1
|
Chlebicka I, Stefaniak AA, Gawdzik A, RygaŁ A, Matusiak Ł, Szepietowski JC. Scalp Lesions Referred For Surgical Procedures: Single-Center 5-year Experience in Southwestern Poland. In Vivo 2021; 34:2733-2738. [PMID: 32871807 DOI: 10.21873/invivo.12095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/15/2020] [Accepted: 05/06/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND/AIM The head is a body site with a particular predisposition to skin malignancies due to exposure to UV radiation. The aim of the study was to better elucidate the characteristics of skin lesions that develop on the scalp. PATIENTS AND METHODS A retrospective review of all excised and histologically assessed lesions of the scalp at a single dermatosurgery unit throughout a five-year period was performed. Demographic features and lesion characteristics were compiled and analyzed. RESULTS Among 5,601 procedures during the analyzed period, 293 were performed on lesions on the scalp area (5.2%) with a mean patient age of 66±19.7 years. The defects were closed, mainly using primary closure, followed by skin grafts, and, least often, flaps (65.1%, 28.5%, 4.9%, respectively). Two thirds of the excised scalp lesions were histologically confirmed as malignant scalp tumors (mostly basal cell carcinomas followed by squamous cell carcinomas). CONCLUSION The vast majority of scalp lesions referred for surgical procedures appeared to be malignant. Therefore, dermatologists should pay special attention to the scalp by examining it thoroughly, as the lesions may be hidden by hair.
Collapse
Affiliation(s)
- Iwona Chlebicka
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Aleksandra A Stefaniak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Anna Gawdzik
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Alicja RygaŁ
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| |
Collapse
|
2
|
Bertrand N, Guerreschi P, Basset-Seguin N, Saiag P, Dupuy A, Dalac-Rat S, Dziwniel V, Depoortère C, Duhamel A, Mortier L. Vismodegib in neoadjuvant treatment of locally advanced basal cell carcinoma: First results of a multicenter, open-label, phase 2 trial (VISMONEO study): Neoadjuvant Vismodegib in Locally Advanced Basal Cell Carcinoma. EClinicalMedicine 2021; 35:100844. [PMID: 33997740 PMCID: PMC8093898 DOI: 10.1016/j.eclinm.2021.100844] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Surgery is the primary treatment for basal cell carcinoma (BCC). In locally advanced basal cell carcinoma (laBCC), surgery may cause functional or aesthetic damage. In laBCC, neoadjuvant administration of vismodegib, an inhibitor of the Hedgehog signaling pathway, may reduce tumor size, facilitate resection, and reduce functional and aesthetic consequences of surgery. The VISMONEO study assessed efficacy and safety of vismodegib in neoadjuvant treatment of laBCC. METHODS VISMONEO (NCT02667574) is an open-label, noncomparative, multicenter, phase 2 study. Patients with ≥1 histologically confirmed facial BCC, inoperable or operable with functional or major aesthetic sequelae risk, were included. Oral vismodegib 150 mg was administered once daily for 4 to 10 months before planned surgery, which was performed once the best response under vismodegib was observed. Primary endpoint was percentage of patients with BCC with tumor downstaging following surgical resection after neoadjuvant vismodegib. Downstaging was defined according to a 6-stage surgical classification related to the aesthetic and functional consequences of surgery. FINDINGS 55 patients (median age: 73 years) with laBCC were included from November 2014 to June 2015. At inclusion, 4 patients were inoperable, 15 were operable with a major functional risk, and 36 were operable with a minor functional risk or a major aesthetic risk. Mean size of target lesion was 47.3 mm (SD: 27.2 mm). 44 patients presented with downstaging after vismodegib treatment (80%; 95% confidence interval [CI], 67 to 90). Of these 44 patients, 27 had a complete response (25 proved by biopsy). Mean treatment duration was 6.0 months. Overall Response Rate according to RECIST 1.1 criteria was 71% (95% CI, 59 to 88). At 3-years of follow-up, 16/44 patients had known recurrence (36%; 95%CI, 22 to 51). INTERPRETATION Neoadjuvant vismodegib allows for a downstaging of the surgical procedure for laBCCs in functionally sensitive locations. FUNDING VISMONEO was funded by F. Hoffmann-La Roche Ltd.
Collapse
Affiliation(s)
| | - Pierre Guerreschi
- Univ. Lille, CHU Lille, Plastic and Reconstructive Surgery Department, Lille, France
| | | | - Philippe Saiag
- Hôpital Ambroise Paré AP-HP, Dermatology Department, Boulogne‐Billancourt, France
| | - Alain Dupuy
- CHU Rennes, Dermatology Department, Rennes, France
| | | | | | - César Depoortère
- Univ. Lille, CHU Lille, Plastic and Reconstructive Surgery Department, Lille, France
| | | | - Laurent Mortier
- Univ. Lille, INSERM U1189, CHU Lille, Dermatology Department, Lille, France
| |
Collapse
|
3
|
Xing MH, Ansari E, Levy JC, Samankan S, Khorsandi A, Urken ML. Incongruent radiographic indication of calvarial metastatic diploic space invasion with absent histologic findings in a patient with basal cell carcinoma of the scalp. Head Neck 2020; 42:E1-E5. [PMID: 32011047 DOI: 10.1002/hed.26097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/15/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Radiographic imaging is often used to determine basal cell carcinoma (BCC) extension and invasion and to define a surgical plan. However, imaging modalities may overestimate tumor invasion and lead to unnecessarily aggressive treatment. METHODS A 77-year-old woman was seen with a growing BCC of the scalp with MRI imaging indicative of calvarial diploic space invasion. The patient underwent Mohs surgery followed by a parietal craniectomy. RESULTS Contrary to the MRI findings, histological evaluation of the cortical parietal calvarium and the diploic space did not demonstrate BCC. CONCLUSIONS Surgeons should be wary of diploic space changes in the absence of cortical erosion demonstrated in MRI as it may not explicitly indicate tumor invasion. Biopsy of the diploe is necessary in such cases to determine the surgical course and to avoid morbidity associated with calvarium removal.
Collapse
Affiliation(s)
- Monica H Xing
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York
| | - Edward Ansari
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York
| | - Juliana C Levy
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York
| | - Shabnam Samankan
- Department of Pathology, Icahn School of Medicine and Mount Sinai, New York, New York
| | - Azita Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Mark L Urken
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York
| |
Collapse
|
4
|
Kwon CS, Awar OA, Ripa V, Said G, Rocka S. Basal cell carcinoma of the scalp with destruction and invasion into the calvarium and dura mater: Report of 7 cases and review of literature. J Clin Neurosci 2018; 47:190-197. [DOI: 10.1016/j.jocn.2017.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/29/2017] [Indexed: 12/27/2022]
|
5
|
Naumann IC, Cordes SR. Giant Basal Cell Carcinoma of the Forehead with Extensive Intracranial Involvement. Ann Otol Rhinol Laryngol 2016; 116:663-6. [DOI: 10.1177/000348940711600907] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Basal cell carcinoma (BCC) is the most common malignant skin lesion and is frequently curatively treated with local excision. Improper removal or neglect of BCC is a particular problem for head and neck surgeons. We describe a case of a recurrent BCC that aggressively grew from the forehead skin through the skull and into the frontal lobe. We also present a review of the literature. Despite its fairly benign growth pattern, BCC should never be underestimated, and care should be taken not only in the complete primary excision but also in cancer surveillance.
Collapse
|
6
|
Maugeri R, Basile L, Giugno A, Graziano F, Iacopino DG. Impasse in the management of recurrent basal cell carcinoma of the skull with sagittal sinus erosion. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2015. [DOI: 10.1016/j.inat.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
7
|
Erdem GU, Sendur MAN, Ozdemir NY, Yazıcı O, Zengin N. A comprehensive review of the role of the hedgehog pathway and vismodegib in the management of basal cell carcinoma. Curr Med Res Opin 2015; 31:743-56. [PMID: 25690490 DOI: 10.1185/03007995.2015.1018988] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common cancer. Most cases of BCCs are treated with only optimal surgical resection. However, unresectable, locally advanced or metastatic tumors might have potential to progress. In this patient group, there is no standardized treatment approach. Vismodegib is a new selective inhibitor of the hedgehog (Hh) pathway. This manuscript is aimed to review the efficacy of the Hh pathway inhibitor vismodegib in BCC patients with locally advanced or metastatic disease. SCOPE Vismodegib showed positive results in clinical studies. A computerized search of the PubMed and American Society of Clinical Oncology Meeting abstracts was performed, by searching for the following keywords: 'vismodegib', 'pathway', 'inhibitor', and 'targeted therapies for BCC'. The last search was done on 1 September 2014. Most of the vismodegib data depend on phase I and II trials. FINDINGS Preclinical and clinical studies have shown that Hh pathway activation occurs in BCC. In BCC patients the role of chemotherapy is not completely known. Although conventional chemotherapies like cisplatins increase the response rate in BCC, improvement in overall survival and progression free survival were not demonstrated. Results of both phase I and phase II studies have shown that vismodegib is a potential new treatment strategy for patients with locally advanced and metastatic BCC. As in previously published phase I trials, in the ERIVANCE BCC study the primary endpoint, objective response rate, significantly increased by 43% and 30% in patients with locally advanced and metastatic BCC, respectively. Because of the promising results in phase I and II trials, vismodegib was approved by the Food and Drug Administration (FDA) in the treatment of patients with BCC who are not suitable for surgery or radiotherapy or with relapsed locally advanced disease following surgery or metastatic disease. CONCLUSION Recent trials have shown that vismodegib has produced promising activity in patients with locally advanced and metastatic BCC. The ongoing studies with vismodegib in other solid tumors and BCC will shed light on more certain treatment pathways.
Collapse
Affiliation(s)
- Gökmen Umut Erdem
- Ankara Numune Education and Research Hospital, Department of Medical Oncology , Ankara , Turkey
| | | | | | | | | |
Collapse
|
8
|
Burch MB, Chung TK, Rosenthal EL, Schmalbach CE. Multimodality management of high-risk head and neck basal cell carcinoma requiring free-flap reconstruction. Otolaryngol Head Neck Surg 2015; 152:868-73. [PMID: 25805638 DOI: 10.1177/0194599815575720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/11/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES (1) Investigate overall survival (OS) and disease-free survival (DFS) for high-risk head and neck basal cell carcinoma (HNBCC) requiring large extirpation with free-flap reconstruction. (2) Determine impact of prognostic features-tumor size, subsite, number of high-risk features, perineural invasion, and bony invasion-on high-risk HNBCC survival. (3) Determine survival benefit of adjuvant radiation for high-risk HNBCC. STUDY DESIGN Case series with chart review (2002-2013). SETTING Academic tertiary care center. SUBJECTS AND METHODS Consecutive head and neck patients (N = 431) required free-flap reconstruction following tumor extirpation, 38 for aggressive HNBCC. All cases were high risk. DFS and OS were examined using Kaplan-Meier analysis. Prognostic variables and adjuvant radiation were analyzed utilizing Student's t test for continuous variables and Fisher's exact testing for categorical dependent variables. Complications were reported. RESULTS Mean tumor diameter was 5.17 cm (range, 1.2-15.0 cm). Mean follow-up was 19.9 months. Overall 2-year survival was 80%, falling to 66% at 5 years. Two-year disease-free survival was 72%. Six patients recurred (n = 5 local, 1 distant). Adjuvant radiotherapy improved DFS (P < .01) but not OS (P = .66). Tumors >2.5 cm did not affect OS (P = .61), regardless of subsite. Bone involvement (44.7% cases) did not affect DFS (P = .39) or OS (P = .18). CONCLUSIONS Larger HNBCC warranting free tissue transfer do not confer worse outcomes, independent of subsite. Adjuvant radiotherapy does not improve OS but significantly affected DFS, allowing for 13.7 additional months of DFS. Bone involvement does not influence DFS or OS and should not preclude surgery, even in advanced cases requiring free-flap reconstruction.
Collapse
Affiliation(s)
- M Benjamin Burch
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Alabama, USA
| | - Thomas K Chung
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Alabama, USA
| | - Eben L Rosenthal
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Alabama, USA
| | - Cecelia E Schmalbach
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Alabama, USA
| |
Collapse
|
9
|
Wollina U, Pabst F, Krönert C, Schorcht J, Haroske G, Klemm E, Kittner T. High-risk basal cell carcinoma: an update. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Rakic VS, Brasanac DC, Janjić ZM, Bogdanovic SM, Arafeh MA. Clinical and pathological features of the giant, invasive basal cell carcinoma of the scalp. J Craniofac Surg 2013; 24:e610-4. [PMID: 24220482 DOI: 10.1097/scs.0b013e3182a2b744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The giant, invasive basal cell carcinoma of the scalp is a rare clinical form of this tumor that appears on the skin, but may spread to some of the following structures: soft tissues of the scalp, bones, meninges, and the brain. In literature, so far, it is known as the GBCC. It is caused by aggressive BCC subtypes. METHODS We will present here a research of clinical and pathological features of 47 pathological specimens in 31 patients where the following features were examined: the dimension of the tumor, the dimension of the tissue segment, tumor area, segmentation area, resection margin width, microscopic resection margin status, tumor invasion level, and the outcome. RESULTS AND CONCLUSIONS We have concluded that microscopic resection margin dimensions from 1 to 10 mm are safe and that relapse occurrences in giant, invasive BCCs of the scalp depend on microscopic resection margin dimensions, resection margin status, tumor invasion levels, risky occupation, and risky behavior of the patient.
Collapse
Affiliation(s)
- Vesna S Rakic
- From the *Clinic for Burns, Plastic and Reconstructive Surgery, Clinical Center of Serbia, Belgrade; †Institute of Pathology, School of Medicine, University of Belgrade, Belgrade; and ‡Clinic for Plastic and Reconstructive Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia
| | | | | | | | | |
Collapse
|
11
|
Skull invaders: when surgical pathology and neuropathology worlds collide. J Neuropathol Exp Neurol 2013; 72:600-13. [PMID: 23771219 DOI: 10.1097/nen.0b013e318299c40f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Skull and dura serve as effective barriers to penetration by most tumors, often preventing masses originating intracranially from extending into the contiguous bone and soft tissues, or those arising in head and neck regions from extending into the dura and brain tissue. We review our 15-year experience with extracranial tumors that had sufficiently invaded adjacent skull, dura, or brain from the "outside-in" to require a neurosurgeon to participate in the surgical resection and discuss our 40 cases in context with the literature. Sinonasal-origin tumors (n = 17) and cutaneous tumors (n = 10) were the most frequent skull-invaders. Most of the cutaneous tumor types were squamous cellcarcinomas (n = 9); diverse sinonasal-origin types included 4 squamous cell carcinomas, 4 adenoid cystic carcinomas, 2 sinonasal undifferentiated carcinomas, 2 sinonasal adenocarcinomas, and single examples each of sinonasal-origin hemangiopericytoma, solitary fibrous tumor, melanoma, mucocele, and teratocarcinoma. There were 9olfactory neuroblastomas, and middle ear-origin basal cell carcinoma,recurrent glomus jugulare, and orbital malignant hidradenoma were also seen. Unique tumors included a cutaneous cylindroma invasive of skull convexity occurring in familial cylindromatosis and a ganglioneuroma of the middle ear with massive bilateral skull base extension. Convexity dural spread, a seldom-reported pattern of dissemination, was seen in 1 olfactory neuroblastoma and 1 adenoid cystic carcinoma. The ability to show skull/dural invasion did not correlate with specific histopathologic features; even benign tumor types can show skull/dural penetration.
Collapse
|
12
|
|
13
|
Axelson M, Liu K, Jiang X, He K, Wang J, Zhao H, Kufrin D, Palmby T, Dong Z, Russell AM, Miksinski S, Keegan P, Pazdur R. U.S. Food and Drug Administration approval: vismodegib for recurrent, locally advanced, or metastatic basal cell carcinoma. Clin Cancer Res 2013; 19:2289-93. [PMID: 23515405 DOI: 10.1158/1078-0432.ccr-12-1956] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The data and regulatory considerations leading to the U.S. Food and Drug Administration (FDA) January 30, 2012 approval of Erivedge (vismodegib) capsules for the treatment of patients with recurrent, locally advanced, or metastatic basal cell carcinoma (BCC) are described. The FDA's approval decision was based primarily on the results observed in a single-arm, parallel cohort, international trial of vismodegib, administered orally at 150 mg daily until disease progression, in patients with pathologically confirmed, recurrent, locally advanced basal cell carcinoma (laBCC) or metastatic basal cell carcinoma (mBCC). An independent review committee confirmed an overall response rate (ORR) of 30.3% [95% confidence interval (CI): 15.6-48.2] in 33 patients with mBCC and an ORR of 42.9% (95% CI: 30.5-56.0) in 63 patients with laBCC; median response durations were 7.6 months and 7.6 months for patients with mBCC and laBCC, respectively. The most common adverse reactions were muscle spasms, alopecia, dysgeusia, weight loss, fatigue, nausea, diarrhea, decreased appetite, constipation, cough, arthralgias, vomiting, headache, ageusia, insomnia, and upper respiratory tract infection. Animal toxicology studies confirmed that vismodegib is a potent teratogenic agent. Approval was based on durable objective tumor responses supported by knowledge of the pathologic role of Hedgehog signaling in BCC and acceptable toxicity in a population without effective alternative therapies.
Collapse
Affiliation(s)
- Michael Axelson
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland 20993, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
HAY ASHLEY, STRAHAN JAMISONE, TORRES ABEL, KIM JOHNY. Basal Cell Carcinoma with Calvarium Invasion. Dermatol Surg 2011; 37:399-401. [DOI: 10.1111/j.1524-4725.2011.01896.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Taboada A, Couto I, Brea B, González E, Prieto A. Carcinoma basocelular invasivo de cuero cabelludo. Caso clínico. Neurocirugia (Astur) 2010. [DOI: 10.1016/s1130-1473(10)70090-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Von Hoff DD, LoRusso PM, Rudin CM, Reddy JC, Yauch RL, Tibes R, Weiss GJ, Borad MJ, Hann CL, Brahmer JR, Mackey HM, Lum BL, Darbonne WC, Marsters JC, de Sauvage FJ, Low JA. Inhibition of the hedgehog pathway in advanced basal-cell carcinoma. N Engl J Med 2009; 361:1164-72. [PMID: 19726763 DOI: 10.1056/nejmoa0905360] [Citation(s) in RCA: 805] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mutations in hedgehog pathway genes, primarily genes encoding patched homologue 1 (PTCH1) and smoothened homologue (SMO), occur in basal-cell carcinoma. In a phase 1 clinical trial, we assessed the safety and pharmacokinetics of GDC-0449, a small-molecule inhibitor of SMO, and responses of metastatic or locally advanced basal-cell carcinoma to the drug. METHODS We selected 33 patients with metastatic or locally advanced basal-cell carcinoma to receive oral GDC-0449 at one of three doses; 17 patients received 150 mg per day, 15 patients received 270 mg per day, and 1 patient received 540 mg per day. We assessed tumor responses with the use of Response Evaluation Criteria in Solid Tumors (RECIST), physical examination, or both. Molecular aspects of the tumors were examined. RESULTS The median duration of the study treatment was 9.8 months. Of the 33 patients, 18 had an objective response to GDC-0449, according to assessment on imaging (7 patients), physical examination (10 patients), or both (1 patient). Of the patients who had a response, 2 had a complete response and 16 had a partial response. The other 15 patients had either stable disease (11 patients) or progressive disease (4 patients). Eight grade 3 adverse events that were deemed to be possibly related to the study drug were reported in six patients, including four with fatigue, two with hyponatremia, one with muscle spasm, and one with atrial fibrillation. One grade 4 event, asymptomatic hyponatremia, was judged to be unrelated to GDC-0449. One patient withdrew from the study because of adverse events. We found evidence of hedgehog signaling in tumors that responded to the treatment. CONCLUSIONS GDC-0449, an orally active small molecule that targets the hedgehog pathway, appears to have antitumor activity in locally advanced or metastatic basal-cell carcinoma. (ClinicalTrials.gov number, NCT00607724.)
Collapse
Affiliation(s)
- Daniel D Von Hoff
- Translational Genomics Research Institute and Scottsdale Healthcare, Scottsdale, AZ, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Kleydman Y, Manolidis S, Ratner D. Basal cell carcinoma with intracranial invasion. J Am Acad Dermatol 2009; 60:1045-9. [PMID: 19467376 DOI: 10.1016/j.jaad.2008.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 10/03/2008] [Accepted: 10/05/2008] [Indexed: 10/20/2022]
Abstract
The risk of invasion and destruction of cranium, underlying dura, and cranial nerves by basal cell carcinoma (BCC) is extremely low, with an estimated incidence of 0.03%. Intracranial BCC invasion by direct extension is rare, and orbital spread from a nasal lesion has not been reported in the literature. We describe a case of intracranial invasion of a multiply recurrent nasal BCC, which caused progressive bilateral blindness from optic nerve compression, with spinal canal involvement causing subsequent lower extremity weakness and paralysis. This case underscores the importance of early and appropriate treatment of high risk BCC, and aggressive treatment of recurrent lesions as early as possible.
Collapse
|
18
|
Soma PF, Chibbaro S, Makiese O, Marsella M, Diemidio P, Fricia M, Passanisi M, Catania V, Siragò P, Ventura F. Aggressive scalp carcinoma with intracranial extension: a multidisciplinary experience of 25 patients with long-term follow-up. J Clin Neurosci 2008; 15:988-92. [PMID: 18653348 DOI: 10.1016/j.jocn.2007.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 09/12/2007] [Accepted: 09/16/2007] [Indexed: 10/21/2022]
Abstract
Malignant skin cancer of the scalp with skull invasion, dural infiltration and brain involvement is a uncommon lesion. This scenario is most often encountered in patients where initial scalp lesions are not appropriately diagnosed or their extent is underestimated by the patient and/or the doctor. Our study is a retrospective review of 25 patients treated using a multidisciplinary approach (combined plastic surgery/neurosurgery procedure and neuro-oncological management). After a mean follow-up of 7 years, 22 patients did not show local recurrence or distant metastases of their primary disease. Overall, these 22 patients had excellent quality of life; however, three patients died from causes not related to their primary pathology. To obtain a complete and definitive cure, prompt diagnosis of scalp cancers followed by appropriate multidisciplinary management is strongly advised.
Collapse
Affiliation(s)
- P F Soma
- Department of Plastic Surgery, University Hospital, Catania, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Belmahi A, Oufkir AA. Lambeaux locaux pour pertes de substance transfixiantes du scalp sur tumeurs évoluées. À propos d'une série de 21 patients. ANN CHIR PLAST ESTH 2007; 52:569-76. [PMID: 17382442 DOI: 10.1016/j.anplas.2007.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 01/18/2007] [Indexed: 10/23/2022]
Abstract
SUBJECT The advanced tumors of the scalp can involve the calvarium, the dura and the cerebral tissue. The medium sized full thickness scalp defects secondary to the excision of such cutaneous malignancy can be successfully treated with local flaps coming from the remaining scalp if these flaps are large and including at least one major pedicle of the scalp. The cranioplasty can be done immediately or secondarily. PATIENTS AND METHODS From May 2001 to July 2006, 21 patients aged between 52 and 78 years old, suffering from advanced basal and squamous cell carcinomas with invasion of the calvarium in all cases, the dura in 1 case and the cerebral tissue in 2 cases have benefited from an excision of the scalp and calvarium with a margin between 1 and 3 cm. The secondary defects measured between 9 and 15 cm for the scalp and between 6 and 9 cm for the calvarium. In 1 case, the dura was resected and reconstructed with a fascia lata graft. The flaps used were: a single pedicled transposition flap based on one or two occipital pedicles in 10 cases--a bipedicled transposition flap based on the superficial temporal pedicles in 3 cases and on the frontal and occipital pedicles in 4 cases--a large rotation flap in 4 cases. These flaps were undermined under the galea without any galeotomies. Their donor sites were immediately grafted. The calvarium was reconstructed by a methylmetacrylate implant in 9 cases, simultaneously with these flaps in 4 cases and secondarily in 5 cases. RESULTS There were no vascular problems in all these flaps--3 cases of infection in the simultaneous reconstruction of the scalp and calvarium are reported. The two patients with cerebral invasion are deceased 1 year after the surgery. The other patients are still alive without any recurrence or metastasis with a mean follow-up of 36 months. CONCLUSION Such complex defects of the tumoral scalp can be reconstructed with large and axial local flaps of the remaining scalp with safety. The cranioplasty has to be delayed.
Collapse
Affiliation(s)
- A Belmahi
- Service de chirurgie plastique et chirurgie de la main, hôpital Avicenne, 9, rue Ghzaoua, Souissi, Rabat, Maroc.
| | | |
Collapse
|
20
|
Chiu CS, Lin CY, Kuo TT, Kuan YZ, Chen MJ, Ho HC, Yang LC, Chen CH, Shih IH, Hong HS, Chuang YH. Malignant cutaneous tumors of the scalp: A study of demographic characteristics and histologic distributions of 398 Taiwanese patients. J Am Acad Dermatol 2007; 56:448-52. [PMID: 17141358 DOI: 10.1016/j.jaad.2006.08.060] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 08/04/2006] [Accepted: 08/17/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND The scalp is a unique anatomic region, in which pilosebaceous follicles are concentrated. OBJECTIVE We sought to investigate demographic characteristics and histologic distributions of malignant scalp tumors. METHODS Primary and metastatic scalp malignancies diagnosed histopathologically between 1983 and 2003 were reviewed. Age at diagnosis, sex, and histologic types were analyzed. RESULTS A total of 398 Taiwanese patients (200 males, 198 females) were selected. Age at diagnosis ranged from 3 to 103 years. Most malignant scalp tumors (69.8%) occurred in those 50 years or older. Basal (41.2%) and squamous (16.6%) cell carcinomas were the most common histologic types. Surprisingly, metastatic tumors (12.8%) came in third, in which lung cancers were the most frequent primary tumor in both male and female patients. LIMITATIONS In our series, the case number of metastatic scalp malignancies was underestimated because not all patients with metastatic scalp tumors received a scalp skin biopsy. CONCLUSION Because a wide spectrum of primary and metastatic malignancies can occur on the scalp, scalp inspection should be included in general screening for either skin or internal cancers.
Collapse
Affiliation(s)
- Cheng-Sheng Chiu
- Department of Dermatology, Min-Sheng General Hospital, Taoyuan, Taiwan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Griffiths RW, Suvarna SK, Stone J. Basal cell carcinoma histological clearance margins: an analysis of 1539 conventionally excised tumours. Wider still and deeper? J Plast Reconstr Aesthet Surg 2006; 60:41-7. [PMID: 17126265 DOI: 10.1016/j.bjps.2006.06.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Revised: 06/09/2006] [Accepted: 06/16/2006] [Indexed: 11/16/2022]
Abstract
An analysis of peripheral and deep margins of histological clearance around 1539 consecutive basal cell carcinomas excised by conventional surgery showed that 81 lesions (5.3%) were incompletely excised peripherally; 36 lesions (2.3%) were incompletely excised deeply; 13 lesions (0.8%) were incompletely excised peripherally and deeply. Nine hundred and ninety-six lesions (65%) were excised with a peripheral histological clearance margin<5mm (0.1-4.9mm), whereas 1303 lesions (85%) were excised with a deep histological clearance margin<5mm (0.1-4.9mm). Four hundred and eight lesions (27%) had a peripheral histological clearance margin of 5.0-9.9mm, whereas 170 lesions (11%) had a deep histological margin of 5.0-9.9mm. Peripheral histological clearance margins exceeded 10mm in 41 lesions (3%) and deep histological margins exceeded 10mm in 17 lesions (1%). Thus 30% of peripheral histological margins were 5mm or more but only 12% of deep histological margins were 5mm or more. Despite a relative sparing of deep tissue, incomplete excision in depth affected only 36 lesions compared with 81 incomplete peripheral excisions. Peripheral histological clearance was <5mm (0.1-4.9mm) for 55% of temple lesions, 50% of scalp lesions and 43% for limb lesions. In the cosmetically sensitive areas of peri-orbital region, nose, cheek, lip, neck and chin more than 70% of lesions were excised with a peripheral histological margin<5mm. This study of conventional surgical excision of basal cell carcinomas with an incomplete excision rate of 8% has shown that 65% of lesions were excised with <5mm histological clearance peripherally and 85% with <5mm deep clearance. These figures for 'normal tissue sacrifice' are not excessive when compared with those of 'tissue sparing' Mohs' micrographic surgery in which the operator may take a margin of several millimetres of normal tissue in the initial 'slice', or in the subsequent 'safety margin' beyond the eventual tumour free plane. However, peripheral margins did exceed 5mm in more than 30% of lesions of scalp, temple and forehead, and for these sites where even with loupe magnification the tumour edge could be difficult to define, either frozen section control or Mohs' technique, might with benefit be more often used in order to minimise normal tissue sacrifice.
Collapse
Affiliation(s)
- R W Griffiths
- Department of Reconstructive Plastic Surgery, Northern General Hospital, Sheffield Teaching Hospitals Trust, Herries Road, Sheffield S5 7AU, UK.
| | | | | |
Collapse
|