Giant epithelial malignancies (Basal cell carcinoma, squamous cell carcinoma): a series of 20 tumors from a single center

Current Surgical Therapy of Locally Advanced cSCC: From Patient Selection to Microsurgical Tissue Transplant. Review

Among the non-melanoma skin cancers (NMSC) the squamous cell carcinoma (SCC) is one of the most challenging for the surgeon. Local aggressiveness and a tendency to metastasize to regional lymph nodes characterize the biologic behavior. The variants locally advanced and metastatic require wide excision and node dissection. Such procedures can be extremely detrimental for patients. The limit of the surgery can be safely pushed forward with a multidisciplinary approach. The concept of skin oncoplastic surgery, the ablative procedures and the reconstructive options (skin graft, pedicled flap, microsurgical free flap) are discussed together with a literature review.

Extra-anogenital giant cutaneous squamous cell carcinomas require multidisciplinary management

Cutaneous squamous cell carcinoma (cSCC) is a highly prevalent cancer and the majority of cSCC have a good prognosis. However, a subset of cSCC can progress to advanced disease. We present the first reported case of a giant cSCC located on the breast. In addition, a systematic literature search on extra-anogenital giant (EAG) cSCC was performed using Pubmed and MEDLINE databases. Thirty-one articles could be retained which were relevant for this review. A total of 42 well-described cases were identified. Median age at presentation was 70 years (range 9-100 years). Twenty-four (57%) patients were male, eighteen were female (43%). The estimated median delay of treatment was 12 months (range 1 to >240 months). In 27 patients (64%) the giant cSCC was localized on the neck, face or scalp, 6 on the thoracic wall or back (14%), 4 on the lower limb (10%), 2 on the hip or buttock (5%), 2 on the upper limb (5%), one (2%) on the breast. Tumor stage at presentation was T2, T3 and T4 in respectively 26 (62%), 11 (26%) and 5 (12%) cases. Lymph node metastases were identified in 1 patient (2%) and distant metastases in another patient (2%). In 34 out of 42 cases (81%) primary radical surgical excision was performed, 3 received radiotherapy, 2 chemotherapy and 3 palliative care. In the cases with reported follow-up, four patients (4/30: 13%) died of disease. The treatment of EAG cSCC poses many problems, making a multidisciplinary approach of paramount importance.

A lobulated mass on the upper back with prominent vasculature: A giant basal cell carcinoma

Basal cell carcinoma (BCC) is characterized by slow but locally invasive growth. Although there is low metastatic potential, if not treated early, these skin cancers can lead to significant morbidity and mortality. In this case report, we present a man with a neglected BCC that developed into what is termed a giant BCC or one that is greater than 5 cm. This tumor was discovered only upon workup of orthostatic lightheadedness and iron deficiency anemia. Although rare, basal cell carcinoma must be included on the differential of a large cutaneous lesion and may be a source of significant blood loss.

Giant-neglected facial Marjolin's ulcer associated with perioperative blood loss anemia

Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in humans after basal cell carcinoma. Marjolin’s ulcer is a form of cutaneous malignancy, and mostly represents cSCC, arising from chronic burns and wounds. We describe an interesting case of giant-neglected facial Marjolin’s ulcer identified as cSCC associated with perioperative blood loss anemia. We also highlight its staging workup and the treatment options provided.

Multidisciplinary management of giant cervicothoracic cutaneous squamous cell carcinoma

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Non treated squamous cell carcinoma could present as an uncontrollable and substantial disaurement neoplasm.

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Squamous cell carcinoma that are diagnosed early and successfully treated by surgical excision, has a better forecast.

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When a patient present with a gigant squamous cell carcinoma always requires a multidisciplinary team.

Introduction

Cutaneus squamous cell carcinoma (SCC) is the second most common type of nonmelanoma skin cancer. SCC is a malignant neoplasm of the skin characterized by aberrant proliferation of keratinocytes.

Presentation case

We report multidisciplinary surgical management of a 36-year-old male who presented with a huge cutaneous protruding tumor of the cervicothoracic wall. Clinically, he presented with a growing mass on the anterior cervicothoracic wall 3 years ago. Microscopic examination revealed SCC. He underwent complete excision of the lesion. The patient neglected attending our oncological department for receiving chemotherapy. Today, one year after surgery, he is alive without evidence of disease recurrence.

Discussion

SCC treatment depends on location of the lesion, involvement of neighboring structures, functional level of the patient, and the patient’s acceptance of the proposed management strategy.

Conclusion

We conclude that SCC can grow to a huge size if left untreated. Surgery by a multidisciplinary surgical team is the primary mode of treatment, followed by chemotherapy if necessary.

Ulcerating Lichen Planopilaris - Successful Treatment by Surgery

Lichen planus is a T-cell mediated autoimmune disorder affecting the skin and mucous membranes. Ulcerating lichen planus is uncommon mostly on oral and genital mucosa but not skin. Lichen planopilaris, however, is a subtype of lichen planus affection hair follicles and leading to permanent scarring alopecia. We report a case of lichen planopilaris of the scalp with multiple alopecic patches ulceration – a hitherto unreported clinical feature. The patient was treated surgically, and the defect could be closed by combined tissue advancement and extension.

Ulcerated Metatypical Basal Cell Carcinoma of the Forehead

An 81-year-old male presented with an ulcerated lesion on the frontal area. The lesion had started three years before with a small ulceration and was initially treated with a cream of betamethasone and fusidic acid twice daily for several months. The clinical impression was ulcerated basal cell carcinoma (BCC). The histopathological findings after surgical excision were consistent with metatypical or basosquamous carcinoma. The importance of metatypical and basosquamous carcinomas is their potential for a more aggressive behaviour than conventional BCC, both regarding local recurrences and metastatic disease. Clinicians should be aware of the more aggressive behaviour of metatypical BCC since it may influence the protocols of follow-up of these patients to timely detect local recurrences and/or metastatic disease.

Very Rare Amelanotic Lentigo Maligna Melanoma with Skull Roof Invasion

BACKGROUND

Lentigo malignant melanoma is a melanoma subtype of chronic sun-damaged skin in elderly Caucasians. Amelanotic variants of lentigo malignant are extremely rare.

CASE PRESENTATION

This is a case report of an 80-year-old male patient who presented with a non-pigmented exophytic tumour of his bald head. After complete surgical excision under the suspicion of squamous cell carcinoma, three-dimensional histologic examination confirmed an amelanotic lentigo malignant melanoma with a tumour thickness of 1.76 mm, resected R0. Five years later he developed the first relapse, the other year a satellite metastasis was surgically removed. One year later, this patient had developed a large relapsing lentigo malignant melanoma with skull roof invasion. There was no evidence of distant metastatic spread. Amelanotic lentigo malignant melanoma is a very rare tumour.

CONCLUSIONS

Serial excision or slow Mohs and Mohs micrographic surgery are the treatments of choice especially in the head and neck area. These tumours may be locally very aggressive as it is shown by skull invasion in the present case.

Scalping Surgery - Dermatologic Indications beyond Curative Primary Skin Cancer Surgery

Skin tumours are among the most frequent tumour types of mankind. In the case of large tumours, field cancerization, or satellitosis scalping surgery is a possible option. The procedure can also be used in a palliative setting with tumour debulking. Less common indications are multiple benign tumours of the scalp and chronic inflammatory scalp dermatoses not responding to medical treatment. We present a case series and discuss surgical modalities beyond curative surgery of primary skin cancer.

A giant squamous cell carcinoma of the skin of the thoracic wall: a case report and review of the literature

Background

We report a case of a 48-year-old white woman who presented with a huge cutaneous protruding tumor of the thoracic wall below her left breast.

Case presentation

The lesion was excised with clear margins from the adjacent skin, and subcutaneous tissue was left to heal with second intention. A histological examination of the surgical specimen revealed a well-differentiated infiltrative cutaneous squamous cell carcinoma. Our patient neglected to attend our Oncological Department to receive chemotherapy. Today, 12 months after surgery, she is alive and without evidence of disease recurrence.

Conclusions

Cutaneous squamous cell carcinoma can reach a huge size if left untreated. Surgery is the primary mode of treatment, followed by chemotherapy if applicable.

Giant Basal Cell Carcinoma: A 12-Year Follow-up Case Report

Giant basal cell carcinomas (GBCCs) are a strange and aggressive variety of basal cell carcinomas (BCCs); they are characterized by deep tissue invasion, rapid growth, high risk of metastasis, and a poor prognosis. GBCCs represent 0.4%-1% of all BCCs. The pathogenesis of GBCC is sometimes linked to a spontaneous mutation in the PTCH gene, mapped to the q22.33 locus of chromosome 9. The key factor in the development of GBCC, in at least 30% of the cases, is the delay in seeking medical attention (7.5 ± 3.1 years). This is associated to a poor socioeconomic level, deficient hygiene, mental illness, advanced age, and the fact that BCCs are painless lesions. The authors present a Mexican female with a 2-year ulcer diagnosed as a GBCC in the year 2000, its initial therapeutic approach, and her follow-up during the next 12 years.

Myiasis on a Giant Squamous Cell Carcinoma of the Scalp: A Case Report and Review of Relevant Literature

Non-melanoma skin cancer is the most common malignancy amongst Caucasians worldwide with basal cell and squamous cell cancer being the most common. Giant skin cancers are a relatively rare type of skin cancer that are, by definition, greater than 5 cm. This subtype by itself is associated with a significantly increased risk of complications and mortality. Myiasis is defined as infestation of body tissues of humans by dipterous larvae. Myiasis is often associated with malignant skin conditions. We describe a rare case of cutaneous myiasis located on a giant squamous cell carcinoma of the scalp in an elderly female. Myiasis coupled with malignant skin conditions provides a unique surgical challenge. This is especially true if the malignancy is invasive, as in our case, often requiring a multidisciplinary multimodality treatment plan.

Relapsing advanced metatypical basal cell carcinomas (MTBCC) of the face: surgical modalities

Metatypical basal cell carcinoma (MTBCC) represents a high-risk type of cutaneous tumour. We report about three different patients with relapsing advanced large MTBCC: one of the scalp and two of the cheek region. Such patients required in most of the cases a complex surgical approach to achieve a stable and complete remission. In the first presented patient a combination of flaps and grafts has been performed. We describe tailored surgical approaches. By this contrivance it is possible to treat even elderly patients with exposed bone after complete excision effectively and safe. Interdisciplinary team work is for the benefit of these patients.

Metatypical Basal cell carcinomas: a successful surgical approach to two cases with different tumor locations

We present 2 rare cases of metatypical basal cell carcinoma - two 72-year-old male patients with ulcerative lesions localized either to the left forehead or the back. The biopsy revealed a metatypical basal cell carcinoma. The treatment consisted of a wide local elliptical excision with good cosmetic results. There was no sign of recurrence or metastasis during a 12 months follow-up period.Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) make up 95% of the most common types of cancer in the world - the non-melanoma skin cancer (NMSC). BCC is known for its potential to be locally invasive while SCC for its potential to metastasize in lymph nodes. The meta-typical basal cell carcinoma (MTBC) is a rare type of tumor which combines the clinical and histopathological features of both BCC and SCC with a 5% risk for the development of metastases. The gold standard for diagnosis lies in the histopathological verification of the lesional tissue. Clinical examinations alone are not enough.

Advanced basal cell carcinoma

Basal cell carcinoma (BCC) is the most common skin malignancy worldwide. Ultraviolet light exposure is the best known exogenous factor in BCC development. This is also the target for primary prevention. Advanced BCC include locally advanced tumors and metastatic tumors. Prognosis is worse compared to stage I and II BCCs. Mohs or micrographically controlled surgery is the gold standard of treatment. In patients with tumors that cannot be completely removed radiotherapy was the only alternative in the past. More recently new drugs for targeted therapy of signaling pathways like sonic hedgehog or epidermal growth factor receptor became available. More small molecules are under investigation. Since the complete response rates are limited, future research has to evaluate their combination with surgery.

Repair of the donor areas defects after split-thickness skin grafts utilizing an advanced epithelialization dressing

INTRODUCTION

The management of surgical wounds of the donor areas for split-thickness skin grafts might be difficult in terms of pain, risk of infection, and delayed healing.

MATERIALS AND METHODS

In the period from September 2011 to June 2012, 12 patients affected by large ulcerated basal cell carcinoma (BCC) of the lower legs, 2 patients affected by squamous cell carcinoma (SCC), and 1 patient presenting malignant melanoma located on the scalp, with split-thickness skin grafts were treated. In the 12 BCC patients, the donor site areas were situated on the anterior or lateral site of the contralateral thigh and in 3 other patients on the forearms. Immediately after dermatome skin removal of 0.3 mm layer of epidermis, the donor sites were treated by applying an advanced epithelialization dressing consisting of pure cellulose film in all patients. The wound surfaces were covered by the cellulose dressing with 1 cm of excess. Bleeding was controlled with slight compression with sterile gauzes before the medication was applied. Multiple small cuts of the cellulose dressing, with a No. 11 surgical blade were made, in order to avoid hematoma formation or fluid accumulation. A mild compression bandage was used in all patients. The patients were visited after 7, 14, and 21 days. The bandage was removed after 1 week and the medical device was left at the site for other 7 days.

RESULTS

After 2 weeks, the medical device was partially detached on the underlying areas showing almost completely reepithelialization. Almost no pain was referred by the patients. In the authors' experience, this medical device markedly reduces the level of pain especially at the time of dressing application, after the surgical procedure, and during the healing process. No infections were observed. The healing process was fast and produced good aesthetic results.

CONCLUSIONS

The use of Cuticell® Epigraft BSN medical device simplifies the management and healing of the donor areas for split-thickness skin grafts.