Fibroepithelioma of Pinkus Revisited

Basal cell carcinoma: Comprehensive clinical and histopathological aspects, novel imaging tools and therapeutic approaches (Review)

Basal cell carcinoma (BCC) is one of the most common malignant tumors worldwide, involving the skin. It is also part of keratinocyte carcinomas, alongside its squamous counterpart. It has low mortality and extremely low metastatic rates (although when present, it indicates a poor patient prognosis); it also has a high morbidity rate through local destruction and recurrence, particularly when perineural invasion is observed, clinically or histopathologically. BCC development is the result of environmental and patient factors, with genetics and ultraviolet radiation playing major roles. The clinical and histopathological aspects vary according to tumor subtype, being classified as high-risk tumors (nodular, superficial, pigmented and infundibulocystic BCC with adnexal differentiation) and fibroepithelial subtypes, or as high-risk tumors (micronodular, infiltrating, sclerosing/morphoeic and basosquamous subtype or the type with sarcomatoid differentiation). Dermoscopy is now complimented by novel in vivo diagnostic tools (optical coherence tomography, reflectance confocal microscopy, high-resolution ultrasonography, Raman spectroscopy or terahertz pulse imaging), improving the diagnostic accuracy and providing tumor depth and lateral margins without the use of invasive techniques. Novel treatment approaches for the treatment of BCC have recently been investigated with the use of hedgehog pathway inhibitors, such as Vismodegib. These approaches aim for complete resolution, minimal side-effects, high patient satisfaction with the optimal cosmetic results, particularly in key areas, such as the face. The present review article summarizes and discusses the comprehensive clinical and histopathological aspects of BCC, and presents novel imaging tools and therapeutic approaches that have been identified.

Basaloid tumors arising from seborrheic keratosis: Malignant basal cell carcinoma or benign basaloid follicular hamartomatous proliferation?

BACKGROUND

Basaloid tumors arising from seborrheic keratosis (SK) that resembled basal cell carcinoma (BCC) were infrequently observed in our patients. They also exhibited morphologic features similar to those of trichoblastoma or basaloid follicular hamartoma.

METHODS

We retrospectively collected cases of SK with basaloid tumors from 2001 to 2017. Ten cases of BCC, five of nevus sebaceus with trichoblastoma, five of trichoblastoma, and five of trichoepithelioma were included as controls. Tumor-associated antigens Bcl-2, CD10, PHLDA1, and CK20 were tested. Antigenic markers CD34 and CD10 were used to analyze peritumoral stroma features and Ki-67 and pHH3 to measure the mitotic activity.

RESULTS

Ten cases of SK with basaloid tumors were found and all located in non-sun-exposed areas, including five men and five women, with a mean age of 61 years. A distinct PHLDA1 staining was not observed. The staining patterns of basaloid tumor lobules associated with SK were similar to the benign control group. Bcl-2 staining in the tumor lobules was mostly negative. Peritumoral CD10 stain and CK20-positive Merkel cells in the lobules were observed and the mitotic counts were low.

CONCLUSION

Basaloid tumors arising from SK are not always BCC. They were all benign follicular hamartomatous proliferation in this case series.

Basal Cell Carcinoma: A Patient and Physician's Experience

In this article, the first coauthor, a patient with a basal cell carcinoma on her upper lip, discusses her experience with Mohs micrographic surgery for the treatment of the skin cancer. The second coauthor, who is the patient's physician (a dermatologist who shares her last name but is not a relative), diagnosed her skin cancer and referred her for Mohs surgery. The third coauthor, who is the patient's son and not only a dermatologist, but also a dermatopathologist and a Mohs surgeon (and also shares her last name), summarizes the presentation and treatment of the basal cell carcinoma.

Differential diagnostic significance of epithelial and stromal CD10 expression in tumors of trichogenic origin

BACKGROUND AND OBJECTIVES

The histological differential diagnosis between benign trichogenic skin tumors and basal cell carcinoma may be challenging. We therefore set out to investigate whether expression of CD10, a cell surface protein with neutral endopeptidase activity, might be a suitable marker for the histological differential diagnosis of trichogenic skin tumors.

PATIENTS AND METHODS

We immunohistochemically analyzed 119 cases of benign trichogenic skin tumors and basal cell carcinoma. These included 28 nodular and 15 sclerosing basal cell carcinomas, 21 Pinkus tumors, 20 trichoblastomas, nine trichofolliculomas, eleven trichoepitheliomas, five desmoplastic trichoepitheliomas, and ten seborrheic keratoses.

RESULTS

The majority of nodular basal cell carcinomas expressed CD10 in tumor cells at the peripheral (22/28 [75 %]). On the other hand, trichoblastomas revealed peripheral CD10 expression in only 10 % (2/20) of cases, whereas 50 % showed central expression (10/20). Peripheral epithelial expression of CD10 was also found in Pinkus tumors (9/21 [42.9 %]) and trichoepithelioma (4/11 [36.4 %]). Desmoplastic trichoepithelioma showed no tumoral CD10 expression at all (0/5 [0 %]), while the majority of sclerosing basal cell carcinomas was positive for CD10 (13/15 [86.7 %]).

CONCLUSIONS

Our findings suggest that epithelial expression of CD10 - and not peritumoral stromal CD10 expression, as has been postulated - may well be of differential diagnostic significance. The pattern of distribution of CD10-positive neoplastic cells in particular can be useful in the diagnosis of trichogenic tumors.

Fibroepithelioma of Pinkus (FeP) Located in the Left Lower Quadrant of the Abdomen - Case Report and Review of the Literature

BACKGROUND

Fibroepithelioma of Pinkus (FeP) is an uncommon and controversial skin lesion, sharing features of both basal cell carcinoma (BCC) and trichoepithelioma. In this article, we present a case of FeP and synthesise current concepts on the etiopathogenesis, diagnosis and treatment of this uncommon tumour.

CASE REPORT

We report the case of an 88-year-old male patient presenting to the dermatology clinic for a sharply demarcated, pink, exophytic cutaneous tumour situated in the left inguinal region. The histopathological examination performed after complete surgical excision of the lesion revealed a diagnosis of FeP. A systematic review of the literature was conducted. The terms `fibroepithelioma` and `Pinkus` have been searched in bibliographical databases, including PubMed and Google Scholar, without time limitation up to February 15th, 2017. Seventy-nine articles that fulfilled all the required conditions were identified. Relevant citations and additional articles identified from references have been assessed. The systematic review included a total number of 452 cases of FeP.

CONCLUSION

Even though FeP is considered a relatively rare tumour, its true incidence rate might be higher than previously believed. The clinical aspects of the lesion described in this paper and its location in the left lower quadrant of the abdomen are classic features of FeP. Histopathologic examination revealed features of both BCC and trichoepithelioma. Further epidemiological studies are required to clarify whether patients with FEP should be screened for the occurrence of other malignancies.

Basal Cell Carcinoma of the Umbilicus: A Comprehensive Literature Review

Basal cell carcinoma (BCC) typically occurs in sun-exposed sites. Only 16 individuals with umbilical BCC have been described in the literature, and the characteristics of patients with umbilical BCC are summarized. PubMed was used to search the following terms: abdomen, basal cell carcinoma, basal cell nevus syndrome, and umbilicus. Papers with these terms and references cited within these papers were reviewed. BCC of the umbilicus has been reported in five men and 11 women; one man had two tumors. Two patients had basal cell nevus syndrome (BCNS). Other risk factors for BCC were absent. The tumor most commonly demonstrated nodular histology (64%, 9/14); superficial and fibroepithelioma of Pinkus variants were noted in three and two patients, respectively. The tumor was pigmented in eight individuals. Treatment was conventional surgical excision (87%, 13/15) or Mohs micrographic surgery (13%, 2/15); either adjuvant laser ablation or radiotherapy was performed in two patients. The prognosis after treatment was excellent with no recurrence or metastasis (100%, 16/16). In conclusion, BCC of the umbilicus is rare. It usually presents as a tumor with a non-aggressive histologic subtype in an individual with no risk factors for this malignancy. There has been no recurrence or metastasis following excision of the cancer.