Carcinomas basocelulares: estudo clínico e anatomopatológico de 704 tumores

TERTp mutations and p53 expression in head and neck cutaneous basal cell carcinomas with different aggressive features

Cutaneous basal cell carcinoma (cBCC) is an economic burden to health services, due to its great morbidity and increasing incidence in old people. Infiltrative cBCCs and cBCCs with micronodular pattern are considered as more aggressive. The role of p53 expression and TERTp mutation on cBCC behavior remains to be clarified. We aimed to assess TERTp mutations and p53 expression in relation to the cBCC histological subtype in a cohort of patients referred to an ENT Department of a tertiary Hospital of Northern Portugal. We performed a retrospective clinicopathological and histological review of the head and neck cBCCs followed-up at the otorhinolaryngology department of Trás-os-Montes e Alto Douro hospital (January 2007–June 2018). We assessed TERTp mutations in 142 cBCCs and p53 protein expression, through immunohistochemistry, in 157 cBCCs. We detected TERTp mutations in 43.7% of cBCCs and p53 overexpression in 60.5% of cBCCs. We spotted association of p53 overexpression and TERTp mutation with necrosis. In the infitrative-growth pattern cBCCs, there was no significant association with the clinical and histological features evaluated, except for necrosis. In the indolent-growth cBCCs, we identified a significant association of TERTp mutation status with female sex, necrosis, multiple cBCCs, and p53 positive expression. Our results suggest that TERTp mutation may be useful to identify more aggressive features in the indolent-growth pattern cBCCs (nodular and superficial subtypes). Further studies with larger cohorts are warranted to clarify the relevance of TERTp mutation in cBCCs.

Clinical and histopathological profile of basal cell carcinoma in a population from Criciúma, Santa Catarina, Brazil

Basal cell carcinoma is a local, invasive epidermal neoplasia, the most common type of which is nodular basal cell carcinoma. The objective of the present study was to evaluate the occurrence of basal cell carcinoma, characterizing its distribution in accordance with patients' age, gender, the site of the lesion and its histopathological characteristics. Anatomopathology reports of cases of basal cell carcinoma diagnosed in Criciúma, Santa Catarina, Brazil between June 2005 and June 2007 were analyzed. A descriptive, observational, cross-sectional study was conducted. The majority of patients were females over 40 years of age. Most of the tumors were of the nodular type and were situated on the face. There was ulceration in 27.5%, infiltration in 24.5% and invasion of the deep dermis in 61.8%. Local data must be evaluated in order to emphasize the importance of early diagnosis.

Epidemiology of basal cell carcinoma

Basal cell carcinoma is the most common malignant neoplasm in humans and its incidence has increased over the last decades. Its high frequency significantly burdens the health system, making the disease a public health issue. Despite the low mortality rates and the rare occurrence of metastases, the tumor may be locally invasive and relapse after treatment, causing significant morbidity. Exposure to ultraviolet radiation is the main environmental risk factor associated with its cause. However, other elements of risk are described, such as light skin phototypes, advanced age, family history of skin carcinoma, light eyes and blond hair, freckles in childhood and immunosuppression. Behavioral aspects such as occupational sun exposure, rural labor and sunburns at a young age also play a role. Between 30% and 75% of the sporadic cases are associated with patched hedgehog gene mutation, but other genetic changes are also described. The tumor is commonly found in concomitance with skin lesions related to chronic sun exposure, such as actinic keratoses, solar lentigines and facial telangiectasia. The prevention of basal cell carcinoma is based on the knowledge of risk factors, early diagnosis and treatment, as well as on the adoption of specific measures, particularly in susceptible populations. The authors present a review of the epidemiology of basal cell carcinoma.

Corrective eyeglasses and medial canthal basal cell carcinoma: a case-control study

BACKGROUND

Corrective eyeglasses are frequently worn by adults, particularly at older ages. Their lenses and frames provide ultraviolet protection. Medial canthal basal cell carcinomas are infrequent (3-8%), and their relation with the use of corrective glasses was not yet investigated.

OBJECTIVES

To assess the prevalence of corrective eyeglasses use in individuals with medial canthal basal cell carcinoma.

METHODS

Case-control study using two controls matched by age, gender, and ethnicity for each case. Cases were patients with medial canthal basal cell carcinoma, and controls were patients with basal cell carcinoma elsewhere on the face. The prevalence of major risk variables was estimated and adjusted by conditional multiple logistic regression.

RESULTS

Fifty cases and 100 controls were assessed. The mean patient age was 69.7 years, and 54% of the subjects were females. No difference regarding the eyeglasses use or use duration was found between groups. However, when visual defects were separately evaluated, eyeglasses for myopia correction were independently associated with lower risk of medial canthal basal cell carcinoma development (OR=0.26; P=0.03), what can be related to long term local photoprotection.

CONCLUSION

The use of eyeglasses for myopia correction is associated with lower prevalence of medial cantal basal cell carcinoma. Risk-reducing mechanisms should be elucidated.

Quantitative study of Langerhans cells in basal cell carcinoma with higher or lower potential of local aggressiveness

BACKGROUNDS

Basal cell carcinoma affects areas of the body that have been exposed to the sun, and this disorder has different clinical and histopathologic presentations. Some of these forms have a higher potential of local aggressiveness, while others have a lower potential. Langerhans cells actively participate in the skin immune system.

OBJECTIVES

To quantitatively evaluate the number of Langerhans cells on the epidermis of basal cell carcinoma with lower and higher potential of local aggressiveness and on adjacent normal epidermis.

METHODOLOGY

The authors divided the sample into two groups with 14 histological slides each: one with basal cell carcinoma with lower potential of local aggressiveness and the other with basal cell carcinoma with higher potential of local aggressiveness. Immunohistochemistry with S-100 protein was used in the identification of Langerhans Cells. Langerhans cells present in 7 microscopic fields were counted using optical microscopy (400X magnification) and Weibel's morphometric grade. The mean for each lamina was obtained. Wilcoxon's statistical test was employed.

RESULTS

In the group with lower potential of local aggressiveness, there was a significant increase in the number of Langerhans cells in the adjacent normal epidermis, as compared with the number of cells in the epidermis superposed to the basal cell carcinoma (pd 0.05). There was no significant statistical difference in the group with higher potential of local aggressiveness (p >0.05).

CONCLUSION

The higher number of Langerhans cells in the normal epidermis adjacent to the tumoral lesion with lower potential of local aggressiveness could indicate greater immunological resistance of the epidermis, thus limiting the aggressiveness of the neoplasm.

Aplicação de substituto de pele em oncologia cutânea: estudo experimental com derme acelular e ceratinócitos cultivados

FUNDAMENTOS: As neoplasias malignas da pele de grandes dimensões apresentam dificuldades de reconstrução após a excisão. OBJETIVO: O objetivo deste estudo foi avaliar a exeqüibilidade de uma nova proposta de cobertura para feridas cirúrgicas criadas após a ressecção de grandes tumores cutâneos, a combinação da derme acelular humana com epitélio autólogo cultivado. MÉTODOS: A aplicação dos substitutos de pele foi feita em quatro pacientes com área de implante variando de 33 a 120 cm2. Além da observação dos resultados clínicos, realizou-se estudo morfológico para avaliação da integração dos implantes. RESULTADOS: Ceratinócitos autólogos cultivados foram enxertados em dois pacientes e não demonstraram integração. A derme acelular foi aplicada em quatro pacientes, sendo que em um deles foram feitas duas aplicações. Dos cinco implantes de derme acelular realizados, dois não apresentaram integração, em dois a integração foi de 70%, e de 50% no último. CONCLUSÃO: A cobertura imediata e definitiva de defeitos cirúrgicos através da aplicação de derme acelular humana combinada com epitélio autólogo cultivado é exeqüível. Em oncologia cutânea apenas em situações especiais o uso de substitutos de pele pode ser conveniente no sentido de evitar reconstruções mais complexas.

Basal cell carcinoma: an updated epidemiological and therapeutically profile of an urban population

PURPOSE: To describe the epidemiological profile of basal cell carcinoma patients at a private hospital in São Paulo and to evaluate the treatment adopted. METHODS: A prospective study of 202 patients, on which 253 lesions were diagnosed for histopathological exam as basal cell carcinoma within the period of January 2001 to September 2003, in the Plastic Surgery Residency Program at the Hospital Jaraguá. The susceptibility factor of the host, the environment variables, the characteristics of the lesions and the efficacy of the treatment were examined. The data were statistically evaluated. RESULTS: The incidence of basal cell carcinoma was 126 cases per 100,000 patients in a period of 32 months (36 cases per 100,000 patients/year). The patients were evenly distributed in terms of sex: 48% male and 52% female. The greater incidence was in patients between the ages of 60 and 80 years and the average was 64 years. The survey revealed susceptibility factors such as white race and phototypes I and II in 95.5% of the patients. Exposition to ultraviolet radiation was reported by 77% of the patients and the most frequent location of tumors was on the face (71.2% of the cases). Actinic keratosis and a history of skin cancer were reported in 43.6% and in 25% of the cases, respectively. The adopted treatment was surgery in 99.4% of the cases and only one patient was treated with radiotherapy. Twenty lesions (8%) had incomplete excision.The recurrence rate was 2% (5 cases). There were no cases with metastasis or fatal outcome. CONCLUSIONS: The factors related to the development of basal cell cancer which were significantly present in the population surveyed were: older age, white individuals, phototypes I and II, presence of actinic keratosis, previous history of non-melanoma skin cancer and exposure to ultra-violet rays both in recreational and in occupational form.The surgical treatment employed was effective with a rate of incomplete excision and recurrence similar to those found in the literature.

Carcinoma basocelular - Análise de 300 casos observados em Uberlândia - MG

FUNDAMENTO: O carcinoma basocelular é o câncer da pele mais comum, compreendendo 75% dos tumores epiteliais malignos. Localiza-se na face e acomete indivíduos brancos, acima de 40 anos de idade, com história de exposição repetitiva à luz solar. OBJETIVO: Descrever o carcinoma basocelular em suas variáveis epidemiológica, clínica e histopatológica. CASUÍSTICA: Realizou-se estudo transversal de 300 pacientes com carcinoma basocelular atendidos no Serviço de Dermatologia do Hospital de Clínicas, no período de 1999 a 2003. Foram preenchidos protocolos com identificação do paciente, história de exposição solar e caracterização do carcinoma basocelular. RESULTADOS: Foram identificadas 447 lesões de carcinoma basocelular nos 300 pacientes estudados, cuja maioria era do sexo feminino (59,3%) e da raça branca (93%), com história de exposição solar (90,3%), apresentando lesão única (74%), predominantemente facial (77% das lesões). O tipo histopatológico mais freqüente foi o nodular (46,3% das lesões), com predomínio do superficial no tronco. CONCLUSÕES: Observou-se predomínio do carcinoma basocelular no sexo feminino, demonstrando a tendência atual desse tumor. A presença de vários tumores sucessivos ou simultâneos em um mesmo paciente salienta a importância de exames periódicos nesses doentes. Não se estabeleceu correlação entre os tipos clínicos e histopatológicos. Confirmou-se que o tipo superficial é mais freqüente no tronco.