Giant Basal Cell Carcinomas Express Neuroactive Mediators and Show a High Growth Rate: A Case-Control Study and Meta-Analysis of Etiopathogenic and Prognostic Factors

How cancer hijacks the body's homeostasis through the neuroendocrine system

During oncogenesis, cancer not only escapes the body's regulatory mechanisms, but also gains the ability to affect local and systemic homeostasis. Specifically, tumors produce cytokines, immune mediators, classical neurotransmitters, hypothalamic and pituitary hormones, biogenic amines, melatonin, and glucocorticoids, as demonstrated in human and animal models of cancer. The tumor, through the release of these neurohormonal and immune mediators, can control the main neuroendocrine centers such as the hypothalamus, pituitary, adrenals, and thyroid to modulate body homeostasis through central regulatory axes. We hypothesize that the tumor-derived catecholamines, serotonin, melatonin, neuropeptides, and other neurotransmitters can affect body and brain functions. Bidirectional communication between local autonomic and sensory nerves and the tumor, with putative effects on the brain, is also envisioned. Overall, we propose that cancers can take control of the central neuroendocrine and immune systems to reset the body homeostasis in a mode favoring its expansion at the expense of the host.

GIANT NODULAR BASAL CELL SKIN CANCER

Clinical observations of primary giant nodular basal cell skin cancer in two patients with a gender ratio of 1:1 at the age of 64 and 68 years and disease duration of 20 and 15 years, respectively, are presented. The reasons for the late appeal of patients for medical help are established - psychological states of fear and anxiety. The clinical picture of the presented observations was characterized by a slow long-term asymptomatic growth of solitary tumor-like nodes of a mushroom-shaped form of stagnant pink color with a bumpy surface, densely elastic consistency, soldered to the underlying soft tissues, sizes 9.5x7.0 cm and 5.0x9.0 cm, respectively. Giant basaliomas were localized on the scalp in a woman and on the skin of the trunk in a man. The clinical features of the tumors corresponded to those of a large conglomerated basal cell skin cancer. A description of the clinical and dermatoscopic picture of giant nodular basaliomas is presented. The patients underwent radical surgical excision of tumors with pathomorphological examination of the postoperative material. The histological picture of giant basal cell carcinoma in both cases is represented by tumors of a complex structure - a solid adenoid type with invasion into the reticular dermis and subcutaneous fat. The low biological potential of giant nodular basaliomas has been established.

Neuroendocrine signaling in the skin with a special focus on the epidermal neuropeptides

The skin, which is comprised of the epidermis, dermis, and subcutaneous tissue, is the largest organ in the human body and it plays a crucial role in the regulation of the body's homeostasis. These functions are regulated by local neuroendocrine and immune systems with a plethora of signaling molecules produced by resident and immune cells. In addition, neurotransmitters, endocrine factors, neuropeptides, and cytokines released from nerve endings play a central role in the skin's responses to stress. These molecules act on the corresponding receptors in an intra-, juxta-, para-, or autocrine fashion. The epidermis as the outer most component of skin forms a barrier directly protecting against environmental stressors. This protection is assured by an intrinsic keratinocyte differentiation program, pigmentary system, and local nervous, immune, endocrine, and microbiome elements. These constituents communicate cross-functionally among themselves and with corresponding systems in the dermis and hypodermis to secure the basic epidermal functions to maintain local (skin) and global (systemic) homeostasis. The neurohormonal mediators and cytokines used in these communications regulate physiological skin functions separately or in concert. Disturbances in the functions in these systems lead to cutaneous pathology that includes inflammatory (i.e., psoriasis, allergic, or atopic dermatitis, etc.) and keratinocytic hyperproliferative disorders (i.e., seborrheic and solar keratoses), dysfunction of adnexal structure (i.e., hair follicles, eccrine, and sebaceous glands), hypersensitivity reactions, pigmentary disorders (vitiligo, melasma, and hypo- or hyperpigmentary responses), premature aging, and malignancies (melanoma and nonmelanoma skin cancers). These cellular, molecular, and neural components preserve skin integrity and protect against skin pathologies and can act as "messengers of the skin" to the central organs, all to preserve organismal survival.

Axial flap for giant basal cell carcinoma of the anterior chest wall: Case report

Introduction and importance

Anterior chest wall Giant Basal Cell Carcinoma (GBCC) is rare amongst GBCC cases and results in a large defect that is challenging to resect and reconstruct. It requires multidisciplinary approach to prevent recurrence.

Case presentation

A 72-year-old man with giant basal cell carcinoma at the anterior chest wall measuring 10 × 6 cm. Wide resection of 1 cm margin with axial flap was performed to close the defect. The follow-up report stated that the patient was satisfied with the result and there was no recurrence observed.

Clinical discussion

Review of literatures concludes that GBCC is excised with a minimum of 4-6 mm margin outside the tumor area. The axial IMAP flap is ideal to close the upper chest wall defect because of the better aesthetic outcome compared to other conventional flaps, especially in stable elderly male, patients with noninfected wound. Increased skin laxity and more relaxed skin tension associated with aging allows easier tissue mobilization and transfer to close the defect.

Conclusion

Axial flap for GBCC in anterior chest wall is ideal, safe, and has the advantage of aesthetic reasons of suitable skin tone, particularly for stable elderly male patients.

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A 72-year-old man presented with a seven-year history of ulcerating mass on his anterior chest wall.

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Histopathologic examination confirmed the diagnosis of giant basal cell carcinoma (GBCC).

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We performed wide resection with 1 cm margin and reconstruct the defect with axial flap.

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No evidence of recurrence observed after 1 year of resection.

Endogenous opiates and behavior: 2017

This paper is the fortieth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2017 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).

Complex reconstruction of the orbitofrontal regions using three regional flaps after orbital exenteration for the treatment of basal cell carcinoma

Objective. The current paper presents an interesting case of facial reconstruction after the excision of a giant basal cell carcinoma located in the orbitofrontal region. Methods. Performing the excision while securing the appropriate oncologic safety margin has determined the appearance of a soft tissue defect that required a complex reconstruction using three regional flaps: frontal, temporal fascial and temporal muscle flaps. Results. After the excision and reconstruction in a single surgical stage, the postoperative result was favorable, the 12 months assessment showing that the patient was satisfied with the aesthetic aspect. Conclusion. Including the orbital exenterations in the excisional treatment of giant neoplasms located in the facial region requires a complex reconstructive plan. The surgical team has to consider the relief of the anatomical structures that are targeted, as well as the necessity of achieving satisfactory aesthetic results while ensuring oncological radicality.

Giant basal cell carcinoma: clinical-histological characteristics of 115 cases

INTRODUCTION

Giant basal cell carcinoma (GBCC) is a tumor ≥5 cm in size, with aggressive biological behavior, that represents 1% of basal cell carcinomas (BCC), and studies regarding it are scarce. Our objective was to investigate the clinical-histopathological characteristics of GBCC and the risk factors associated with its development.

METHODS

A retrospective study over 8 years included patients with the clinical and histopathological diagnosis of GBCC. Age, sex, localization, size, evolution time, risk factors, and histological variants were compared to conventional BCC. Descriptive and inferential statistics were used, and a value of P < 0.05 was considered statistically significant.

RESULTS

Of 5958 patients with BCC, 115 (2%) of them corresponded to GBCC. The average patient age was 73 ± 11 years, and the male sex (52%) and localization on the head and neck (63%) predominated. Average tumor size was 6.6 ± 2.2 cm, evolution time was 96 ± 86 months, and high-grade histological variants (51%) predominated. The group with GBCC had higher age (P < 0.01), greater frequency in the male sex (P = 0.01), longer evolution time (P < 0.01); a greater prevalence of risk factors (24% vs. 16%, P = 0.01), antecedents of other types of cancer (P = 0.03), and of burns (P = 0.03); and a greater frequency of high-grade histological variants (51% vs. 29%, P < 0.01).

CONCLUSIONS

This is the largest series of GBCC published to date. Findings are similar to those previously reported, although the prevalence found here was greater.

Giant morphea-form basal cell carcinoma of the umbilicus: Successful debulking with vismodegib

Basal cell carcinoma of the umbilicus is very rare. The nodular subtype is the main representative. Giant basal cell carcinomas represent around 1% of all basal cell carcinomas. The hedgehog pathway inhibitor vismodegib is indicated for advanced basal cell carcinoma and CD56-negative immunostaining seems indicative for successful treatment. A 54-year-old man presented a 10 cm × 14 cm large and 4.5 cm deep morphea-form basal cell carcinoma with faint immunohistochemical CD56 expression arising from the umbilicus. A sequential treatment was initiated with debulking using vismodegib 150 mg per day for 4 months, followed by reconstructive surgery. To the best of our knowledge, this is the first report of a giant basal cell carcinoma of the morphea-form type of the umbilicus. The sequential treatment plan reduces the duration of vismodegib inherent adverse effects and significantly reduces the tumor mass prior to surgery. Besides increasing adherence to vismodegib treatment, this approach facilitates the surgical technique and improves cosmetic outcome.

Conventional Versus Giant Basal Cell Carcinoma, a Review of 57 Cases: Histologic Differences Contributing to Excessive Growth

Background:

Giant basal cell carcinoma (GBCC) is defined as a basal cell carcinoma (BCC) exceeding 5 cm in size. While these tumors impart significant morbidity due to local tissue destruction and have a higher rate of metastatic disease than their conventional (smaller) counterparts, reasons for their large size remain unclear. While theories relating to neglect or faster growth rate are often invoked; to date, there has not been a comprehensive evaluation of the histologic features of these large tumors that may contribute to their size.

Methods:

Histologic features of GBCCs (n = 29) were evaluated and compared to those of conventional BCC (n = 28). Available clinical demographic data were also reviewed.

Results:

GBCCs, in addition to overall larger size, more often were thicker, displayed ulceration, and showed a more infiltrative growth pattern than their conventional counterparts. These rare tumors also displayed an insignificant increased propensity for a brisk host immune response, and the infiltrate significantly more often included clusters of plasma cells.

Conclusions:

Most histologic features seen in GBCCs likely reflect their large size. Histologic features alone are unlikely to explain the size of these rare tumors. The possibility of an altered host immune response contributing to the growth of these tumors requires further investigation.