Which features of advanced head and neck basal cell carcinoma are associated with perineural invasion?

Basal Cell Carcinoma Perineural Invasion and Suggestive Signs of Perineural Invasion-Findings and Perspectives

Basal cell carcinoma (BCC) is a malignant tumor with a rising incidence and is the beneficiary of several innovative evaluation techniques. Histopathology remains the gold standard for assessment, having the possibility of addressing multiple high-risk factors such as perineural invasion (PNI). The current study included a number of 244 BCC patients and targeted the identification of positive PNI and its suggestive signs, and whether they correlated or not with other high-risk tumor signs. PNI was found in 20.1% of patients, with 30.7% of patients having perineural chronic inflammation (PCI), which is a suggestive sign of PNI. PNI was also found in larger tumors, with deeper Clark levels, in high-risk BCCs and high-grade tumors. PNI and PCI are both important for pathology reporting, aiding in treatment choice and further patient management, with possibly positive outcomes concerning morbidity and mortality.

Basal Cell Carcinoma With Perineural Invasion: A Systematic Review and Pooled Survival Analysis

BACKGROUND

Perineural invasion (PNI) is considered a high-risk histopathologic feature in many skin cancers. Perineural invasion is a well-known poor prognostic factor of squamous cell carcinoma, but is poorly understood in the context of basal cell carcinoma (BCC).

OBJECTIVE

To analyze available demographic, clinical, and treatment data for BCC with PNI and the effect of these variables on recurrence patterns, disease progression, and cancer-specific mortality (CSM).

METHODS

A systematic review and pooled-survival analysis was performed using case reports and series of patients with perineural BCC.

RESULTS

This review included 159 patients from 49 publications. Of these cases, 57 patients reported at least one recurrence. Where reported, median follow-up time was 31 months for patients without recurrence ( n = 79) and 21 months for patients with recurrence ( n = 32). The cumulative incidence of CSM at 5 years was 8.5% (95% confidence interval [CI] 0.028-0.186) and the overall five-year survival was 90.9% (95% CI 0.796-0.961).

CONCLUSION

Male gender, multifocal nerve involvement, presence of clinical symptoms, and PNI detected on imaging are associated with poor prognosis of BCC with PNI. The high rate of disease recurrence and suboptimal cumulative incidence of CSM highlights the importance of early clinical detection, before the onset of symptomatic PNI and multifocal nerve involvement.

Comparison of Demographic and Clinicopathological Characteristics of Basal Cell Carcinoma on the Nose and Other Sites of the Face: A Cross-Sectional Study

Introduction:

The clinicopathological characteristics of basal cell carcinoma (BCC) in different areas of the face, including the nose, are important and may be different. Accurate recognition of these characteristics may be necessary for the planning and selection of appropriate treatment.

Materials and Methods:

This cross-sectional study was conducted on 328 patients (131 females and 197 males) with 371 documented facial BCC in the West of Iran within 2013-2018. The demographic and clinicopathological data of the patients in the nose area were compared with other sites of the face by appropriate statistical methods.

Results:

Out of 371 lesions, 38.8% of the cases were on the nose, 75.8% were primary lesions, 97.8% had no perineural invasion, 89.2% were nodular, and 65.8% were of nodular clinical and pathologic type, which were the most common variables of patients. It was revealed that early-onset (P<0.001), smaller size (P<0.001), high-risk pathologic type (P=0.01), and recurrent lesions (P=0.013) were significantly higher in the nasal BCC. However, there was no significant difference between BCC in the nose and other sites of the face in terms of gender (P=0.654), high-risk clinical type (P=0.06), and perineural invasion (P=0.275).

Conclusion:

Considering the nasal site as an important cosmetic unit, more limitation of the nose in performing any procedure, and presence of the more risk factors in the nose than in other areas of the face, the definite treatment of nasal BCC requires special attention, expertise, and experience.

Basal cell carcinoma with perineural invasion: A prospective study examining subtype, tumor surface diameter, invasion depth, and anatomic site in 3005 consecutive cases

BACKGROUND

Basal cell carcinoma (BCC) may present with or without perineural invasion (PNI). We reviewed BCC for PNI by subtype, microscopic tumor surface diameter, invasion depth, and anatomic site.

METHOD

Consecutive excisions were prospectively collected in an Australian center 2016-2018.

RESULTS

Total cases were 3005 including 40 with PNI: 28 in males, 12 in females. Superficial and nodular subtypes had no PNI. As the percentage tumor mass of infiltrative BCC increased beyond 90% the presence of PNI substantially escalated (OR7.0). Comparing PNI absent or present the respective maximum mean tumor microscopic surface diameters ranged from (95%CI [9.6-10.0] P < .001) to 11.2 mm (95%CI [9.4-13.0] P = .59). Respective maximum mean invasion depths were from 1.0 mm (95%CI [0.98-1.05] P < .001) to 2.3 mm (95%CI [1.8-2.7] P < .001). Respective maximum mean invasion depths were from 1.0 mm (95%CI [0.98-1.05] P < .001) to 2.3 mm (95%CI [1.8-2.7] P < .001) to 2.3 mm (95%CI[1.8-2.7] P < .001). Males recorded most PNI on the scalp, followed by cheek and chin. Patients with more than two BCC cases had a greater proportional PNI risk (OR3.7). Mean PNI nerve diameters were 0.06 mm² (males) and 0.03 mm² (females).

CONCLUSION

Increases in percentage infiltrative subtype within the tumor mass, microscopic tumor diameter, tumor invasion depth, and BCC cases per patient all recorded more PNI. Minimum invasion depths with PNI were 1.0 mm on males (nose) and 1.0 mm females (forehead).

Attributes and risk factors of positive margins on 864 excisions of basal cell carcinomas: a single-center retrospective study

Background: Residual tumors increase the likelihood of recurrence of basal cell carcinoma (BCC).Objective: We determined the attributes and risk factors for positive surgical margins (+SM) of excised BCC in a university hospital.Methods: In this cross-sectional retrospective study, we reviewed the histologic reports of BCC removed via conventional surgical excision (CSE) by specialists from different fields.Results: Among excised BCCs (n = 864), there was a predominance of nodular BCC (82.64%) in the facial H-area (72.81%; average diameter = 9.12 mm), which had the highest + SM rate (20.17%). Most cephalic (ce-BCC; 69.01%) and non-cephalic (91.11%) BCCs were excised by dermatologists, with low rates of + SM (4.53%; 1.46%, respectively); the overall + SM rate was 12.73%. Men had larger (p < .001) and more ulcerated (p = .04) BCC. An aggressive histologic pattern (Ag-P) (p < .04) and ulceration (p < .001) were correlated with tumor size on multivariate analysis. The risk for + SM increased in ulcerated ce-BCC (p = .02), BCC with Ag-P (p = .02), and in the H-area (p < .001), nasal (p = .007), and labial (p = .05) regions. ce-BCC excised by head-neck surgeons had a high chance of ulceration (p < .001) and Ag-P (p = .002).Conclusions: Ag-P and H-zone remain critical risk factors for + SM. Accordingly appropriate treatment protocols should be used to ensure low + SM rates via CSE.

Recurrence rate of basal cell carcinoma in patients submitted to skin flaps or grafts

BACKGROUND

Basal cell carcinoma is the most common type of skin cancer. Although the literature provides a great deal of information on the recurrences of basal cell carcinoma, studies about these indices addressing only the cases in which flaps and/or grafts have been performed for surgical reconstruction of the excision of this tumor are still lacking.

OBJECTIVES

To evaluate rates of recurrence of basal cell carcinoma submitted to conventional surgery with pre-established margins and reconstruction by flaps or grafts.

METHODS

A retrospective and observational study was performed through the analysis of 109 patients, who met inclusion criteria with 116 basal cell carcinomas submitted to conventional surgery and pre-established safety margins, requiring reconstruction through a graft or cutaneous flap. This work was performed the small surgeries sector of Dermatology of the Specialty Outpatient Clinic of the University Hospital of the State University of Londrina, between January 1, 2011 and December 31, 2015. The following data were collected and inserted in an Excel worksheet: name, registration number of the hospital patient, sex, age, tumor location, histopathological type of BCC, procedure performed (type of flap and/or graft), follow-up time, recurrence.

RESULTS

Of the 116 procedures, there were recurrences in 3 cases (2.6%) that were located in the nasal region and related to sclerodermiform or micronodular histological types.

STUDY LIMITATIONS

Retrospective nature of the study.

CONCLUSION

The present study of the dermatology department of this university hospital showed a low rate of recurrence of basal cell carcinoma in cases where flaps and/or grafts were used in the surgical reconstruction.

Oncologic outcomes after surgery for locally aggressive basal cell carcinoma of the head and neck

OBJECTIVE

Although basal cell carcinoma (BCC) is the most common skin cancer, locally aggressive BCC of the head and neck is rare and not well studied.

STUDY DESIGN

Retrospective review of patients who underwent primary surgical resection of locally aggressive head and neck BCC at a single tertiary academic center.

RESULTS

Eighty-seven patients with 98 tumors demonstrated a 5-year Kaplan-Meier estimated recurrence-free survival of 64.5%, overall survival of 83.3%, and disease-specific survival of 98.3%. Intraoperative positive frozen section margin was a strong independent predictor of local recurrence (hazard ratio 6.88, P = 0.038) and was more likely to occur in tumors previously treated with radiation (odds ratio 6.47 = 0.05).

CONCLUSION

Locally aggressive BCCs of the head and neck have high rates of local recurrence but low disease-specific mortality when treated with primary surgery and selected use of adjuvant therapy. Intraoperative positive frozen section margin is a strong independent predictor of local recurrence and is more likely in tumors that were previously treated with radiation therapy.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:115-119, 2020.