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Scotti B, Melotti B, Baraldi C, Comito F, Venturi F, Lambertini M, Dika E. Analysis of basal cell carcinomas' histological subtypes and relative response to vismodegib in six patients diagnosed with Gorlin-Goltz syndrome: A retrospective study. J Eur Acad Dermatol Venereol 2024; 38:e339-e341. [PMID: 37909360 DOI: 10.1111/jdv.19608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Biagio Scotti
- Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dermatology, Department of Medical and Surgical Sciences Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Barbara Melotti
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinic of Sant'Orsola, Italy
| | - Carlotta Baraldi
- Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dermatology, Department of Medical and Surgical Sciences Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Comito
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinic of Sant'Orsola, Italy
| | - Federico Venturi
- Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Martina Lambertini
- Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dermatology, Department of Medical and Surgical Sciences Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emi Dika
- Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dermatology, Department of Medical and Surgical Sciences Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Manca R, Dattolo A, Valenzano F, Castriota M, Martella A, Galdo G, Argenziano G, Abeni D, Fania L. Proposal of a new dermoscopic criterion for pigmented basal cell carcinoma: a multicentre retrospective study. Dermatol Reports 2024; 16:9691. [PMID: 38623374 PMCID: PMC11017719 DOI: 10.4081/dr.2023.9691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/24/2023] [Indexed: 04/17/2024] Open
Abstract
Dermoscopy is widely used for the diagnosis of skin cancer and it increases the accuracy of basal cell carcinoma (BCC) detection. BCC dermoscopic criteria have been updated and divided into vascular, pigment-related, and non-vascular/non-pigment-related. Our multicenter retrospective study tested a new dermoscopic pigment-related characteristic to detect pigmented BCC (pBCC) [brown homogeneous blotches (BHB)]. Cases of pBCC were collected from the databases of IDI-IRCCS of Rome and from three Italian private dermatology centers. BHB are confined patches of brown uniform pigmentation without dermoscopic features (net, fat fingers, etc.) or other internal dermoscopic structures, except for occasional vascular ones like arborizing vessels or globules/dots. Melanocytic and non-melanocytic controls were used. We reviewed photos of 270 pigmented lesions (female 145; 51.8%), including 90 histopathologically verified pBCC and 180 control cases (90 melanocytic and 90 non-melanocytic). BHB were found in 61 cases of 90 pBCC patients. The results showed a 67.8 sensitivity, 93.3 specificity, 83.6 positive and 85.3 negative predictive values, posLR 10.2, negLR 0.3, odds ratio 29.4, p<0.001. Our multicentre retrospective analysis suggested the BHB may be a novel dermoscopic pBCC diagnosis criterion.
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Affiliation(s)
| | - Anna Dattolo
- IDI-IRCCS, Dermatological Research Hospital, Rome
| | | | | | | | | | | | | | - Luca Fania
- IDI-IRCCS, Dermatological Research Hospital, Rome
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Behera B, Kumari R, Thappa DM, Gochhait D, Srinivas BH, Ayyanar P. Dermoscopic features of basal cell carcinoma in skin of color: A retrospective cross-sectional study from Puducherry, South India. Indian J Dermatol Venereol Leprol 2023; 89:254-260. [PMID: 33969659 DOI: 10.25259/ijdvl_420_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 01/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Dermoscopy is useful in the diagnosis of basal cell carcinoma (BCC). However, most descriptions of the dermoscopic features of BCCs are in Caucasians (skin types I-III) and there is a paucity of data in dark-skinned Indian patients. AIMS The aim of this study was to describe the various dermoscopic features of BCC in dark-skinned patients from South India and correlate these with the histopathologic subtypes. METHODS A retrospective observational study of biopsy-proven cases of BCC was conducted at a tertiary care center in South India using nonpolarized contact dermoscopy. RESULTS Sixty BCCs in 35 patients predominantly of skin phototypes IV or V were studied. These included 32 nodular, 27 superficial and 1 infiltrative type of BCC. The most common dermoscopic features noted were maple leaf-like areas (61.7%), blue-white veils (53.4%), ulceration (48.4%) and short fine telangiectases (46.7%). Ulceration, blue-white veils and arborizing vessels were significantly associated with nodular BCCs, while maple leaf-like areas, red-white structureless areas, multiple small erosions and spoke wheel areas were noted with superficial BCCs. LIMITATIONS The limitations of this study include its retrospective nature, the use of only nonpolarized light for examination, the lack of other histopathological variants of BCC as well as the lack of a comparison group. CONCLUSION We report a dermoscopic study of BCC in dark-skinned patients from Puducherry, South India. The blue-white veil was observed in half of the patients and was significantly associated with nodular BCCs. The addition of the blue-white veil to the diagnostic criteria for pigmented BCC could improve the diagnostic accuracy of dermoscopy in Indian patients.
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Affiliation(s)
- Biswanath Behera
- Department of Dermatology, and Venereology AIIMS, Bhubaneswar, Odisha, India
| | - Rashmi Kumari
- Department of Dermatology, Venereology and Leprology JIPMER, Puducherry, India
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Assessment of Basal Cell Carcinoma Using Dermoscopy and High Frequency Ultrasound Examination. Diagnostics (Basel) 2022; 12:diagnostics12030735. [PMID: 35328289 PMCID: PMC8947530 DOI: 10.3390/diagnostics12030735] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/09/2022] [Accepted: 03/17/2022] [Indexed: 01/27/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common form of cutaneous neoplasia in humans, and dermoscopy may provide valuable information for histopathological classification of BCC, which allows for the choice of non-invasive topical or surgical therapy. Similarly, dermoscopy may allow for the identification of incipient forms of BCC that cannot be detected in clinical examination. The importance of early diagnosis using the dermoscopy of superficial BCC forms is proven by the fact that despite their indolent clinical appearance, they can be included in high-risk BCC forms due to the rate of postoperative recurrence. Nodular pigmentary forms of BCCs present ovoid gray-blue nests or multiple gray-blue dots/globules associated with arborized vessels, sometimes undetectable on clinical examination. The management of BCC depends on this, as pigmentary forms have been shown to have a poor response to photodynamic therapy. High frequency ultrasound examination (HFUS) aids in the diagnosis of BCC with hypoechoic tumour masses, as well as in estimating tumour size (thickness and diameter), presurgical margin delineation, and surgical planning. The examination is also useful for determining the invasion of adjacent structures and for studying local recurrences. The use of dermoscopy in combination with HFUS allows for optimisation of the management of the oncological patient.
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Balcere A, Karls R, Čēma I, Rone Kupfere M, Vīksna L, Krūmiņa A. Treatment of Actinic Keratoses Facilitates Dermatoscopic Diagnosis of Early Basal Cell Carcinoma: A Case Report and Review. Case Rep Dermatol 2019. [DOI: 10.1159/000496329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chronic exposure to ultraviolet radiation induces gradual changes in cutaneous morphology, which with increasing damage leads to the appearance of cancerous skin lesions. Among them, basal cell carcinomas (BCCs) and actinic keratoses (AKs) are the most common entities. Both lesions often develop as two separate lesions in a single individual at a conspicuous distance, close proximity or as collision lesions, which are characterized by the coexistence of both cancers in the same anatomical site. Collision lesions in which AK precisely overlies BCC is a rarely reported entity. We report a case where the presence of BCC was dermatoscopically detected after an overlying AK was treated with topical chemotherapy, thus indicating that treatment of AK allows better visualization of other underlying malignancies.
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Papageorgiou C, Apalla Z, Vakirlis E, Sotiriou E, Ioannides D, Lallas A. Use of Dermoscopy to Diagnose and Select BCCs that can be Treated Empirically. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0215-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Navarrete-Dechent C, Bajaj S, Marchetti MA, Rabinovitz H, Dusza SW, Marghoob AA. Association of Shiny White Blotches and Strands With Nonpigmented Basal Cell Carcinoma: Evaluation of an Additional Dermoscopic Diagnostic Criterion. JAMA Dermatol 2017; 152:546-52. [PMID: 26792406 DOI: 10.1001/jamadermatol.2015.5731] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Basal cell carcinoma (BCC) is the most common type of skin cancer and is usually nonpigmented. Shiny white structures (SWSs) are frequently present in BCC. OBJECTIVE To determine the diagnostic accuracy of various morphologies of SWSs for diagnosis of nonpigmented BCC. DESIGN, SETTING, AND PARTICIPANTS Nonpigmented skin tumors, determined clinically and dermoscopically, were identified from a database of lesions consecutively biopsied over a 3-year period (January 2, 2009, to December 31, 2012) from a single dermatology practice. Data analysis was conducted from October 9, 2014, to November 15, 2015. Investigators blinded to histopathologic diagnosis evaluated the polarized dermoscopic images for the presence of SWSs, which were categorized as blotches, strands, short white lines, and rosettes. Measures of diagnostic accuracy for BCC were estimated. Participants included 2375 patients from a dermatologic clinic in Plantation, Florida. Review of the medical records identified 2891 biopsied skin lesions; 457 of these were nonpigmented neoplasms. MAIN OUTCOMES AND MEASURES Diagnosis of BCC with dermoscopy compared with all other diagnoses combined was the primary outcome; the secondary outcome was diagnosis of BCC compared with amelanotic melanoma. We calculated diagnostic accuracy measured as odds ratios (ORs), sensitivity, and specificity of shiny white blotches and/or strands for the diagnosis of BCC. RESULTS Of the 457 nonpigmented neoplasms evaluated, 287 (62.8%) were BCCs, 106 (23.2%) were squamous cell carcinoma, 39 (8.5%) were lichen planus-like keratosis, 21 (4.6%) were melanomas, and 4 (0.9%) were nevi. The prevalence of SWSs was 49.0% (n = 224). In multivariate analysis (reported as OR [95% CI]) controlling for age, sex, and anatomical location, the presence of any SWS was associated with a diagnosis of BCC (2.3 [1.5-3.6]; P < .001). Blotches (6.3 [3.6-10.9]; P < .001), strands (4.9 [2.9-8.4]; P < .001), and blotches and strands together (6.1 [3.3-11.3]; P < .001) were positively associated with BCC. Shiny white blotches and strands together had a diagnostic sensitivity of 30% and specificity of 91%. CONCLUSIONS AND RELEVANCE The combined presence of shiny white blotches and strands is associated with high diagnostic specificity for nonpigmented BCC.
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Affiliation(s)
- Cristián Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Hauppauge, New York2Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Shirin Bajaj
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Hauppauge, New York3currently a medical student, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Hauppauge, New York
| | | | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Hauppauge, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Hauppauge, New York
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Lallas A, Apalla Z, Ioannides D, Argenziano G, Castagnetti F, Moscarella E, Longo C, Palmieri T, Ramundo D, Zalaudek I. Dermoscopy in the diagnosis and management of basal cell carcinoma. Future Oncol 2015; 11:2975-84. [PMID: 26450622 DOI: 10.2217/fon.15.193] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The dermoscopic findings of basal cell carcinoma (BCC) were first described more than a decade ago and the list of BCC-related criteria has been several times updated and enriched. Today, the dermatoscope is considered the key tool for the diagnosis of BCC, since it allows its early detection and enables its discrimination from other pigmented and nonpigmented skin tumors. The dermoscopic pattern of BCC results from several combinations of well-known BCC criteria, depending on several factors, including histopathologic subtype, location, gender, age and pigmentary trait. In addition, recent evidence highlighted that dermoscopy is also useful in the management of BCC, since it provides information on the tumor subtype, the presence of pigmentation or ulceration and the response to nonablative treatments.
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Affiliation(s)
- Aimilios Lallas
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Zoe Apalla
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | | | - Fabio Castagnetti
- Surgery Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Elvira Moscarella
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Caterina Longo
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Tamara Palmieri
- Radiotherapy Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Dafne Ramundo
- Radiotherapy Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Iris Zalaudek
- Department of Dermatology, Medical University of Graz, Graz, Austria
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Lallas A, Apalla Z, Argenziano G, Longo C, Moscarella E, Specchio F, Raucci M, Zalaudek I. The dermatoscopic universe of basal cell carcinoma. Dermatol Pract Concept 2014; 4:11-24. [PMID: 25126452 PMCID: PMC4131992 DOI: 10.5826/dpc.0403a02] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/08/2014] [Indexed: 11/09/2022] Open
Abstract
Following the first descriptions of the dermatoscopic pattern of basal cell carcinoma (BCC) that go back to the very early years of dermatoscopy, the list of dermatoscopic criteria associated with BCC has been several times updated and renewed. Up to date, dermatoscopy has been shown to enhance BCC detection, by facilitating its discrimination from other skin tumors and inflammatory skin diseases. Furthermore, upcoming evidence suggests that the method is also useful for the management of the tumor, since it provides valuable information about the histopathologic subtype, the presence of clinically undetectable pigmentation, the expansion of the tumor beyond clinically visible margins and the response to non-ablative treatments. In the current article, we provide a summary of the traditional and latest knowledge on the value of dermatoscopy for the diagnosis and management of BCC.
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Affiliation(s)
- Aimilios Lallas
- Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Zoe Apalla
- Dermatology Unit, Medical Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Medical Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Caterina Longo
- Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Elvira Moscarella
- Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Francesca Specchio
- Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Margaritha Raucci
- Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Iris Zalaudek
- Department of Dermatology, Medical University of Graz, Austria
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Lallas A, Argenziano G, Kyrgidis A, Apalla Z, Moscarella E, Longo C, Ferrara G, Piana S, Benati E, Zendri E, Sotiriou E, Zalaudek I. Dermoscopy uncovers clinically undetectable pigmentation in basal cell carcinoma. Br J Dermatol 2014; 170:192-5. [DOI: 10.1111/bjd.12634] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 12/23/2022]
Affiliation(s)
- A. Lallas
- Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Viale Risorgimento 80 42123 Reggio Emilia Italy
| | - G. Argenziano
- Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Viale Risorgimento 80 42123 Reggio Emilia Italy
| | - A. Kyrgidis
- Pathology Unit; Arcispedale Santa Maria Nuova IRCCS; Viale Risorgimento 80 42123 Reggio Emilia Italy
| | - Z. Apalla
- Department of Otolaryngology Head & Neck Surgery; Medical School; Aristotle University; Thessaloniki Greece
| | - E. Moscarella
- Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Viale Risorgimento 80 42123 Reggio Emilia Italy
| | - C. Longo
- Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Viale Risorgimento 80 42123 Reggio Emilia Italy
| | - G. Ferrara
- First Department of Dermatology; Medical School; Aristotle University; Thessaloniki Greece
| | - S. Piana
- State Clinic of Dermatology; Hospital of Venereal and Skin Diseases; Thessaloniki Greece
| | - E. Benati
- Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Viale Risorgimento 80 42123 Reggio Emilia Italy
| | - E. Zendri
- Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Viale Risorgimento 80 42123 Reggio Emilia Italy
| | - E. Sotiriou
- Anatomic Pathology Unit; Department of Oncology; Gaetano Rummo General Hospital; Benevento Italy
| | - I. Zalaudek
- Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Viale Risorgimento 80 42123 Reggio Emilia Italy
- Department of Dermatology; Medical University of Graz; Graz Austria
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Sanchez-Martin J, Vazquez-Lopez F, Perez-Oliva N, Argenziano G. Dermoscopy of Small Basal Cell Carcinoma: Study of 100 Lesions 5 mm or Less in Diameter. Dermatol Surg 2012; 38:947-50. [DOI: 10.1111/j.1524-4725.2012.02358.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kirzhner M, Jakobiec FA. Clinicopathologic and immunohistochemical features of pigmented Basal cell carcinomas of the eyelids. Am J Ophthalmol 2012; 153:242-252.e2. [PMID: 21982104 DOI: 10.1016/j.ajo.2011.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/12/2011] [Accepted: 07/13/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the clinical and microscopic features of pigmented basal cell carcinomas (pBCC) of the eyelid. DESIGN Retrospective observational case series collected at one institution. METHODS An analysis of clinical records, photographs, and histopathologic characteristics of 257 BCCs with a review of the literature. The frequencies of clinically pigmented, and of microscopically pigmented but clinically nonpigmented, BCCs were determined. Cytochemical stains (Fontana-Masson, Prussian blue) and immunohistochemical probes (S-100, microphthalmia-associated transcription factor [MiTF], HMB-45, MART-1, CK20, synaptophysin, chromogranin, CD1a, Ki-67) were then employed and the findings correlated with the degree of clinical pigmentation. RESULTS Histopathologically, 13 of 257 cases (5.06%) were found to have pigment; of these 13, 6 (all white patients) had clinically apparent pigmentation (2.33%), either focal or diffuse. Eight of 13 lesions developed on the lower eyelids. All stained positively for melanin but negatively for iron. MiTF highlighted numerous melanocytic nuclei in the tumor lobules, while MART-1 and HMB-45 revealed the dendritic shapes of the entrapped melanocytes. There was a subtotal blockage of melanin transfer to the surrounding basaloid cells. Intralobular S-100-positive cells included CD1a-positive Langerhans cells, while CK20 did not identify any Merkel cells. CONCLUSIONS Only 1 of 6 lesions was uniformly clinically pigmented, whereas the other 5 were only focally brown-black. The clinical pigmentation was imparted by varying densities and distributions of melanocytes with arborizing dendrites, which were present in all BCCs. Melanophages within the stroma and basaloid cell melanization also contributed to pigmentation. No behavioral or biologic differences in pBCC were documented compared with clinically nonpigmented lesions.
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Affiliation(s)
- Maria Kirzhner
- David G. Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Room 321, 243 Charles St, Boston, MA 02114, USA
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Ro KW, Seo SH, Son SW, Kim IH. Subclinical infiltration of Basal cell carcinoma in asian patients: assessment after mohs micrographic surgery. Ann Dermatol 2011; 23:276-81. [PMID: 21909195 PMCID: PMC3162254 DOI: 10.5021/ad.2011.23.3.276] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 11/23/2010] [Accepted: 11/23/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Several differences in basal cell carcinomas (BCCs) were found, according to the ethnic group; for example, pigmented BCCs was more common in Asian or Hispanic patients. However, there are few reports on the subclinical extension of the BCC in Asian patients. OBJECTIVE The aim of this study was to evaluate the subclinical infiltration of the basal cell carcinoma in Asian patients. METHODS All patients with BCC who visited the department of dermatology at Korea University Ansan Hospital were treated with Mohs micrographic surgery. In 81 patients, 83 tumors of BCC were completely eradicated by Mohs micrographic surgery (MMS) from April 2001 to August 2008, and were reviewed in this study. Information recorded included the total margin and the number of stages of Mohs micrographic surgery, anatomic location, tumor size, presence of pigmentation, clinical type, and pathological subtype. We divided the clinical types into nodular, ulcerated, and pigmented, and the pathological types into nodular, micronodular, morpheaform, and adenoid. The BCC was of pigmented type if pigmentation covered more than 25% of the tumor, regardless of whether pigmentation was distinct, or if there was apparent pigmentation that covered more than 10% of the tumor. RESULTS The nose and cheek were the most common sites requiring more than one stage of surgery. In tumors smaller than 1 cm, 91.7% required only one stage of excision, compared with 60.6% in tumors larger than 1 cm. More than two Mohs stages were required in 25% of non-ulcerated BCCs and in 46.2% of ulcerated BCCs. Sixty eight percent of pigmented BCCs required only one stage of Mohs micrographic surgery. In cases of non-pigmented BCCs, only 45% required one Mohs stage. More than one Mohs stage was required in 19.2% of non-aggressive BCCs and in 42.9% of aggressive BCCs. CONCLUSION Subclinical infiltration differed between the two groups according to the size of the BCC (1 cm threshold) and most of the BCCs were located in the head and neck area. Considering this result, indication for MMS can be extended for BCCs larger than 1 cm in Asian patients. Ulcerated BCCs required more Mohs stages than non-ulcerated BCCs. Pigmented BCCs might show lesser subclinical infiltration than non-pigmented BCCs. Aggressive pathological subtypes showed more subclinical infiltration than the non-aggressive types; however, after evaluation of the border that was excised with MMS, mixed histologic types were found to be more frequent than generally accepted. Therefore, we consider that, when planning surgery, dermatologists should not place too much confidence in the pathologic subtypes identified by biopsy.
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Affiliation(s)
- Ki Woong Ro
- Department of Dermatology, Cheongju St. Mary's Hospital, Cheongju, Korea
| | - Soo Hong Seo
- Department of Dermatology, College of Medicine, Korea University, Seoul, Korea
| | - Sang Wook Son
- Department of Dermatology, College of Medicine, Korea University, Seoul, Korea
| | - Il-Hwan Kim
- Department of Dermatology, College of Medicine, Korea University, Seoul, Korea
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Tiberio R, Valente G, Celasco M, Pertusi G, Veronese F, Bozzo C, Gattoni M, Colombo E. Pigmented basal cell carcinomas in Gorlin syndrome: two cases with different dermatoscopic patterns. Clin Exp Dermatol 2011; 36:617-20. [PMID: 21771005 DOI: 10.1111/j.1365-2230.2010.03987.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We describe two nonconsanguineous white patients with multiple pigmented basal cell carcinomas (BCCs) that were histopathologically confirmed. The first patient had calcification of the cerebral falx, multiple keratocysts in the jaw, and other malformations of the cranial and finger bones. The second patient presented with multiple dermoid cysts, calcification of the cerebral falx, keratocysts of the mandible, and agenesis of left kidney. Both patients had palmar pits. Both denied any family history of cutaneous tumours. On dermatoscopic examination of patient 1, multiple, bluish, confluent and large globules were seen. The second patient had blue ovoid globules, arborizing vessels, and areas shaped like maple leaves and spoke-wheels. Based on the clinical and radiological features we diagnosed both patients as having Gorlin syndrome (GS). To our knowledge, there are no previous reports of white patients with GS showing only pigmented BCCs. The dermatoscopic patterns were different in the two patients, and to our knowledge, this is the first report of a patient with GS showing a spoked-wheel dermatoscopic pattern.
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Affiliation(s)
- R Tiberio
- Dermatological Clinic, University of Piemonte Orientale A. Avogadro, Novara, Italy.
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