logistic regression, head/neck location (odds ratio [OR], 9.7; 95% confidence interval [CI], 3.0-31.3) and depth beyond fat (OR, 3.1; 95% CI, 1.0-9.6) were associated with LR in large BCCs. Risk of LR was lower with Mohs micrographic surgery (OR, 0.14; 95% CI, 0.04-0.5). Head/neck location (OR, 5.3; 95% CI, 1.2-23.2), tumor diameter ≥4cm (OR, 11.9; 95% CI, 2.4-59.4), and depth beyond fat (OR, 28.6; 95% CI, 6.7-121) were significant predictors of M/D in large BCCs. Retrospective cohort design. Large BCCs, particularly those with additional risk factors, have a high enough risk of recurrence and metastasis to warrant further investigation to optimize management.

Interobserver agreement on dermoscopic features of small basal cell carcinoma (

The basal cell carcinoma (BCC) assessment in dermoscopy is based on the recognition of specific characteristics synthesized and described as classical and non-classical criteria, but which may not necessarily present all at the same time. Consequently, a deep knowledge in detecting the aforementioned dermoscopic criteria is crucial in diagnosis. The aim of the study was to evaluate which criteria are more frequently recognized among a group of low-experienced dermoscopists when confronted with the difficult diagnosis of BCC with a diameter lower than 5 mm. We examined 100 BCC finding that data displays a full agreement only for one classical criterion, the lack of pigmented network (Fleiss' κ = 1), while among other classical criteria only arborizing vessels and ulceration exhibit a good agreement among observers (Fleiss' κ > 0.40). Analyzing non-classical criteria, only blue-whitish veil and blue in-focus dots show a good agreement among low-experience observers (Fleiss' κ > 0.40). It is evident that in small size BCC classic dermoscopic criteria are often substituted by non-classical criteria, which represent the neoplasm's early phase. Thus, it is of importance, especially for low-experience dermoscopists, to analyze even the non-classical criteria in order to obtain a diagnosis of early BCC.

Extensive, neglected basal cell carcinoma of the half of the face-surgical treatment and reconstruction with an anterolateral microvascular thigh flap.

Extensive, neglected basal cell carcinoma of the half of the face-surgical treatment and reconstruction with an anterolateral microvascular thigh flap.

Usefulness of Photodynamic Therapy as a Possible Therapeutic Alternative in the Treatment of Basal Cell Carcinoma.

Basal cell carcinoma (BCC) is the most common cancer in individuals with fair skin type (I–II) and steadily increasing in incidence (70% of skin malignancy). It is locally invasive but metastasis is usually very rare, with an estimated incidence of 0.0028%–0.55%. Conventional therapy is surgery, especially for the H region of the face and infiltrative lesions; in case of inoperable tumors, radiotherapy is a valid option. Recently, topical photodynamic therapy (PDT) has become an effective treatment in the management of superficial and small nodular BCC. PDT is a minimally invasive procedure that involves the administration of a photo-sensibilizing agent followed by irradiation at a pre-defined wavelength; this determines the creation of reactive oxygen species that specifically destroy target cells. The only major side effect is pain, reported by some patients during the irradiation. The high cure rate and excellent cosmetic outcome requires considering this possibility for the management of patients with both sporadic and hereditary BCC. In this article, an extensive review of the recent literature was made, in order to clarify the role of PDT as a possible alternative therapeutic option in the treatment of BCC.

Basal Cell Carcinoma of the Skin to Tirana-Albania

Basal cell carcinoma (BCC) is the most frequent epithelial tumor of the skin, characterized by a local infiltrative growth in contrast to a very rarely metastatization. In rare cases this neoplastic process behaves aggressively with deep invasion and high recurrence risk after surgery. The pathogenesis and the factors that determine the extensive growth are not completely understood. The American Joint Committee on Cancer published on 1988 the morphologic characteristics necessary to define a BCC as giant. Only the 1% of all BCC achieves these parameters. Basal Cell Carcinoma is linked to a spontaneous mutation of PTCH gene situated in chromosome region 9q22.3. Environmental factors, as sun exposition, trauma or smoking, play an important role in the tumor development. The tumor on sets most frequently in the middle part of the face and scalp even that it can develop on all sun exposed skin. Aim of this study is to review the available literature on BBCs. Between April 2014 and March 2015, 50 patients with BCC were treated in the Department of Plastic and Reconstructive Surgery of Tirana. According to the AJCC classification, 40 tumors were T1 (80%), 5 tumors were T2 (10%) and 5 were T3 (5%). All patients received surgical excision of neoformation and immediate reconstruction. For small BCC (1-2cm), the surgical excisions require clinical margin of 3-5mm and the recurrence risk in this tumor is 4%-14%. Actually the gold standard is to perform a one-step or two-step surgery. In one step surgery the surgical defect is close directly and the reconstructive procedure is definitive. One step surgery, using Mohs Micrographic surgery, affords superior clinical outcomes, with a five-years tumor-free rate of over 99% for primary BCC and over 95% for recurrent BCC, compared to the rate of 93% and 80% respectively for other interventions. Collected data from our personal experience, according with the literature review, demonstrate that early diagnosis on association with the correct treatment is the only strategy to have a good prognosis of the disease. DOI: 10.5901/ajis.2015.v4n2s2p100

Combined Carbon Dioxide Laser with Photodynamic Therapy for Nodular and Superficial Basal Cell Carcinoma

Basal cell carcinomas (BCCs) are often seen by general practitioners, plastic surgeons, and dermatologists in the outpatient setting. Photodynamic therapy (PDT) and CO2 laser when used as monotherapy have been successfully used to treat small BCC, with greatest success in the superficial histological subtype but have limitations compared to surgical excision due to a limited depth of penetration of PDT (2 mm absorption) limiting efficacy. We describe our experience of dual-modality treatment improving efficacy, cosmetic outcomes, and minimizing recurrence. One hundred ten patients with a total of 177 lesions mainly on the head and neck were treated with combined therapy using an UltraPulse CO2 laser and PDT using methyl aminolevulinate (METVIX) at the same sitting, with repeat PDT 1 week later. We evaluated recurrences, cosmetic outcomes, patient satisfaction, and costs. The mean age of patients was 67 years. The mean follow-up period was 32.2 months, with a range of 7.7 to 68.5 months. Eighty six lesions were followed up for more than 3 years. A total of 177 lesions were diagnosed and treated. Only biopsy-proven BCCs were included in this study. Histologically, 34 (19.2%) were superficial subtype, 50 (28.2%) nodular, 9 (5.08%) infiltrative, 7 (3.95%) morpheic, 3 (1.69%) mixed, and in 74 (41.8%) diagnosis was simply BCC. All lesions responded to treatment as assessed by clinical evaluation with regular follow-up. The total recurrence-free rate was 97.1%. In 88.1% lesions, a single cycle of treatment was required; 9.03% had 2 cycles and 0.56% underwent 3 cycles. In 3 of the patients, no data were available. Recurrences were noted in 5 (2.82%) cases. All recurrences were treated successfully, all but one using repeat laser-PDT. One patient underwent surgical excision. No significant complications were encountered, although mild hypopigmentation was occasionally seen and some discomfort is experienced with PDT. Combined CO2 laser and PDT have equivalent cure rates to surgery for BCCs--notably of the nodular subtype--these modalities acting synergistically. This strategy provides cure often with scarless outcomes as illustrated. Laser with PDT is most appropriate for patients who value excellent cosmetic outcomes and where avoidance of an invasive procedure is an important factor. In addition, this modality comes into its own for specific groups of patients, such as those on Warfarin or those with diffuse or multiple lesions.

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.

High and sustained efficacy after two sessions of topical 5-aminolaevulinic acid photodynamic therapy for basal cell carcinoma: a prospective, clinical and histological 10-year follow-up study

Prolonged follow-up data on topical photodynamic therapy (PDT) in basal cell carcinoma (BCC) are necessary for a full evaluation of its effect and for comparison with conventional treatment methods. To assess 10-year long-term PDT efficacy in primary and recurrent BCC and to evaluate clinical and histopathological factors which may be associated with treatment failure. We performed a longitudinal study on 60 histologically verified BCCs in 44 patients treated with curettage and one or two sessions of dimethylsulphoxide (DMSO)-supported topical 5-aminolaevulinic acid (ALA)-based PDT. Treated lesions were investigated by clinical and histopathological examination at regular intervals. The main outcomes were 10-year lesion complete response rate using a time-to-event analysis, histological treatment failure and cosmesis. Overall complete response rate for all lesions was 75% (95% confidence interval 64-87%); 60% after one and 87% after two treatment sessions. The response rate was 78% for primary lesions; 63% after one and 90% after two sessions. The cosmetic outcome was rated as good or excellent in 91-100% of evaluated cases. Treatment failure was documented in 15 (25%) of 60 lesions; clinical investigation identified 14 of them. All failures were noted within 3 years of treatment. Male gender, recurrent tumour and one treatment session were factors significantly associated with treatment failure. The only lesion larger than 2·0 cm relapsed. Two sessions of DMSO-supported topical ALA-PDT and curettage can provide long-term effective treatment results with favourable cosmetic outcome in primary, small BCC.

Nodular Basal Cell Carcinoma Successfully Treated with Intralesional 5-Aminolevulinic Acid Injection-Photodynamic Therapy

Dear Editor: Basal cell carcinoma (BCC) is now frequently treated with photodynamic therapy (PDT), because of favorable treatment response and cosmetic outcome1. However, it is less effective in nodular BCC than in superficial BCC due to limited penetration of the photosensitizer. We recently successfully treated a thick lesion of classic Kaposi sarcoma with intralesional 5-aminolevulinic acid (ALA) injection PDT2. Intralesional injection (ILI)-PDT has also been tried in various cutaneous diseases with good clinical outcomes3. To our knowledge only one case of nodular BCC treated with 5-ALA ILI-PDT has been reported4. Herein, we report another case of nodular BCC successfully treated with 5-ALA ILI-PDT after a relatively short incubation time. A 63-year-old man presented with a 1×0.8 cm-sized brownish papule with a rolled border on the right perinasal area, initially noted six months previously (Fig. 1a). Histopathological examination showed islands of atypical basaloid tumor cells with peripheral palisading, extending into the reticular dermis (Fig. 2a). In an attempt to treat the thick tumor with a shortened incubation time, we utilized 5-ALA ILI-PDT. Twenty-percent 5-ALA solution (Levulan Kerastick®; DUSA Pharmaceuticals, Wilmington, MA, USA) was injected into the lesion (about 0.3 ml/cm2). After 90 minutes, it was irradiated with red light from a Waldman PDT 1200 L lamp (Herbert Waldmann GmbH & Co. KG, Villingen-Schwenningen, Germany) at a light dose of 100 J/cm2, a fluence of 100 mW/cm2 and an emission wavelength of 580 to 740 nm. PDT was delivered repeatedly five times, at two to eight week intervals over six months. During the treatment, there were no noticeable side effects except mild pain during injection. Upon the follow-up visit eight months after the initial treatment, the lesion was cleared, leaving a faintly erythematous scar on the treated site (Fig. 1b). Skin biopsy showed only signs of chronic dermatitis and fibrosis without abnormal tumor cells, confirming the remission histopathologically (Fig. 2b). Fig. 1 (a) A brownish papule on the right side of the nose before photodynamic therapy, (b) resolution of the skin lesion after 5 sessions of treatment. Fig. 2 (a) Atypical basaloid tumor cells extending into the mid-dermis, the tumor thickness measuring 1.3 mm (H&E, ×100), (b) after 5 sessions of treatment, no tumor cell is seen (H&E, ×100). Previous trials of topical PDT in treatment of BCC have shown promising results1. However, insufficient uptake of the photosensitizer to deeply located tumor cells has sometimes led to poor response. To facilitate transcutaneous absorption, various methods of pretreatment were introduced, such as curettage, debulking, tape stripping, microdermabrasion and laser ablation5. These techniques may produce substantial bleeding, consequently washing off the photosensitizer applied superficially on the tumor. Sotiriou et al.3 suggested that the photosensitizer may penetrate the target tissue deeply enough if it is directly injected into the tumor itself. We agree with this idea, because ILI causes only minimal bleeding at the puncture site. It may also shorten the incubation time required before adequate absorption is achieved, since it allows direct infiltration into the tumoral tissue. Therefore, the long incubation time, one of the major drawbacks of topical PDT, could be reduced with ILI of the photosensitizer. However, the cost and prolonged treatment time, compared with simple excision, would discourage the use of ILI-PDT in a small BCC lesion. Further studies of ILI-PDT in nodular BCC with larger lesions are warranted for the evaluation of treatment efficacy and recurrence.

Automatic telangiectasia analysis in dermoscopy images using adaptive critic design

Telangiectasia, tiny skin vessels, are important dermoscopy structures used to discriminate basal cell carcinoma (BCC) from benign skin lesions. This research builds off of previously developed image analysis techniques to identify vessels automatically to discriminate benign lesions from BCCs. A biologically inspired reinforcement learning approach is investigated in an adaptive critic design framework to apply action-dependent heuristic dynamic programming (ADHDP) for discrimination based on computed features using different skin lesion contrast variations to promote the discrimination process. Lesion discrimination results for ADHDP are compared with multilayer perception backpropagation artificial neural networks. This study uses a data set of 498 dermoscopy skin lesion images of 263 BCCs and 226 competitive benign images as the input sets. This data set is extended from previous research [Cheng et al., Skin Research and Technology, 2011, 17: 278]. Experimental results yielded a diagnostic accuracy as high as 84.6% using the ADHDP approach, providing an 8.03% improvement over a standard multilayer perception method. We have chosen BCC detection rather than vessel detection as the endpoint. Although vessel detection is inherently easier, BCC detection has potential direct clinical applications. Small BCCs are detectable early by dermoscopy and potentially detectable by the automated methods described in this research.

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.

Automatic detection of basal cell carcinoma using telangiectasia analysis in dermoscopy skin lesion images

Telangiectasia, dilated blood vessels near the surface of the skin of small, varying diameter, are critical dermoscopy structures used in the detection of basal cell carcinoma (BCC). Distinguishing these vessels from other telangiectasia, that are commonly found in sun-damaged skin, is challenging. Image analysis techniques are investigated to find vessels structures in BCC automatically. The primary screen for vessels uses an optimized local color drop technique. A noise filter is developed to eliminate false-positive structures, primarily bubbles, hair, and blotch and ulcer edges. From the telangiectasia mask containing candidate vessel-like structures, shape, size and normalized count features are computed to facilitate the discrimination of benign skin lesions from BCCs with telangiectasia. Experimental results yielded a diagnostic accuracy as high as 96.7% using a neural network classifier for a data set of 59 BCCs and 152 benign lesions for skin lesion discrimination based on features computed from the telangiectasia masks. In current clinical practice, it is possible to find smaller BCCs by dermoscopy than by clinical inspection. Although almost all of these small BCCs have telangiectasia, they can be short and thin. Normalization of lengths and areas helps to detect these smaller BCCs.

Fluorescence Diagnostics of Basal Cell Carcinomas Comparing Methyl-aminolaevulinate and Aminolaevulinic Acid and Correlation with Visual Clinical Tumour Size

Fluorescence diagnostics based on aminolaevulinic acid (ALA) fluorescence has been suggested as an in vivo pre-surgical tool for tumour demarcation. We performed fluorescence diagnostics of 35 basal cell carcinomas (BCCs) undergoing photodynamic therapy (PDT) using methyl-aminolaevulinate (MAL). In addition, a semi-automated thresholding algorithm was implemented to detect the potential tumour region. The mean tumour fluorescence contrast was found to be 1.65 ± 0.06 during the first MAL-PDT session, and increased to 1.84 ± 0.07 at the second treatment (p < 0.01). This could imply that disruption of the skin barrier and inflammatory responses after the first session of PDT led to higher accumulation of proto-porphyrin IX during the second session of PDT. The tumour areas detected based on fluorescence in small BCCs (< 1 cm(2)) were in general (n = 18/23) larger than the visual clinical tumour size. In addition, the fluorescence contrast using MAL (1.65 ± 0.06) was found to be significantly higher (p<10(-4)) than the contrast (data from previous study) after application of ALA (1.20 ± 0.06). Thus, MAL generally provides higher tumour contrast than ALA in BCCs, and should be preferred for use in fluorescence diagnostics. Correlation between fluorescence, lack of treatment response and/or pain was not observed.

A Case of Superficial Giant Basal Cell Carcinoma with Satellite Lesions on Scalp

Giant basal cell carcinoma (BCC), defined as a lesion greater than 5 cm at its largest diameter, is a rare variant of BCC. In contrast to small BCC, giant BCC develops on skin that is not exposed to sunlight, including the back, shoulder, groin and thigh. Most of the histopathologic subtypes of giant BCC are micronodular, morpheaform and nodular, but the superficial subtype is rare. Giant superficial BCC arising on the scalp is extremely rare. We report the case of giant superficial BCC with four satellite lesions on the scalp in a 53-year-old male without predisposing factors.