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Baker LX, Grilletta E, Zwerner JP, Boyd AS, Wheless L. Clinical and Histopathologic Characteristics of Metastatic and Locally Advanced Cutaneous Basal Cell Carcinomas. Am J Dermatopathol 2021; 43:e169-e174. [PMID: 34001746 PMCID: PMC8595339 DOI: 10.1097/dad.0000000000001985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Locally advanced or metastatic basal cell carcinomas (laBCCs or mBCCs) are rare, with few case series providing information on their epidemiology. We aimed to describe the clinical and histologic features of locally advanced and metastatic basal cell carcinomas. Forty cases of laBCC or mBCC were identified by searching Vanderbilt's database from 1984 to January 2019. A retrospective chart review was performed. Pathology slides were available for 23 cases (13 mBCCs and 10 laBCCs). Twenty-one of 23 cases were Clark level IV or V, with a mean depth of invasion of >7 mm for both types. The mean mitotic rate was 4.4 mitoses/mm2 for laBCCs and 3.3 mitoses/mm2 for mBCCs. Ulceration was identified in 7 laBCC and 8 mBCC cases. Perineural invasion was present in 2 laBCC and 6 mBCC cases, with 3 mBCCs invading nerves >0.1 mm. Of 13 mBCC cases, histologic subtypes included infiltrative (n = 9), nodular (n = 7), morpheaform (n = 4), and superficial (n = 2), with multiple patterns present in some specimens. 10 of 13 patients with mBCC had local recurrence before metastasis. In summary, we identified several potential markers of high-risk BCC, including perineural invasion, deep invasion, elevated mitotic rate, and local recurrence of the primary tumor.
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Affiliation(s)
- Laura X. Baker
- Department of Dermatology, Vanderbilt University Medical Center, Nashville TN
| | - Erica Grilletta
- Department of Dermatology, Vanderbilt University Medical Center, Nashville TN
| | - Jeffrey P Zwerner
- Department of Dermatology, Vanderbilt University Medical Center, Nashville TN
| | - Alan S Boyd
- Department of Dermatology, Vanderbilt University Medical Center, Nashville TN
| | - Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville TN
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2
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Metastatic Basal Cell Carcinoma of the Skin: A Comprehensive Literature Review, Including Advances in Molecular Therapeutics. Adv Anat Pathol 2020; 27:331-353. [PMID: 32618586 DOI: 10.1097/pap.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. In Europe, the incidence of BCC ranges from 44.6 to 128 cases per 100,000 inhabitants annually, whereas in the United States, the yearly incidence rate ranges between 500 and 1500. The global incidence has been calculated to be as high as 10 million cases of BCC per year. There are 2 main clinical patterns of BCC-the familial BCC in basal cell nevus syndrome and sporadic BCC. The etiology of cutaneous BCC is usually the result of the interaction between solar ultraviolet radiation and genetic factors. Somatic or germline mutations in the effector components of the hedgehog signaling pathway (ie, PTCH1, PTCH2, SMO or SUFU genes) are responsible for ∼90% of the cases of both sporadic and familial BCC, all causing a constitutive activation of the hedgehog pathway. Cutaneous BCC very rarely metastasizes, and diagnosis in metastatic sites can be very difficult. Metastatic BCC has weakly effective therapeutic options with a poor prognosis until few years ago. In 2012, small-molecule therapies, involving inactivation of the hedgehog signaling pathway, and capable of reducing tumor growth and progression have been introduced into clinical practice for advanced (locally advanced or metastatic) BCC. We performed a comprehensive literature review on metastatic BCC and found at least 915 cases reported to date. In addition, we extensively discussed the differential diagnosis of metastatic BCC, and outlined the advances in clinical therapeutics involving these small molecules.
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Furlan K, Reddy V, Alabkaa A, Rohra P, Mir F, Gattuso P. Metastatic head and neck cutaneous basal cell carcinomas: a retrospective observational study. Arch Dermatol Res 2020; 313:439-443. [PMID: 32776227 DOI: 10.1007/s00403-020-02120-y] [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: 05/04/2020] [Revised: 07/07/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Abstract
Cutaneous basal cell carcinoma is usually an indolent and slow-growing tumor with potential for local invasion and recurrence; however, metastatic events are exceedingly rare. The annual incidence of metastasis is estimated to range between 0.00281 and 0.05%. A retrospective search in the pathology database of a single tertiary institution was performed in the period between 1999 to 2019. Primary cutaneous metastatic basal cell carcinomas had paraffin blocks and glass slides retrieved. A total of 8673 cases was identified. The overall prevalence of metastatic tumors was 0.05% (4/8673). The median patient's age at diagnosis was 61 years old (range 52-79). The most common primary site of tumor was nose (2/4) and the most common histological subtype was infiltrative. The sampled lymph nodes were identified during primary tumor resection, except for 1 patient who had a sentinel lymph node biopsy performed as a surgeon individual decision. One patient had hematogenous spread to the pleura, diagnosed 5 years after diagnosis. In summary, this study adds new data to the current literature in metastatic primary cutaneous basal cell carcinomas and highlights the importance of early diagnosis and appropriate surgical excision in an effort to prevent local advanced disease, recurrence and lymphovascular dissemination.
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Affiliation(s)
- Karina Furlan
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA.
| | - Vijaya Reddy
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA
| | - Anas Alabkaa
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA
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4
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Cantwell P. Pretibial metastatic basal cell carcinoma. Med J Aust 2019; 212:108-108.e1. [PMID: 32062857 DOI: 10.5694/mja2.50441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Laga AC, Schaefer IM, Sholl LM, French CA, Hanna J. Metastatic Basal Cell Carcinoma. Am J Clin Pathol 2019; 152:706-717. [PMID: 31355851 DOI: 10.1093/ajcp/aqz089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Diagnosis of metastatic basal cell carcinoma (BCC) remains challenging, in part due to its rarity. With the advent of molecularly targeted therapies, recognition of this entity is more important than ever. METHODS We identified 11 cases of metastatic BCC over a 13-year period. We analyzed these tumors in conjunction with their respective primary tumors by histomorphologic, immunohistochemical, and molecular genetic analyses. RESULTS We identified three morphologic patterns of metastasis in BCC. The most common (seven cases) was characterized by completely typical features of BCC. Two cases showed marked squamous differentiation within BCC. The final two cases showed exclusively features of a poorly differentiated carcinoma. One of these was definitively classified by molecular analysis, as both the primary and metastatic tumors harbored the same inactivating PTCH1 mutation. CONCLUSIONS This study illustrates multiple distinct morphologic patterns in metastatic BCC and highlights the utility of ancillary molecular testing for accurate diagnosis.
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Affiliation(s)
- Alvaro C Laga
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Inga Marie Schaefer
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Christopher A French
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - John Hanna
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Day DL, Chakari W, Matzen SH. Malignant transformation of a non-healing traumatic wound on the lower extremity: A case report. Int J Surg Case Rep 2018; 53:468-470. [PMID: 30567071 PMCID: PMC6275160 DOI: 10.1016/j.ijscr.2018.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/28/2022] Open
Abstract
It is important to exclude malignancy in chronic wounds. Change in wound characteristic should be investigated with a biopsy. Marjolin’s ulcer refers most commonly to squamous cell carcinoma arising in scar tissue. Basal cell carcinoma, sarcoma and melanoma are also described in Marjolin’s ulcers.
Objective: Malignant transformation of chronic non-healing wounds is often overlooked. If a chronic wound fails to heal, or if there are changes in the characteristics of a wound, a biopsy should be performed. Methods: This case is presented in line with SCARE guidelines. Presentation of case: We present a case of a man with a non-healing traumatic wound over two years in which a basal cell carcinoma was diagnosed by biopsy. The basal cell carcinoma was radically excised and the defect was closed using a split thickness skin transplant. Discussion: The term Marjolin’s ulcer, pathophysiology and recommended treatment. Conclusion: Delayed diagnosis of malignancy in chronic wounds can lead to a worsened prognosis and therefore it is important to exclude a malignant aetiology. Malignant transformation of chronic wounds is not common but Marjolin's ulcer should be considered.
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Affiliation(s)
- Deborah-Leigh Day
- Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
| | - Wahida Chakari
- Department of Plastic, Reconstructive and Burns Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Steen Henrik Matzen
- Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark
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Metastatic Basal Cell Carcinoma: A Rare Manifestation of a Common Disease. Case Rep Med 2017; 2017:8929745. [PMID: 29279714 PMCID: PMC5723960 DOI: 10.1155/2017/8929745] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 10/10/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Basal cell carcinoma (BCC) is considered the most common malignancy in Caucasians. It constituted about 80% of all nonmelanoma skin tumors and, despite its high prevalence, is an extremely rare occurrence of metastases, with incidence rates varying from 0.0028% to 0.55%. Case Report A 58-year-old male patient with BCC on the left nasolabial sulcus for 17 years, reporting 3 previous excisions, evolved with local recurrence. A new procedure was performed, and anatomopathological study confirmed sclerosing BCC. Seven months later, he presented with a mass in the left submandibular region. Combined positron-emission tomography and computed tomography (PET-CT) showed cervical hypercaptation in the left cervical level I and vertebral body of L5. Excision of the cervical lesion was performed with diagnosis of sclerosing BCC compromising the submandibular gland. Biopsy of the lumbar lesion was found to be compatible with bone metastasis. Conclusion BCC represents a very common entity, and the presence of metastasis, although infrequent, must be proposed because of the greater morbidity and mortality of this complication. This case shows the importance of early diagnosis and intervention in BCC as a way to avoid unfavorable outcomes.
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9
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Jawad SN, Abdullah BH. Ameloblastoma vs basal cell carcinoma: an immunohistochemical comparison. Ann Diagn Pathol 2016; 25:79-84. [PMID: 27806852 DOI: 10.1016/j.anndiagpath.2016.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite behavioral mimicry of ameloblastoma (AB) and basal cell carcinoma (BCC), they are classified at 2 extremes within pertinent WHO classifications with respect to benign and malignant designation. This study aims to appraise the current allocation of AB in the classification through an immunohistochemical comparison of some aspects of behavior with BCC. Sections from retrospectively retrieved formalin-fixed, paraffin-embedded tissue blocks of AB (n = 37) and BCC (n = 34) were comparatively examined for the immunohistochemical expression for Ki-67, Bcl-2, MMP-2, MMP-9, CD31, and D2-40 monoclonal antibodies. No statistically significant differences between the tumors were found regarding the immunoexpressions of Bcl-2 (P = .252), CD31 microvessel density (P = .895), lymphatic vessel density (P = .642), and MMP-9 stromal expression (P = .083). MMP-2 expression was significantly higher in epithelial and stromal regions of AB (P = .009 and P = .001, respectively), whereas Ki-67 and MMP-9 epithelial expressions were significantly higher in BCC (P < .000 and P = .026, respectively). Within the studied immunohistochemical attributes for tumor behavior, the study accentuated the overall behavioral mimicry of the tumors and indicated that BCCs surmount ABs by the proliferative rate only.
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Affiliation(s)
- Salam N Jawad
- Oral pathology, College of Dentistry, Baghdad University, Baghdad, Iraq.
| | - Bashar H Abdullah
- Professor of Oral pathology, College of Dentistry, Baghdad University, Baghdad, Iraq
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10
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Aydin D, Hölmich LR, Jakobsen LP. Metastatic basal cell carcinoma caused by carcinoma misdiagnosed as acne - case report and literature review. Clin Case Rep 2016; 4:601-4. [PMID: 27398205 PMCID: PMC4891487 DOI: 10.1002/ccr3.575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/24/2016] [Accepted: 04/15/2016] [Indexed: 11/17/2022] Open
Abstract
Basal cell carcinoma can be misdiagnosed as acne; thus, carcinoma should be considered in treatment-resistant acne. Although rare, neglected basal cell carcinoma increases the risk of metastasis.
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Affiliation(s)
- Dogu Aydin
- Department of Plastic and Reconstructive SurgeryHerlev‐Gentofte HospitalCopenhagen University HospitalCopenhagenDenmark
| | - Lisbet Rosenkrantz Hölmich
- Department of Plastic and Reconstructive SurgeryHerlev‐Gentofte HospitalCopenhagen University HospitalCopenhagenDenmark
| | - Linda P. Jakobsen
- Department of Plastic and Reconstructive SurgeryHerlev‐Gentofte HospitalCopenhagen University HospitalCopenhagenDenmark
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11
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Two Basal cell carcinomas of the axillae: a metastasis or an independent development? Case Rep Dermatol Med 2015; 2015:637292. [PMID: 25861487 PMCID: PMC4377369 DOI: 10.1155/2015/637292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/08/2015] [Indexed: 11/25/2022] Open
Abstract
Cutaneous basal cell carcinoma (BCC) is a common malignancy amongst the elderly. BCC rarely metastasises, and fewer than 300 cases of metastatic BCC have been reported in the literature. Here, we report a case of sequentially developed BCCs located adjacent to each other. We discuss that these BCCs were considered to have developed independently rather than due to metastasis, after referencing previous studies on metastatic BCC.
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12
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Abstract
BACKGROUND Parotid involvement by basal cell carcinoma (BCC) is rare, and therefore management is controversial. OBJECTIVE To review the treatment and outcomes of patients with BCC involving the parotid by direct infiltration. METHODS AND MATERIALS The authors performed a retrospective chart review of BCC cases involving the parotid. RESULTS From 1994 to 2007, there were 19 cases of BCC involving the parotid gland by direct extension. Nine were primary tumors, and 10 recurrent (nonprimary). Eight tumors were treated with Mohs micrographic surgery (MMS), and 11 with wide local excision (WLE). One patient died of unrelated causes 5 months after treatment, and 2 did not follow up. The remaining 16 cases had an average follow-up of 55.2 months (range, 18-112 months). No primary BCC recurred after treatment. Six of 10 nonprimary BCC (60%) recurred, 2 of 10 metastasized, and 1 of 10 died of metastatic BCC. Two recurrences occurred after MMS, and 4 occurred after WLE with or without parotidectomy. CONCLUSION Mohs micrographic surgery or WLE with intra-operative margin control seems to be an acceptable first-line treatment for primary BCC involving the parotid. Recurrent BCC involving the parotid gland through direct infiltration has high rates of future recurrence, and adjuvant treatment may be required.
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13
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Lear JT, Corner C, Dziewulski P, Fife K, Ross GL, Varma S, Harwood CA. Challenges and new horizons in the management of advanced basal cell carcinoma: a UK perspective. Br J Cancer 2014; 111:1476-81. [PMID: 25211660 PMCID: PMC4200081 DOI: 10.1038/bjc.2014.270] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 02/24/2014] [Accepted: 04/02/2014] [Indexed: 02/06/2023] Open
Abstract
Basal cell carcinoma (BCC) is a common malignancy with a good prognosis in the majority of cases. However, some BCC patients develop a more advanced disease that poses significant management challenges. Such cases include locally advanced, recurrent or metastatic BCC, or tumours that occur in anatomical sites where surgical treatment would result in significant deformity. Until recently, treatment options for these patients have been limited, but increased understanding of the molecular basis of BCC has enabled potential therapies, such as hedgehog signalling pathway inhibitors, to be developed. A clear definition of advanced BCC as a distinct disease entity and formal management guidelines have not previously been published, presumably because of the rarity, heterogeneity and lack of treatment options available for the disease. Here we provide a UK perspective from a multidisciplinary group of experts involved in the treatment of complex cases of BCC, addressing the key challenges associated with the perceived definition and management of the disease. With new treatments on the horizon, we further propose a definition for advanced BCC that may be used as a guide for healthcare professionals involved in disease diagnosis and management.
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Affiliation(s)
- J T Lear
- MAHSC, Manchester Royal Infirmary, The University of Manchester, 46 Grafton Street, Oxford Road, Manchester M13 9NT, UK
| | - C Corner
- Mount Vernon Cancer Centre, Mount Vernon Hospital, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - P Dziewulski
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Broomfield, Chelmsford, Essex CM1 7ET, UK
| | - K Fife
- Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - G L Ross
- Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK
| | - S Varma
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK
| | - C A Harwood
- Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK
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14
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Kraft S, Granter SR. Molecular pathology of skin neoplasms of the head and neck. Arch Pathol Lab Med 2014; 138:759-87. [PMID: 24878016 DOI: 10.5858/arpa.2013-0157-ra] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Skin neoplasms include the most common malignancies affecting humans. Many show an ultraviolet (UV)-induced pathogenesis and often affect the head and neck region. OBJECTIVE To review literature on cutaneous neoplasms that show a predilection for the head and neck region and that are associated with molecular alterations. DATA SOURCES Literature review. CONCLUSIONS Common nonmelanoma skin cancers, such as basal and squamous cell carcinomas, show a UV-induced pathogenesis. Basal cell carcinomas are characterized by molecular alterations of the Hedgehog pathway, affecting patched and smoothened genes. While squamous cell carcinomas show UV-induced mutations in several genes, driver mutations are only beginning to be identified. In addition, certain adnexal neoplasms also predominantly affect the head and neck region and show interesting, recently discovered molecular abnormalities, or are associated with hereditary conditions whose molecular genetic pathogenesis is well understood. Furthermore, recent advances have led to an increased understanding of the molecular pathogenesis of melanoma. Certain melanoma subtypes, such as lentigo maligna melanoma and desmoplastic melanoma, which are more often seen on the chronically sun-damaged skin of the head and neck, show differences in their molecular signature when compared to the other more common subtypes, such as superficial spreading melanoma, which are more prone to occur at sites with acute intermittent sun damage. In summary, molecular alterations in cutaneous neoplasms of the head and neck are often related to UV exposure. Their molecular footprint often reflects the histologic tumor type, and familiarity with these changes will be increasingly necessary for diagnostic and therapeutic considerations.
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Affiliation(s)
- Stefan Kraft
- From the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (Dr Kraft); and the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Granter)
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Kurian RR, Di Palma S, Barrett AW. Basal cell carcinoma metastatic to parotid gland. Head Neck Pathol 2013; 8:349-53. [PMID: 24234479 PMCID: PMC4126929 DOI: 10.1007/s12105-013-0507-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/05/2013] [Indexed: 11/25/2022]
Abstract
Metastasis from basal cell carcinoma of the skin is very rare with cases being documented in the lymph nodes, lung, bone and parotid gland. The main histopathological differential diagnosis is the locally arising basal cell adenocarcinoma from which it is difficult to distinguish by morphology and routine immunohistochemistry. Approximately 85 % of all reported metastatic basal cell carcinomas arise in the head and neck region. Here we present a case of basal cell carcinoma of the skin of the left lateral canthus of the eye which metastasized to the intraparotid lymph nodes with infiltration of the adjacent parotid parenchyma. More awareness and vigilance is required on the part of the reporting pathologist to consider metastasis in the presence of a parotid tumour. Features favouring metastasis include history of primary cutaneous basal cell carcinoma, histological similarity to the primary lesion and absence of any demonstrable direct extension from the skin lesion. We also review the literature on metastatic basal cell carcinoma and discuss the need for adequate follow up in high risk patients.
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Affiliation(s)
- Rinsey Rose Kurian
- Department of Histopathology, Royal Surrey County Hospital (RSCH), Guildford, UK
| | - Silvana Di Palma
- Department of Histopathology, Royal Surrey County Hospital (RSCH), Guildford, UK ,Division of Clinical Medicine, University of Surrey, Guildford, UK
| | - A. W. Barrett
- Department of Histopathology, Queen Victoria Hospital, East Grinstead, UK
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Abstract
BACKGROUND Basal cell carcinoma (BCC) is an extremely common malignancy. Unlike other skin cancers, it very rarely metastasises. METHODS We present two cases of advanced BCC on the eyelids that metastasized to the parotid region after local excision. DISCUSSION We include a review of patients with metastatic BCC originating from the eyelids. CONCLUSION Metastatic BCC from the eyelids is rare, but appears to occur in an older age group with a shorter time before metastasis when compared to metastatic BCC as a whole.
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Affiliation(s)
- Andre S Litwin
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, UK
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17
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Thiele OC, Mertens C, Bacon C, Flechtenmacher C, Zaoui K, Mischkowski RA. Facial basal cell carcinoma with successive metastases to the neck, thyroid gland and lung. J Craniomaxillofac Surg 2013; 42:489-91. [PMID: 23849247 DOI: 10.1016/j.jcms.2013.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 11/30/2022] Open
Abstract
Basal cell carcinoma of the skin is the most common malignancy in the head and neck area. Regional and distant metastases rarely occur with this type of tumour. We report an uncommon case of a sclerodermiform basal cell carcinoma of the facial skin in which metastases developed several years after the primary tumour. The metastases occurred in the soft tissue of the neck, the thyroid gland and the lung. This is the first case of BCC with triple metastases which were histologically confirmed.
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Affiliation(s)
- Oliver C Thiele
- Department of Oral, Maxillofacial and Facial Plastic Surgery (Head: Prof. Robert Mischkowski), Ludwigshafen Hospital, Bremserstrasse 79, 67063 Ludwigshafen am Rhein, Germany.
| | - Christian Mertens
- Department of Oral and Maxillofacial Surgery (Head: Prof. Jürgen Hoffmann), University Hospital Heidelberg, INF 400, Heidelberg, Germany
| | - Claire Bacon
- Department of Human Genetics (Head: Prof. Gudrun Rappold), Molecular Genetics Division, University Hospital Heidelberg, INF 366, Heidelberg, Germany
| | - Christa Flechtenmacher
- Institute of Pathology (Head: Prof. Peter Schirmacher), University Hospital Heidelberg, INF 224, Heidelberg, Germany
| | - Karim Zaoui
- Department of Otolaryngology, Head and Neck Surgery (Head: Prof. Peter Plinkert), University Hospital Heidelberg, INF 400, Heidelberg, Germany
| | - Robert A Mischkowski
- Department of Oral, Maxillofacial and Facial Plastic Surgery (Head: Prof. Robert Mischkowski), Ludwigshafen Hospital, Bremserstrasse 79, 67063 Ludwigshafen am Rhein, Germany
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Fernández-Figueras M, Puig L. Dermatopathology Update. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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Dermatopathology update. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:204-11. [PMID: 23273924 DOI: 10.1016/j.ad.2012.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 12/27/2022] Open
Abstract
This past year has seen a wealth of new developments in dermatopathology that appear to herald the dawning of a new era. Advances in molecular biology and the simplification of techniques have put molecular tests within reach of routine clinical practice and led to a radical change in our approach to lesions such as melanoma; in the future, the genetic characterization of these lesions will be an essential requirement for establishing diagnosis, prognosis, and therapy. Technological innovations have also reached dermatology departments: the introduction of ultrasound scans has propitiated the use of fine-needle aspiration cytology, which allows samples to be stained and studied immediately, thereby facilitating diagnosis of superficial and lymph-node lesions, and allowing staging of tumors such as melanoma. Targeted cancer therapies have led to the introduction of more sensitive and specific systems for identifying new targets, have reawakened interest in forgotten diseases such as aggressive basal cell carcinoma, and have led to dermatological reactions that, together with those caused by biologic drugs, we are just beginning to recognize. Consolidated techniques such as immunohistochemistry continue to advance with the addition of new antibodies that contribute considerably to improved diagnosis. New clinicopathologic diseases have also been described or characterized this year, including 2 new types of melanoma, and progress has been made in our knowledge of other diseases, such as primary cutaneous CD4(+) small/medium-sized pleomorphic T-cell lymphoma. These topics, together with new developments in adnexal tumors, alopecia, and other lesions, will be discussed in this review.
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Tsatsou F, Trakatelli M, Patsatsi A, Kalokasidis K, Sotiriadis D. Extrinsic aging: UV-mediated skin carcinogenesis. DERMATO-ENDOCRINOLOGY 2012; 4:285-97. [PMID: 23467430 PMCID: PMC3583890 DOI: 10.4161/derm.22519] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Age-associated skin lesions linked to UV radiation (UVR) include actinic keratosis, non-melanoma skin cancer-such as basal cell carcinoma and squamous cell carcinoma-lentigo senilis and lentigo maligna. Their incidence is increasing worldwide, mainly due to exaggerated UV exposure and to an aging population. Early diagnosis and therapy of pre-malignant cutaneous lesions is crucial for the secondary prophylaxis of invasive and highly aggressive skin cancers. Combined efforts to increase public awareness, patient education about self-examination, prophylactic modalities, such as consistent and sufficient UV protection, and rigorous follow-up of high-risk groups are of highest importance.
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Affiliation(s)
- Fragkiski Tsatsou
- Second Department of Dermatology and Venereology; Papageorgiou Hospital; Aristotle University School of Medicine; Thessaloniki, Greece
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