Fatal outcome in a metatypical, giant, "horrifying" basal cell carcinoma

Spontaneous Regression of Two Giant Basal Cell Carcinomas in a Single Patient after Incomplete Excision

Background

Spontaneous regression of small basal cell carcinoma has been reported. For giant basal cell carcinoma, however, no spontaneous regression has been described to date.

Case report

We present a patient with two independent giant basal cell carcinomas over the left clavicle and the lower back, measuring 7 × 12 cm and 18 × 20 cm, respectively. Both tumors were excised incompletely (R2) and the patient refused follow-up resections. After 52 and 16 months, respectively, no signs of recurrence were observed.

Conclusion

Incompletely excised giant basal cell carcinomas can regress spontaneously. A watch-and-wait approach after incomplete resection may be pragmatic to avoid mutilating follow-up resections in patients refusing further surgery.

Metatypical basal cell carcinoma: a clinical review

Background

Metatypical cell carcinoma can be considered as a new entity of skin cancer, being an intermediate typology between basal cell carcinomas and squamous cell carcinomas. The behaviour of the metatypical cell carcinoma lies between these two varieties of skin cancer. It is difficult to perform a differential diagnosis based on morphological and clinical features – therefore it is only possible by accurate histology.

Methods

The authors have retrospectively analysed clinical records of 240 patients who were affected by metatypical skin cancer and who were treated by surgery, radiotherapy and chemotherapy.

Results

MTC affected more males than females (62.5% vs 37.5%) than males. The most affected site was the cervicofacial area, 71.7%; then the trunk, 10%; the limbs, 9.6%; the scalp 3.7%; and other regions 5%. A recurrence occurred in 24 cases (10%), mainly in head and neck area.

Conclusion

In this manuscript, the authors have emphasised the importance of conducting a differential diagnosis, and the importance of the specific treatment for metatypical skin cancer, even though more clinical studies and long-term follow-ups are required before establishing specific guidelines.

Giant basal cell carcinoma of the thoracic wall: a case report and review of the literature

Giant basal cell carcinoma is a rare skin tumour with aggressive biological behaviour, and deep invasion and metastasis have been reported. The authors describe a giant basal cell carcinoma involving the anterior chest wall. The lesion infiltrated the mediastinum, occluding the left brachiocephalic vein. Vascular invasion caused venous occlusion affecting the left upper limb. Neither surgical treatment nor radiotherapy were practicable.

Evaluation of basement membrane status in aggressive skin carcinomas with skull base invasion: a case-control study

Some skin carcinomas may be very aggressive. Breached of basement membrane (BM) has been in some situations associated with tumor aggressiveness. In this study, the status of BM in invasion was evaluated in basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) with skull base invasion, and it was compared with tumor's good outcome. Integrity or breached of BM was visualized using immunohistochemistry technique with anti-type IV collagen antibody. The pattern of BM was classified as intact, breached, or absent in 24 BCCs and 11 SCCs with skull base invasion. Control group (good outcome) included 23 BCCs and 10 SCCs. Breached BM and absence of BM were respectively noted in 33.33% and 45.83% of BCCs with skull base invasion, compared with 8.33% and 17.395% in the control group ( P < .001). Regarding SCCs, ruptured and absent BMs were, respectively, noted in 36.36% and 63.64% of BCCs with skull base invasion, compared with 30% and 30% in the control group ( P = .075). In this study, destruction of BM was significantly more common in BCCs with skull base invasion, in comparison with those with good outcome. In SCC, this difference was not statistically significant.

Angiogenesis and skin carcinomas with skull base invasion: a case-control study

BACKGROUND

Some skin carcinomas may be very aggressive. Intensity of angiogenesis, measured by intratumoral vessel density using expression of CD34, has been associated with tumor aggressiveness. In this study, the expression of CD34 in basal cell carcinomas ( BCCs) and squamous cell carcinomas (SCCs) with skull base invasion was compared with that in tumors with good outcome.

METHODS

Expression of CD34 was graded as mild, moderate, and intense, in 24 BCCs and 11 SCCs with skull base invasion. The control group included 23 BCCs and 10 SCCs.

RESULTS

Intense expression of CD34 was noted in 25.00% of BCCs with skull base invasion, compared with 4.35% in the control group (p =.058). Regarding SCCs, intense expression of CD34 was found in 54.55% of aggressive tumors, compared with 10.00% in the control group (p =.133).

CONCLUSIONS

A trend toward denser microvascular angiogenesis was observed in both BCCs and SCCs with skull base invasion compared with less aggressive controls.

Basosquamous carcinoma

BACKGROUND

Basosquamous carcinoma (BSC) is a rare cutaneous tumor that has been poorly described in the dermatologic literature. It has been depicted as an aggressive tumor with a high incidence of distant metastasis.

OBJECTIVE

To examine the average extent of local tissue invasion and presence of distant metastases in cases of BSC compared with those of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

METHODS

One thousand consecutive Mohs surgery cases performed between January 1993 and May 1995 at the Oschner Clinic in New Orleans, Louisiana, for histologically confirmed BCC, SCC, and BSC were reviewed. Each case was retrospectively evaluated for tumor type, anatomic location, number of Mohs stages performed, and presence of metastases at the time of surgery, as determined by chest radiograph.

RESULTS

Seven hundred forty-five BCCs, 228 SCCs, and 27 BSCs (1,000 tumors total) were treated in 580 patients. The average number of stages required for clear margins in cases of BCC, SCC, and BSC was 1.62, 1.51, and 2.00, respectively. The prevalence of metastasis was 0.87% for SCC and 7.4% for BSC, which was statistically significant (P<0.001).

CONCLUSION

In this retrospective study, BSCs displayed tissue invasion similar to that of BCC or SCC but had a higher frequency of pulmonary metastasis than SCC.

Giant basal cell carcinoma affecting the lower abdominal, genital and bilateral inguinal regions

We describe a giant basal cell carcinoma, measuring 40 cm x 20 cm, of the lower abdominal, genital and bilateral inguinal regions. The rectus abdominis muscle and the adductor magnus muscle were exposed centrally, and the penis and scrotum were completely destroyed. Reconstruction was performed with a fillet thigh flap, and an excellent result was obtained 1 year after surgery.

Cellular proliferation characteristics do not account for the behaviour of horrifying basal cell carcinoma. A comparison of the growth fraction of horrifying and non horrifying tumours

This study compared the clinical features, histological subtype, growth fraction (by Ki67 immunohistochemistry) and proliferation pattern of 22 clinically defined horrifying basal cell carcinoma compared to 81 non horrifying lesions. Late presentation was associated with half of the horrifying tumours. The other half developed horrifying tumours despite early intervention. The horrifying tumours exhibited a variety of histological growth patterns. A total of 50% were infiltrative, 23% nodular and 18% micronodular. There was no difference in the growth fraction or proliferation pattern between horrifying and non horrifying tumours of similar growth pattern (P = ns), although infiltrative tumours in either group exhibited a significantly higher growth fraction than nodular tumours (P < 0.01). This suggests that there is no intrinsic biological difference between horrifying and non horrifying tumours to account for their behaviour. We conclude that late presentation, failed or inadequate early management especially of infiltrative tumours (and other subtypes) determines the development of horrifying tumours.

Giant basal cell carcinoma (T3). Who is at risk?

BACKGROUND

Giant basal cell carcinomas can cause extensive local invasion and disfigurement. This study determines in whom giant basal cell carcinomas develop.

METHODS

Fifty patients with giant basal cell carcinomas (over 5 cm, T3) were compared with other groups of patients with small (< 2 cm, T1) or intermediate-sized (2-5 cm, T2) basal cell carcinomas. The patients were treated at the Mayo Clinic between August 1986 and December 1990.

RESULTS

Characteristics that were more common in giant basal cell carcinomas than in smaller lesions were duration, patient neglect, recurrence after previous treatment, aggressive histologic pattern, and history of radiation exposure.

CONCLUSIONS

Patients who have a basal cell carcinoma with an aggressive histologic subtype, a recurrence after previous treatment, a history of radiation exposure, or a history of neglect are at risk for giant basal cell carcinoma.

Metastatic basal cell carcinoma: response to chemotherapy

Basal cell carcinoma is a common cutaneous neoplasm that rarely metastasizes. Unfortunately, there is little effective treatment available when metastasis does occur. Therefore potentially promising therapies for metastatic basal cell carcinoma should be reported. We report a case of basal cell carcinoma metastatic to bone, bone marrow, and the pleural cavity in a 51-year-old woman who showed a striking, albeit brief, response to treatment with a combination of cisplatin, bleomycin, methotrexate, and 5-fluorouracil.