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Zilberg C, Lyons JG, Gupta R, Damian DL. The Immune Microenvironment in Basal Cell Carcinoma. Ann Dermatol 2023; 35:243-255. [PMID: 37550225 PMCID: PMC10407341 DOI: 10.5021/ad.22.042] [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: 03/01/2022] [Revised: 05/07/2022] [Accepted: 08/01/2022] [Indexed: 08/09/2023] Open
Abstract
The immune system plays a key role in the suppression and progression of basal cell carcinoma (BCC). The primary aetiological factor for BCC development is exposure to ultraviolet radiation (UVR) which, particularly in lighter Fitzpatrick skin types, leads to the accumulation of DNA damage. UVR has roles in the generation of an immunosuppressive environment, facilitating cancer progression. Rates of BCC are elevated in immunosuppressed patients, and BCC may undergo spontaneous immune-mediated regression. Histologic and immunohistochemical profiling of BCCs consistently demonstrates the presence of an immune infiltrate and associated immune proteins. Early studies of immune checkpoint inhibitors reveal promising results in BCC. Therefore, the host immune system and tumor responses to it are important in BCC pathogenesis. Understanding these interactions will be beneficial for disease prognostication and therapeutic decisions.
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Affiliation(s)
- Catherine Zilberg
- Department of Dermatology, The University of Sydney at Royal Prince Alfred Hospital, Sydney, Australia.
| | - James Guy Lyons
- Department of Dermatology, The University of Sydney at Royal Prince Alfred Hospital, Sydney, Australia
- Centenary Institute, The University of Sydney, Sydney, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Diona Lee Damian
- Department of Dermatology, The University of Sydney at Royal Prince Alfred Hospital, Sydney, Australia
- Melanoma Institute Australia, Sydney, Australia
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Yumeen S, Gowda A, Hsu MY, Kroumpouzos G. Annular Basal Cell Carcinoma Expanding Around Central Hypertrophic Scarring: A Case Report. Cureus 2023; 15:e35934. [PMID: 36911588 PMCID: PMC9997686 DOI: 10.7759/cureus.35934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
A case of annular basal cell carcinoma (BCC) with central atrophic scarring that developed secondary to spontaneous regression has been reported. We present a novel case of a large, expanding nodular and micronodular BCC with annular morphology with central hypertrophic scarring. A 61-year-old woman presented with a two-year history of a mildly itchy lesion on the right breast. Previously diagnosed as an infection, the lesion persisted after treatment with topical antifungal agents and oral antibiotics. Physical examination revealed a 5x6 cm plaque consisting of a pink-red arciform/annular edge with an overlying scale crust and a large, centrally positioned, firm, alabaster-colored portion. A punch biopsy of the pink-red rim revealed nodular and micronodular BCC features. A deep shave biopsy of the central bound-down plaque showed histopathology of scarring fibrosis with no findings of BCC regression. The malignancy was treated with two sessions of radiofrequency destruction, which led to the resolution of the tumor with no recurrence to date. Contrary to the previously reported case, BCC in our case was expanding, associated with hypertrophic scarring, and showed no signs of regression. We discuss several possible etiologies of the scarring centrally. With further awareness of this presentation, more such tumors can be detected at early stages to facilitate prompt treatment and prevent local morbidity.
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Affiliation(s)
- Sara Yumeen
- Dermatology, Warren Alpert Medical School at Brown University, Providence, USA
| | - Asha Gowda
- Dermatology, Warren Alpert Medical School at Brown University, Providence, USA
| | - Mei-Yu Hsu
- Dermatopathology, StrataDx, Lexington, USA
| | - George Kroumpouzos
- Dermatology, Warren Alpert Medical School at Brown University, Providence, USA
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Wenzel AN, Apel PJ, Gosnell HL, Grider DJ. Fortuitous Eradication of an Aggressive Basal Cell Carcinoma Via Foreign Body Reaction to a Polyurethane Vacuum-Assisted Closure Sponge. Am J Dermatopathol 2021; 43:740-745. [PMID: 33534210 DOI: 10.1097/dad.0000000000001912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The foreign body reaction (FBR) is a well-documented immune reaction. Much of the literature on FBRs has focused on minimizing this immune response to mitigate the impact on medical implants. Here, we present a case that illustrates a serendipitous oncologic outcome from an FBR. A 54-year-old man presented with an aggressive basal cell carcinoma (BCC). At the first resection, he had broadly positive surgical margins. The surgical wound was temporized with a polyurethane wound vacuum assisted closure (VAC) device. He was lost to follow-up having retained a VAC sponge for a total of 12 weeks. A wide re-resection was performed 7 months after the initial resection. Exhaustive examination of the resected specimen was performed. There was an absence of any BCC, replaced by a widespread chronic FBR to polyurethane VAC sponge particles. This suggests that the foreign body immune response was sufficiently intense to eradicate any remaining BCC. This case illustrates the concept of an FBR as a novel method of local immunotherapy.
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Affiliation(s)
| | - Peter J Apel
- Virginia Tech Carilion School of Medicine, Roanoke, VA
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, VA; and
| | | | - Douglas J Grider
- Virginia Tech Carilion School of Medicine, Roanoke, VA
- Dominion Pathology Associates, Roanoke VA
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Jørgensen NG, Kaae J, Grauslund JH, Met Ö, Nielsen SL, Pedersen AW, Svane IM, Ehrnrooth E, Andersen MH, Zachariae C, Skov L. Vaccination against PD-L1 with IO103 a Novel Immune Modulatory Vaccine in Basal Cell Carcinoma: A Phase IIa Study. Cancers (Basel) 2021; 13:cancers13040911. [PMID: 33671555 PMCID: PMC7926323 DOI: 10.3390/cancers13040911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 01/24/2023] Open
Abstract
Simple Summary Basal cell carcinoma is the most common skin cancer and new treatments for patients with widespread and numerous tumors are lacking. In a previous study treating patients with multiple myeloma with a peptide vaccine called IO103 against an immune checkpoint molecule called programmed death ligand 1, two cases of basal cell carcinoma regressed. The aim of the present study was to assess the effect of vaccination with IO103 in ten patients with basal cell carcinoma. Patients were vaccinated with Montanide as adjuvant up to nine times during six months. Regression in tumor size of at least 30% was seen in five of 18 tumors, two of which showed complete regression. Vaccinations resulted in immune responses against the vaccine in blood samples from nine of ten patients and in skin samples from five of nine patients. The findings suggest that the vaccine may be effective against some basal cell carcinomas. Abstract Antitumor activity of immune checkpoint blocking antibodies against programmed death 1 (PD-1) in basal cell carcinoma (BCC) has been described. IO103 is a peptide vaccine against the major PD-1 ligand PD-L1. A phase IIa study of vaccination with IO103 and Montanide adjuvant was conducted in patients with resectable BCC (NCT03714529). Vaccinations were given six times every 2 weeks (q2w), followed by three vaccines q4w in responders. Primary endpoints were clinical responses of target tumors, change in target tumor size and immune responses to the vaccine. Secondary endpoint was safety. One tumor per patient was designated target tumor and biopsied twice during the course of vaccination. Synchronous non-target BCCs were not biopsied during vaccinations. Ten patients were vaccinated (six patients received six vaccinations and four patients received nine vaccinations). A partial response (PR) was seen in two target tumors. Two complete responses (CR) and one PR were observed in eight non-target tumors in four patients. No tumors progressed. Related adverse events were grade 1 and reversible. Immune responses against IO103 were induced in blood samples from nine of ten and skin-infiltrating lymphocytes from five of the nine patients. The regressions seen in non-target tumors suggest that IO103 may be effective against a subtype of BCC.
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Affiliation(s)
- Nicolai Grønne Jørgensen
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark; (J.H.G.); (Ö.M.); (I.M.S.); (M.H.A.)
- Department of Hematology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
- Correspondence:
| | - Jeanette Kaae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark; (J.K.); (C.Z.); (L.S.)
| | - Jacob Handlos Grauslund
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark; (J.H.G.); (Ö.M.); (I.M.S.); (M.H.A.)
| | - Özcan Met
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark; (J.H.G.); (Ö.M.); (I.M.S.); (M.H.A.)
- Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Signe Ledou Nielsen
- Department of Pathology, Herlev and Gentofte Hospital, 2730 Herlev, Denmark;
| | | | - Inge Marie Svane
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark; (J.H.G.); (Ö.M.); (I.M.S.); (M.H.A.)
| | - Eva Ehrnrooth
- IO Biotech ApS, 2200 Copenhagen, Denmark; (A.W.P.); (E.E.)
| | - Mads Hald Andersen
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark; (J.H.G.); (Ö.M.); (I.M.S.); (M.H.A.)
- Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
- IO Biotech ApS, 2200 Copenhagen, Denmark; (A.W.P.); (E.E.)
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark; (J.K.); (C.Z.); (L.S.)
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark; (J.K.); (C.Z.); (L.S.)
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Herwig-Carl MC, Loeffler KU. Regression of Periocular Basal Cell Carcinoma: A Report of Four Cases with Clinicopathologic Correlation. Ocul Oncol Pathol 2019; 6:107-114. [PMID: 32258018 DOI: 10.1159/000501370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/04/2019] [Indexed: 12/29/2022] Open
Abstract
Objectives To describe the spectrum of clinical and histopathological features of a case series of basal cell carcinoma (BCC) with spontaneous regression and to discuss this phenomenon. Method Four cases of BCC with complete/substantial regression were retrospectively identified. Patients' records were analyzed for demographic data, clinical appearance, and the postoperative course. Formalin-fixed, paraffin-embedded specimens were routinely processed and stained with hematoxylin and eosin and periodic acid Schiff. Results Complete (n = 1) or partial (n = 3) regression of BCC was observed in 4 patients. Two lesions at the medial canthus were histologically diagnosed as nodular BCC with significant regression. One lesion at the lower eyelid exhibited a complete regression which did not require surgical intervention. The other lesion at the lower eyelid presenting with ulceration and madarosis was excised. Scar tissue without evidence for a neoplasm was present histologically. Subsequently, the patient developed a recurrence with a histologically proven micronodular BCC. Conclusions BCC can show spontaneous substantial or complete regression. Histological tumor absence in lesions which are clinically suspicious for a neoplasm can be a hint for a regressive BCC. Recurrences may develop from remaining tumor islands warranting periodical clinical visits in cases of clinically as well as histologically suspected regressive BCC.
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Affiliation(s)
- Martina C Herwig-Carl
- Division of Ophthalmic Pathology, Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Karin U Loeffler
- Division of Ophthalmic Pathology, Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Lang CMR, Chan CK, Veltri A, Lien WH. Wnt Signaling Pathways in Keratinocyte Carcinomas. Cancers (Basel) 2019; 11:cancers11091216. [PMID: 31438551 PMCID: PMC6769728 DOI: 10.3390/cancers11091216] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
The skin functions as a barrier between the organism and the surrounding environment. Direct exposure to external stimuli and the accumulation of genetic mutations may lead to abnormal cell growth, irreversible tissue damage and potentially favor skin malignancy. Skin homeostasis is coordinated by an intricate signaling network, and its dysregulation has been implicated in the development of skin cancers. Wnt signaling is one such regulatory pathway orchestrating skin development, homeostasis, and stem cell activation. Aberrant regulation of Wnt signaling cascades not only gives rise to tumor initiation, progression and invasion, but also maintains cancer stem cells which contribute to tumor recurrence. In this review, we summarize recent studies highlighting functional evidence of Wnt-related oncology in keratinocyte carcinomas, as well as discussing preclinical and clinical approaches that target oncogenic Wnt signaling to treat cancers. Our review provides valuable insight into the significance of Wnt signaling for future interventions against keratinocyte carcinomas.
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Affiliation(s)
| | - Chim Kei Chan
- de Duve Institute, Université catholique de Louvain, Brussels 1200, Belgium
| | - Anthony Veltri
- de Duve Institute, Université catholique de Louvain, Brussels 1200, Belgium
| | - Wen-Hui Lien
- de Duve Institute, Université catholique de Louvain, Brussels 1200, Belgium.
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Go U, Miyata K, Fujita M, Ohide T, Mitsuishi T. Spontaneous Regression of Annular Basal Cell Carcinoma: A Case Report. Case Rep Dermatol 2019; 11:145-149. [PMID: 31244639 PMCID: PMC6587202 DOI: 10.1159/000500711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/01/2019] [Indexed: 11/19/2022] Open
Abstract
We herein present a case of annular basal cell carcinoma (BCC) with spontaneous regression on the right temporal region of a 56-year-old Japanese male. Histopathological examination revealed that the central section had no tumor cells. The sweat glands, follicles, and other cutaneous appendages were also absent. This pattern of spontaneous regression is quite uncommon, and understanding the histopathology may be important for future approaches to BCC.
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Affiliation(s)
- Usho Go
- Department of Dermatology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Kazunori Miyata
- Department of Dermatology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Masaru Fujita
- Department of Dermatology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Takashi Ohide
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Tsuyoshi Mitsuishi
- Department of Dermatology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
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Baykal C, Kutlay A, Buyukbabani N. Complete healing of basal cell carcinoma under bendamustine and brentuximab vedotin therapy in a patient with cutaneous lymphoma. Dermatol Ther 2019; 32:e12934. [PMID: 30977947 DOI: 10.1111/dth.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/25/2019] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Armagan Kutlay
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nesimi Buyukbabani
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Furudate S, Fujimura T, Tojo GI, Haga T, Aiba S. Basal cell carcinoma arising from xeroderma pigmentosum: a case report and an immunohistochemical study. Case Rep Dermatol 2013; 5:64-8. [PMID: 23626541 PMCID: PMC3617891 DOI: 10.1159/000350182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe a 26-year-old Japanese patient with basal cell carcinoma arising from xeroderma pigmentosum (XP). Immunohistochemical staining revealed dense infiltration of CD163+ M2 macrophages, together with Foxp3+ regulatory T cells. Interestingly, MMP9, which was reported as one of the functional markers for immunosuppressive macrophages, was also detected in the CD163+ M2 macrophage-infiltrated areas. Our case suggests the immunological background of tumor development in a patient with XP.
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Tsukada A, Fujimura T, Furudate S, Kambayashi Y, Hashimoto A, Aiba S. Basosquamous cell carcinoma developing from a renal transplantation recipient. Case Rep Dermatol 2012. [PMID: 23185157 PMCID: PMC3506065 DOI: 10.1159/000345095] [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] [Indexed: 11/19/2022] Open
Abstract
We describe a case of basosquamous cell carcinoma arising from a 52-year-old Japanese renal transplantation recipient (RTR). In the present case, we investigated the immunohistochemical profiles of tumor-infiltrating lymphocytes, focusing on cytotoxic granules, granulysin-bearing cells and immunosuppressive cells, such as regulatory T cells and tumor-associated macrophages. Our present study suggests some of the possible mechanisms for the carcinogenesis of cutaneous malignancy in RTRs.
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Affiliation(s)
- Akira Tsukada
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Furudate S, Fujimura T, Tsukada A, Numata Y, Kambayashi Y, Aiba S. Profiles of tumor-infiltrating lymphocytes in a case of trichilemmal carcinoma with spontaneous regression. Case Rep Dermatol 2012; 4:215-21. [PMID: 23139660 PMCID: PMC3493020 DOI: 10.1159/000343881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe the case of a 69-year-old Japanese patient with spontaneous regression of trichilemmal carcinoma. We investigated the immunohistochemical profiles of tumor-infiltrating lymphocytes, focusing on cytotoxic granules, granulysin-bearing cells and immunosuppressive cells, such as regulatory T cells and tumor-associated macrophages. Our present study describes some of the possible mechanisms of the self-regression of cutaneous malignant tumors and potential therapies for trichilemmal carcinoma by modifying the tumor microenvironment.
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Affiliation(s)
- Sadanori Furudate
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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