Atypical Presentation of Metastatic Basal Cell Carcinoma

Basal Cell Carcinoma of the Dorsal Foot: An Update and Comprehensive Review of the Literature

BACKGROUND

Ultraviolet radiation is a well-known risk factor for basal cell carcinoma (BCC). Therefore, the high incidence of BCCs in sun-exposed areas such as the head and neck is unsurprising. However, unexpectedly, BCCs on the sun-protected dorsal foot have also been reported, and tumor occurrence here suggests that other factors besides ultraviolet radiation may play a role in BCC pathogenesis. Because only few dorsal foot BCCs have been reported, data on their clinical features and management are limited.

OBJECTIVE

To perform an updated review of the literature on clinical characteristics and treatment of dorsal foot BCCs.

METHODS

We conducted a comprehensive literature review by searching the PubMed database with the key phrases "basal cell carcinoma dorsal foot," "basal cell carcinoma foot," and "basal cell carcinoma toe."

RESULTS

We identified 20 cases of dorsal foot BCCs in the literature, 17 of which had sufficient data for analysis. Only 1 case was treated with Mohs micrographic surgery. We present 8 additional cases of dorsal foot BCCs treated with Mohs micrographic surgery.

CONCLUSION

Basal cell carcinomas on the dorsal foot are rare, and potential risk factors include Caucasian descent and personal history of skin cancer. Mohs micrographic surgery seems to be an effective treatment option.

Fibroepithelioma of Pinkus Revisited

Background

Fibroepithelioma of Pinkus (FeP) is considered a variant of basal cell carcinoma (BCC); however, in the past 20 years, some researchers have argued for its classification as a trichoblastoma. Recently, use of a new immunostaining marker and further dermoscopic characterization of FeP have advanced the debate about its proper classification.

Purpose

A review of the evidence for and against classification of FeP as BCC or trichoblastoma is presented.

Methods

Using PubMed, the term FeP was searched and relevant citations were assessed. Additional relevant articles were identified from references of key papers.

Results

FeP shares characteristics of both trichoblastoma and BCC.

Conclusion

Derived from the same cell type, BCC and trichoblastoma may be best considered as representing opposite ends of a spectrum of differentiation, with FeP deserving an intermediate classification.

[Diagnosis and treatment management of basal cell skin carcinoma - guidelines analysis]

Basal cell carcinoma (BCC) is the most frequent skin cancer in France. BCC has above all a local evolution with an important locoregional morbidity. BCC are found in 80% in the cervicofacial region. Surgery is currently recognized to be the most reliable treatment. The surgeon needs to achieve an in sano excision and must recover the defect with the less aesthetic consequences. The aim of this work is to combine and to get-at-able the recommandations of the "Haute Autorité de santé" of 2004, and also to supply some details for the clinical practice of the plastic surgeon.

Malignant transformation of a chronic venous stasis ulcer to basal cell carcinoma in a diabetic patient: case study and review of the pathophysiology

The degeneration of chronic wounds into basal cell carcinoma is rare. We present an atypical case of basal cell carcinoma diagnosed by soft tissue biopsy in a long-standing wound that had been treated for 3 years as a chronic venous stasis ulcer. In addition to the case report, we review the biomedical literature describing malignant transformation of long-standing wounds. Foot and ankle specialists should be on the lookout for changes that signal malignant transformation in long-standing ulcers.

Metastatic basal cell carcinoma diagnosed by sentinel lymph node biopsy

Although commonly used in the treatment of melanoma, sentinel lymph node biopsy has not yet been successfully used to detect lymphatic metastasis of basal cell carcinoma because of exceedingly low rates of metastasis. We describe the use of lymphatic mapping and sentinel lymph node biopsy in a patient after basal cell carcinoma was identified within a lymphatic vessel in the primary excisional specimen. As a result, the patient was found to have clusters of basal cell carcinoma in a sentinel lymph node resected from the right deltopectoral groove. Although metastatic basal cell carcinoma is exceedingly rare, we conclude that sentinel lymph node biopsy may be useful for certain high-risk lesions, such as lesions demonstrating histologic evidence of lymphatic invasion. Further experience is necessary to determine the clinical usefulness of sentinel node biopsy in these patients and its effect on patient survival.

Simultaneous two organ metastases of the giant basal cell carcinoma of the skin

Background

Basal Cell Carcinoma (BCC) is the most common carcinoma in humans. It accounts for 20% of carcinomas in men and 10–15% of carcinomas in women. Despite its high incidence, metastatic events are exceedingly rare. The reported frequency of metastatic dissemination is estimated at 0.0028–0.5 percent. Once metastasis is detected, there is a high mortality rate of 50% within 8 months.

Methods

In this study, we present a case of simultaneous lung and parotid metastases of giant BCC primary located on the right medial canthus of a 62 year old female.

Results

Examination of the tumor located on the medial canthus obtained showed "adenoid BCC". Computed tomography (CT) was performed to evaluate parotid region for evaluation of parotid gland and chest. Parotid and lung metastasis were detected in CT. Routine labarotory tests and radiological investigations were done. There was no abnormal finding. We also investigated this patient with a bone scan (normal), abdominal and cranial CT scans (also normal).

Conclusion

Although metastasis of BCC is a very rare condition, this study reports a case of simultaneous parotid gland and lung metastasis originating from a giant BCC primary that was located on the right inner canthus of a 62 year old female.