Basal cell carcinoma: 10 years of experience

Use of preoperative and perioperative ex vivo dermoscopy for precise mapping of margins for standard surgical excision of primary basal cell carcinoma

Background The utility of preoperative and perioperative dermoscopy in standard surgical excision for radical excision of primary basal cell carcinoma remain unexplored. Aims To evaluate the use of preoperative and perioperative dermoscopy for precise mapping of margins during standard surgical excision of primary basal cell carcinoma. Methods In this retrospective, observational study, 17 patients clinically diagnosed with various morphological subtypes of basal cell carcinoma were included. Data about previous history, clinical examination of lesions and regional lymph nodes and preoperative dermoscopy were retrieved. After standard surgical excision had been carried out as per mapping of lateral margins, all the excised surgical specimens were subjected to perioperative dermoscopy and later reconfirmed with histopathology. Results Seventeen patients with mean age of 60.82 ± 9.99 years and median disease duration of 14 months were analysed. Clinically, basal cell carcinomas were of pigmented superficial subtype [6 (35.3%)], followed by pigmented nodular [5 (29.4%)], nodulo-ulcerative [4 (23.5%)] and micro nodular [2 (11.8%)]. Mean extension of clinical margin after dermoscopy was 0.59 ± 0.52 mm. Mean pre-assessed depth of tumour and mean depth of tumour were 3.46 ± 0.89 mm and 3.49 ± 0.92 mm, respectively. No recurrence was reported. Frequently found pre-operative dermoscopic features were maple leaf like structures [6 (35%)], blue grey dots and globules [6 (35%)] and short fine telangiectasias [6 (35%)]. Commonly observed perioperative dermoscopic features were: (1) irregular band with brown-grey pigmentation of dots, globules, streaks and pseudopodia like extensions [3 (50%)]; (2) irregular band of pseudo granulomatous structureless vascular areas in psoriasiform pattern with diffuse white streaks in pseudopodia like manner [1 (50%)]; (3) irregular band of pseudo granulomatous structureless vascular areas in psoriasiform pattern with streaks of white pseudopodia like structureless areas [1 (50%)]. Limitation This was a single-centre study with a small sample size. Conclusion This study highlights significance of preoperative and perioperative dermoscopy for precise planning and radical excision of primary basal cell carcinoma by standard surgical excision.

Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer

Simple Summary

Although significant progress in pharmacotherapy for skin cancer has been made in the past several years, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgeries including lymph node dissection and skin graft can cause various complications, and these complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.

Abstract

Despite the significant progress made in the past several years in pharmacotherapies for skin cancer, such as BRAF/MEK inhibitors, immune checkpoint inhibitors, and Hedgehog pathway inhibitors, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In cases of lymph node metastases with clinically palpable lymphadenopathy, lymph node dissection (LND) is typically performed for most skin cancers. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgery can cause various complications. Although skin graft is frequently used for reconstruction of the surgical defect, extensive graft necrosis may develop if optimal stabilization of the graft is not obtained. LND also sometimes causes complications such as intraoperative or postoperative bleeding and postoperative lymphoceles. Moreover, as in other types of surgery, surgical site infection, intraoperative anxiety, and intraoperative and postoperative pain may also develop. These complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.

Risk Factors and Clinicopathological Features for Developing a Subsequent Primary Cutaneous Squamous and Basal Cell Carcinomas

BACKGROUND

Patients with diagnosed keratinocyte carcinomas (KCs) have an increased risk of subsequent skin cancers development. Current studies indicate that patients with subsequent tumors should be followed up regularly. However, none of the studies indicate the connection between the specific subtypes and an increased risk for further KCs development. The study assesses the differences in the risk of developing a subsequent skin cancer after a previous diagnosis of KC, especially considering individual types of skin malignances, and identifies potential factors associated with an increased risk of new cutaneous tumor describing non-invasive diagnosis and monitoring.

METHODS

Pathology and medical records were examined to identify the characteristics of patients with multiple KCs diagnosed between 1999 and 2019.

RESULTS

The study group comprised 13,913 KCs occurring in 10,083 patients. Multiple KCs were observed in 2300 patients (22.8%). The analysis showed aggressive subtypes, multiple tumors, and male sex as significant prognostic factors.

CONCLUSIONS

The most crucial risk factors for developing subsequent KC are being of a male gender, an aggressive tumor subtype, and previous history of multiple skin cancers. Basal cell carcinoma subtypes, such as infiltrative basosquamous, with aggressive growth patterns predispose not only to increased risk for the recurrence but are also expected to be at higher risk of subsequent KCs.

Numerical Simulation of Enhancement of Superficial Tumor Laser Hyperthermia with Silicon Nanoparticles

Biodegradable and low-toxic silicon nanoparticles (SiNPs) have potential in different biomedical applications. Previous experimental studies revealed the efficiency of some types of SiNPs in tumor hyperthermia. To analyse the feasibility of employing SiNPs produced by the laser ablation of silicon nanowire arrays in water and ethanol as agents for laser tumor hyperthermia, we numerically simulated effects of heating a millimeter-size nodal basal-cell carcinoma with embedded nanoparticles by continuous-wave laser radiation at 633 nm. Based on scanning electron microscopy data for the synthesized SiNPs size distributions, we used Mie theory to calculate their optical properties and carried out Monte Carlo simulations of light absorption inside the tumor, with and without the embedded nanoparticles, followed by an evaluation of local temperature increase based on the bioheat transfer equation. Given the same mass concentration, SiNPs obtained by the laser ablation of silicon nanowires in ethanol (eSiNPs) are characterized by smaller absorption and scattering coefficients compared to those synthesized in water (wSiNPs). In contrast, wSiNPs embedded in the tumor provide a lower overall temperature increase than eSiNPs due to the effect of shielding the laser irradiation by the highly absorbing wSiNPs-containing region at the top of the tumor. Effective tumor hyperthermia (temperature increase above 42 °C) can be performed with eSiNPs at nanoparticle mass concentrations of 3 mg/mL and higher, provided that the neighboring healthy tissues remain underheated at the applied irradiation power. The use of a laser beam with the diameter fitting the size of the tumor allows to obtain a higher temperature contrast between the tumor and surrounding normal tissues compared to the case when the beam diameter exceeds the tumor size at the comparable power.

Vulvar Pilomatrix Carcinoma: Morphologic and Molecular Features

Pilomatrix carcinoma (PC) is a rare malignant variant of pilomatrixoma, a skin adnexal tumor originating from hair matrix cells. It is most often located in the head, neck region, upper back and upper extremities. PC has a locally aggressive behavior but metastasis only occur in 10% of cases. Mutations in CTNNB1, the encoding gene of beta-catenin, have been found in both pilomatrixoma and PC, but other molecular alterations are unknown. The authors present a case of PC in the clitoris, the third known reported case located on the external genitalia. The tumor followed an unusual clinical course with the development of multiple metastases. Next-generation sequencing analysis of the tumor identified, in addition to a characteristic CTNNB1 mutation, pathogenic mutations in PTEN, PIK3CA, and ARID1A, which could explain the aggressive course of the disease. The diagnostic criteria of PC and the differential diagnoses of this unusual tumor in the genital area are discussed.

Peritumoral Clefting and Expression of MMP-2 and MMP-9 in Basal Cell Carcinoma of the Skin

BACKGROUND/AIM

Peritumoral clefting is one of the main histologic features of basal cell carcinoma of the skin (BCC). The aim of the study was to analyze the expression of MMP-2 and MMP-9 both in cells of basal cell carcinoma and in the adjacent stroma and to correlate the findings of immunohistochemical analysis with the presence of peritumoral clefting.

PATIENTS AND METHODS

The study was made on archival material comprising 48 cases of BCC. These were scanned for the presence of peritumoral clefts. The results of immunohistochemical staining for MMP-2 and MMP-9 were determined semiquantitatively using immunohistochemical staining index (ISI).

RESULTS

Peritumoral retractions were found in 40 BCC cases. Positive immunohistochemical reaction for MMP-2 in tumor cells was found in 47 cases and in all cases in the adjacent stroma. Positive immunostaining for MMP-9 in BCC tumor cells was observed in 37 cases and in all cases in the adjacent stroma. There was no statistically significant association between peritumoral retractions and expression of MMPs. A statistically significant correlation was found in the expression of both MMP-2 and MMP-9 between the tumor and the stroma.

CONCLUSION

Tumor cells elaborate MMP-2 and -9, but they also produce some other factors that may induce production of MMPs in adjacent stromal cells. The role of MMPs in the development of peritumoral clefts could not be confirmed.

Treatment and Outcomes for Cutaneous Periauricular Basal Cell Carcinoma: A 16-Year Institutional Experience

Objective

To report a single institutional experience with the surgical management of cutaneous periauricular basal cell carcinoma.

Study Design

Retrospective chart review.

Setting

Tertiary academic center.

Methods

Retrospective chart review of 71 patients diagnosed with periauricular basal cell carcinoma managed surgically from 2000 to 2016. Data were analyzed with descriptive statistics.

Results

The median age at diagnosis was 73.0 years (interquartile range, 13.0). Of all lesions, 2.8% (n = 2) were preauricular, 80.3% (n = 57) auricular, and 16.9% (n=12) postauricular. Auricular subsites included conchal bowl (36.6%, n = 26), helix (21.1%, n = 15), antihelix (1.4%, n = 1), peritragus (5.6%, n = 4), triangular fossa (1.4%, n = 1), external auditory canal (2.8%, n = 2), and lobule skin (1.4%, n = 1). Surgical approach included wide local excision (80.3%, n = 57), partial auriculectomy (8.5%, n = 6), and total auriculectomy or other combinations of surgical methods (11.3%, n = 8). Due to aggressive pathology, 3 cases required concurrent parotidectomy, neck dissection, ear canal sleeve resection, or mastoidectomy. In sum, 52.1% (n = 37) of cases had clear margins on first pass in the operating room; 25.4% (n = 18) required further resection; and 12.7% (n = 9) demonstrated final positive/overturned margins read as negative from the frozen sections. Reconstruction included full-thickness (25.4%, n = 18) or superficial-thickness (29.6%, n = 21) skin grafts and local flap reconstruction (25.4%, n = 18), while 5.6% (n = 4) required combinations of free flap and/or other reconstruction techniques; 14.1% (n = 10) did not undergo formal reconstruction.

Conclusion

Periauricular basal cell carcinoma occurs in anatomically diverse locations in and around the ear, and multiple surgical methods are required for successful treatment.

Optical design of a variable angle irradiation system for skin cancer laser phototherapy

Photothermal therapy is a developing therapeutic technic mainly regarding the usage of nanoparticles considering their proneness to assemble around malignant tissue and induce their destruction by converting electromagnetic radiation into thermal radiation. In order to optimize this process, controlling the area of incidence in a way that it can fit the tumour and prevent damage of healthy cells is of great importance. This study was conducted by designing an optical system based on zoom systems for manipulating an initial input beam and adjust it to the most common skin cancer sizes. Two solutions are proposed, accomplishing spot sizes at 150 mm from the last lens within the approximate range of 2 mm to 76 mm, with beam divergences lower than 3 mrad.

Basal cell carcinoma: Contemporary approaches to diagnosis, treatment, and prevention

As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education series provides a comprehensive and contemporary review of basal cell carcinoma. The second article in this series will present both the current standard of care and newly developed approaches to diagnosis, treatment, and prevention of this disease.

A Review on Imiquimod Therapy and Discussion on Optimal Management of Basal Cell Carcinomas

Basal cell carcinoma (BCC) is the most common type of skin cancer with an increasing incidence. However, it is still poorly researched compared to many other human diseases. Today, cutaneous neoplasms are a frequent, major problem faced by medical professionals. BCC tumors can cause extensive cosmetic distress as well as disfigurement to patients especially when on the face. Treatment options include surgery, systemic agents, and topical agents. Over the past few decades more studies have been performed to evaluate the utility of topical imiquimod therapy for treatment of BCC. Imiquimod is a toll-like receptor that modifies the immune response via the up-regulation of cytokines and has the capacity to improve a person's immune response. Multiple clinical studies have demonstrated the ability of topical imiquimod to diminish or even eradicate basal cell carcinoma. Given this variety of treatment options and the need for noninvasive options, this review is focused on summarizing the existing information available on the use of imiquimod for BCC and comparing it to other treatment modalities. While excision is the first line treatment and often has greater success with regards to clearance, imiquimod has been shown to be an efficacious treatment modality for BCC. Imiquimod therapy has been shown to be a less invasive and cheaper option than many other treatment modalities. It may be used as either monotherapy or in combination with other treatments, though occlusion has not been shown to be helpful. Several dosing regimens have been studied in the literature. Dosing should take into account factors such as the type of BCC, location, and physician/patient comfort with the regimen. Variability in response to treatment with imiquimod amongst studies suggests that response to treatment may depend on location of lesion, thus more research must be done in this area.

Characteristics and Factors Related to Eyelid Basal Cell Carcinoma in Saudi Arabia

PURPOSE:

Data on basal cell carcinoma (BCC) from the Middle East are deficient. We present the features and management outcomes for BCC over the last 36 years in Saudi Arabia.

SUBJECTS AND METHODS:

This retrospective chart review included BCC patients diagnosed and treated at Saudi Arabia between 1980 and 2016. Data were collected on patient demographics, clinical and histopathological characteristics of the lesions, management, and follow-up.

RESULTS:

One hundred and twenty-six patients with BCC were included in this study. The incidence of BCC in Saudi Arabia is 0.8 cases a year. The median age of the patients was 71 years. BCC affected 58.9% of males. The lower lid was the most common site of occurrence (52.7%). Clinically, BCC was most commonly recognized as a mixed lesion (41.1%) and 50.4% were histologically nodular. Risk factors for poor prognosis included tumor localization in the medial aspect of the lid, tumor size > 5 mm, histological subtype being ulcerative or morphea forms, affected margins, and recurrent lesions.

CONCLUSION:

BCC is a rare condition in Saudi Arabia. The clinical features and histopathology of BCC in Saudi Arabia are similar to the patterns observed in other regions of the world. Early detection and timely management mitigates the extensive destructive ocular/orbital damage due to BCC and results in better patient outcomes.

Novel concept of detecting basal cell carcinoma in skin tissue using a continuous-wave millimeter-wave rectangular glass filled probe

Purpose

This article presents the study and simulation results of a millimeter (mm)-wave device for cancerous tissue detection. mm-Wave approach ensures cheaper equipment instead of the traditional terahertz (THz) frequency approach. A probe that could be implemented using inexpensive silicon technology is proposed, and it also permits integration of entire measuring tool for easy deployment. Skin cancer was chosen as it representŝ80% of all newly diagnosed cases and is the most common form of cancer in Australia. For an initial development and validation, due to data availability consideration in the open literature, basal cell carcinoma (BCC) was used for simulations.

Methods and results

A probe, using high-frequency signals in the upper mm-wave frequency spectrum (90-300 GHz) to maximize the lateral resolution (mm precision) and allows the detection of tumors located at up to 0.5 mm deep in the skin, is proposed. A frequency-dependent relativity permittivity and an equivalent conductivity of skins were calculated based on the double Debye parameters. For the first time, electromagnetic (EM) models were generated and used along with a high-frequency EM simulator, ANSYS HFSS, to demonstrate the sensitivity of the concept. The following two scenarios were studied: in scenario one, a BCC layer of different thicknesses (10-3000 μm) was located on the top of the normal skin and, in scenario two, the BCC was embedded in normal skin at depths from 10 to 3000 μm. Variability using ±10% of the corresponding dielectric property was also considered.

Conclusion

This study showed that the reflection coefficients vs frequency could capture useful information indicating the possible presence of BCC at mm-wave frequencies. Both magnitude and phase of the reflection coefficient were quantified, with two scenarios analyzed. It was found that a dual-band approach, 100-150 and 200-250 GHz, has the ability to highlight deviations from the normal skin.

Clinical and pathologic parameters predicting recurrence of facial basal cell carcinoma: a retrospective audit in an advanced care center

OBJECTIVES

This study was designed to investigate the associations between clinical, pathologic, and therapeutic parameters of facial basal cell carcinoma (BCC) and recurrence rates in patients treated at an advanced care center.

METHODS

A retrospective cohort study was performed. Patients who presented to an advanced care center within a 6-year period with facial BCC and who received surgical treatment were included for further review according to predefined inclusion criteria. The predictor variable was defined as "negative-margin (R0) resection after the first surgery". The primary outcome variable was defined as "BCC recurrence". Descriptive and inferential statistics were computed. The significance level was set at P ≤ 0.05.

RESULTS

A total of 71 patients (29 female, 42 male; average age: 71.76 years) were found to meet all of the study inclusion criteria. All BCCs had been referred, and 50.7% had been submitted to previous surgery. The mean ± standard deviation tumor diameter was 2.3 ± 1.8 cm. Recurrence of BCC was observed in 11 patients (15.5%). Large tumor diameters, increased patient age, and failure to achieve R0 resection at the first surgical appointment significantly increased recurrence rates.

CONCLUSIONS

Complete facial BCC excision at the first surgical appointment is pivotal in reducing the likelihood of recurrence. The influence of the anatomic location of facial BCC on recurrence rates may be limited.

Analysis of effectiveness of a surgical treatment algorithm for basal cell carcinoma

BACKGROUND

Surgical excision is the treatment of choice for basal cell carcinoma and micrographic surgery considered the gold standard, however not yet used routinely worldwide available, as in Brazil. Considering this, a previously developed treatment guideline, which the majority of tumors were treated by conventional technique (not micrographic) was tested.

OBJECTIVE

To establish the recurrence rate of basal cell carcinomas treated according to this guideline.

METHOD

Between May 2001 and July 2012, 919 basal cell carcinoma lesions in 410 patients were treated according to the proposed guideline. Patients were followed-up and reviewed between September 2013 and February 2014 for clinical, dermatoscopic and histopathologic detection of possible recurrences.

RESULTS

After application of exclusion criteria, 520 lesions were studied, with 88.3% primary and 11.7% recurrent tumors. Histological pattern was indolent in 85.5%, 48.6% were located in high risk areas and 70% small tumors. Only 7.3% were treated by Mohs micrographic surgery. The recurrence rate, in an average follow-up period of 4.37 years, was 1.3% for primary and 1.63% for recurrent tumors. Study limitations: unicenter study, with all patients operated on by the same surgeon.

CONCLUSION

The treatment guideline utilized seems a helpful guide for surgical treatment of basal cell carcinoma, especially if micrographic surgery is not available.

The epidemic spreading of basal cell carcinoma: incidence trend, demographic features, characteristics and risk factors in a retrospective study of 8557 lesions in Bologna. A 25-year analysis in a Dermatology referral center

BACKGROUND

The aim of this study was to retrospectively analyze all the cases of BCC histologically diagnosed in the Cutaneous Tumor Center of Dermatology of Bologna University, in a period between 1990 and 2014.

METHODS

All the consecutive histopathologically diagnosed BCCs at the Dermatology of the Bologna University from 1990 to 2014 were retrospectively reviewed. We evaluated the absolute number of basal cell carcinoma (BCCs), the demographic features of patients and the characteristics of BCCs with statistically significant correlations.

RESULTS

During the investigated 25 years, 8557 BCCs were collected in 7297 patients. We observed that the incidence of this cancer, after stabilizing around a plateau of 400 cases/year in 2005, progressively increased onwards reaching a maximum of cases (821) in 2014 (+105.25%), with an 8.32% mean increase per year in those last 9 years. Moreover, we found a significant correlation (P<0.01%) between gender and the onset of BCC, between the anatomic location and the occurrence of the tumor, between the onset of recurrent or new BCCs and sun exposure.

CONCLUSIONS

The present study collects the largest series in the Italian literature focused on demographic features and characteristics of BCC, highlights its higher increasing incidence in Bologna and the need to improve preventive strategies to stem the epidemic diagnosis of BCC.

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.

Expression of metalloproteinases (MMP-2 and MMP-9) in basal-cell carcinoma

The aim of this study was to compare the expressions of mRNA for metalloproteinases (MMP-2 and MMP-9) and type IV collagen in two different histological types of basal-cell carcinoma (BCCs; nodular and infiltrative) and in normal tissues from the tumor interface. The study included biopsy specimens of the skin involved with BCC and normal skin adjacent the lesion. The expressions of mRNA for MMP-2, MMP-9 and type IV collagen were determined by means of RT-PCR (Reverse transcription polymerase chain reaction). The level of type IV collagen mRNA in nodular and infiltrative BCCs turned out to be significantly lower, and the expressions of MMP-2 and MMP-9 mRNA significantly higher than in normal tissues adjacent to these tumors. The expression of mRNA for MMP-9 but not for MMP-2 was significantly higher in infiltrative BCCs than in the nodular BCCs. In turn, normal tissues adjacent to nodular BCCs showed significantly higher levels of mRNA for MMP-2 and significantly lower levels of type IV collagen mRNA than the normal tissues from the interface of infiltrative BCCs. The findings suggest that MMP-2 and MMP-9 could be used as prognostic factors of BCCs.

Giant Fungating Basal Cell Carcinoma of the Scrotum

We present an unusual case of basal cell carcinoma (BCC) arising from a non-sun-exposed area. The patient was 69-year-old male with an enlarging giant fungating mass protruding from his scrotum for which he did not seek medical treatment until recently. The mass did not involve the scrotum or epididymis and was confirmed on ultrasound. The patient underwent wide surgical excision and was diagnosed with BCC of the scrotum. Scrotal BCC appears to be more aggressive and more likely to metastasize compared with lesions arising from other areas of the body.

The pattern of lip cancer occurrence over the 1990-2011 period in public hospitals in Madrid, Spain

BACKGROUND

Some regions of Spain along with Canada and Australia have the highest rates of lip cancer in the world. The objective of this study was to examine the trends in the pattern of occurrence of lip cancer in Madrid, Spain.

METHODS

Data were extracted from the Central Tumour Registry of Madrid, between 1990 and 2011. Variables examined were age, sex, topographic and morphological location and tumour histology. Two consecutive periods, 1990-2001 and 2002-2011, were studied by descriptive and analytical methods, and the data from the two periods were statistically compared.

RESULTS

A total of 881 cases were registered during the period 1990-2011. Comparing data between the two periods (1990-2001 and 2002-2011), subtle variations in age, histology and location were noted. Gender ratios remained constant. The mean age increased from 66.3 to 69.7 years (P < 0.05). In the second period, the histological distribution showed an increase in frequency of basal cell carcinoma, from 2.1% to 4.7%, while the frequency of squamous cell carcinomas remained constant. Basal cell carcinoma no longer predominantly occurred in women, decreasing from 80% to 21.1% (P < 0.001). The distribution by gender of squamous cell carcinoma had become more equal due an increase in its frequency in women (P < 0.001). Frequency of tumours on lip mucosa and commissure had increased between the two periods (P < 0.004).

CONCLUSIONS

The pattern of lip cancer reported to Public Hospitals of Madrid is changing: declining rates are noted since 2001-02. However, it is necessary to monitor these data to confirm the observed trends in future years.

Surgical treatment of basal cell carcinoma: an algorithm based on the literature

Although basal cell carcinoma can be effectively managed through surgical excision, the most suitable surgical margins have not yet been fully determined. Furthermore, micrographic surgery is not readily available in many places around the world. A review of the literature regarding the surgical treatment of basal cell carcinoma was conducted in order to develop an algorithm for the surgical treatment of basal cell carcinoma that could help the choice of surgical technique and safety margins, considering the major factors that affect cure rates. Through this review, it was found that surgical margins of 4mm seem to be suitable for small, primary, well-defined basal cell carcinomas, although some good results can be achieved with smaller margins and the use of margin control surgical techniques. For treatment of high-risk and recurrent tumors, margins of 5-6 mm or margin control of the surgical excision is required. Previous treatment, histological subtype, site and size of the lesion should be considered in surgical planning because these factors have been proven to affect cure rates. Thus, considering these factors, the algorithm can be a useful tool, especially for places where micrographic surgery is not widely available.

Photodynamic therapy with methyl aminolevulinate in the treatment of basal cell carcinoma

The article presents the results of the studies on the effectiveness of treatment basal cell carcinoma of the skin with photodynamic therapy with 5-aminolevulinic acid and methyl aminolevulinate. The results of the comparing trials between photodynamic therapy with methyl aminolevulinate and different other treatment modalities are presented.

Incompletely excised basal cell carcinoma: residual tumor rates at Mohs re-excision

BACKGROUND

Basal cell carcinoma (BCC) is the most common skin cancer, and incompletely excised BCC is a commonly encountered clinical scenario.

OBJECTIVE

To investigate the incidence of histologic and clinical evidence of residual BCC at Mohs micrographic surgery (MMS) for the treatment of incompletely excised BCC.

METHODS AND MATERIALS

One hundred incompletely excised BCCs, from our practice and referred to our practice by local family doctors, treated using MMS between 2005 and 2007 were studied. Patient data included sex, age, anatomic location of tumor, histologic subtype, margin involved, initial closure and closure after MMS, and Mohs stages required for histologic clearance.

RESULTS

Sixty-nine percent of incompletely excised BCCs had residual tumor at MMS re-excision, and 12% had clinically evident residual disease.

CONCLUSION

Immediate re-excision using MMS is recommended for treatment of incompletely excised BCC because the majority of cases have histologically detectable BCC. Watch and wait advice could lead to significant morbidity because recurrence may necessitate more extensive closures and costs. Long-term follow-up is recommended. It is important to conduct self-audits of incomplete excisions and follow up these patients.

Basal cell carcinoma of the head and neck region: an analysis of 171 cases

Objective. To analyze the pattern of presentation of basal cell carcinoma (BCC) and margin status for excised specimens in the head and neck region. Study Design. Retrospective cross-sectional. Duration of Study. January 2009 to December 2011. Methodology. The database of the pathology department was searched to identify records of all malignant skin tumors that underwent standard excision with margins. Out of these records, tumors with a diagnosis of BCC in the head and neck region were retrieved and separated. Age, gender, anatomic location, pattern of tumor, and margin status were noted. Results. A total of 171 cases of BCC from various sites of head and neck were retrieved. Male to female ratio was 1.4 : 1. The age ranged from 22 to 90 years. Seventy-six cases presented on right side, 79 on left, and 16 were in the midline. Most common anatomical site was the nose followed by the cheek. Nodular lesions were the most common (46.2%) followed by pigmented variety (18.7%). Margins were clear in 77 (45.1%) cases, involved in 86 (50.2%) cases, and close in 8 (4.7%) cases. Conclusion. Nose was the most common site followed by the cheek. Nodular and pigmented varieties were the most frequent and margins were involved in more than fifty percent of the cases.

High and sustained efficacy after two sessions of topical 5-aminolaevulinic acid photodynamic therapy for basal cell carcinoma: a prospective, clinical and histological 10-year follow-up study

BACKGROUND

Prolonged follow-up data on topical photodynamic therapy (PDT) in basal cell carcinoma (BCC) are necessary for a full evaluation of its effect and for comparison with conventional treatment methods.

OBJECTIVES

To assess 10-year long-term PDT efficacy in primary and recurrent BCC and to evaluate clinical and histopathological factors which may be associated with treatment failure.

METHODS

We performed a longitudinal study on 60 histologically verified BCCs in 44 patients treated with curettage and one or two sessions of dimethylsulphoxide (DMSO)-supported topical 5-aminolaevulinic acid (ALA)-based PDT. Treated lesions were investigated by clinical and histopathological examination at regular intervals. The main outcomes were 10-year lesion complete response rate using a time-to-event analysis, histological treatment failure and cosmesis.

RESULTS

Overall complete response rate for all lesions was 75% (95% confidence interval 64-87%); 60% after one and 87% after two treatment sessions. The response rate was 78% for primary lesions; 63% after one and 90% after two sessions. The cosmetic outcome was rated as good or excellent in 91-100% of evaluated cases. Treatment failure was documented in 15 (25%) of 60 lesions; clinical investigation identified 14 of them. All failures were noted within 3 years of treatment. Male gender, recurrent tumour and one treatment session were factors significantly associated with treatment failure. The only lesion larger than 2·0 cm relapsed.

CONCLUSIONS

Two sessions of DMSO-supported topical ALA-PDT and curettage can provide long-term effective treatment results with favourable cosmetic outcome in primary, small BCC.

Interaction between functional polymorphic variants in cytokine genes, established risk factors and susceptibility to basal cell carcinoma of skin

Basal cell carcinoma (BCC) of the skin is the most common neoplasm among the Caucasian population of the Western world. Inflammation may result in oxidative stress and contribute to promotion and progression of tumors, including BCC. The role of cytokines, which are inflammatory modulators, in the biology of tumors has been extensively studied and it is well known that they are aberrantly produced by cancer cells, macrophages and other phagocytic cells. Genetic polymorphisms are known in several cytokine genes, which result in altered expression. In the present association study, we investigated the association of 14 functional polymorphisms in 11 cytokines genes with BCC risk in 529 BCC cases and 532 healthy controls. We have also tested the possible interactions between the genetic variants and three known risk factors for BCC: skin complexion, sun effect and skin response to sun exposure. We did not observe any statistically significant association between SNPs and BCC risk. However, we found that, in a subgroup of subjects more prone to skin burns, carriers of at least one copy of the G allele of rs1800629 (TNF) had an increased risk of BCC [odds ratio (OR) = 2.40, 95% confidence interval (CI) 1.38-4.16, P = 0.0005]. Moreover, in subjects less prone to sunburns, we observed that carriers of the C allele of rs1143627 (IL1B) showed a decreased risk (OR = 0.53, 95% CI 0.34-0.82, P = 0.0019). In conclusion, we found that two polymorphisms in inflammatory genes interacting with environmental risk factors could modulate BCC risk.