Multiple Facial Basal Cell Carcinoma With Xeroderma Pigmentosum

Multiple basal cell carcinomas are rare in children and adolescents. Xeroderma pigmentosum (XP) is a rare autosomal recessive hereditary disease characterized by photosensitivity, changes in skin pigmentation, and early onset of skin cancer. XP is extremely rare in clinical practice, with only a few cases worldwide. XP is clinically incurable. The main goal of treating this disease is to diagnose as early as possible, educate patients to strictly avoid ultraviolet radiation for life, and follow up regularly to treat skin malignant tumors in time. The authors report a 15-year-old boy with facial multiple basal cell carcinoma with XP. Its medical history, clinical features, auxiliary examination, and surgical treatment process have great reference value for the in-depth understanding of the disease. The authors will discuss how to delay the progression of the disease and treat the existing lesions in different clinical stages of the disease in combination with the existing relevant literature.

Marginal Mandibulectomy and Oral Rehabilitation of Xeroderma Pigmentosum Patient

Xeroderma pigmentosum (XP) may cause tissue deformation in patients who have undergone oral cancer surgery requiring resection of any part of the mandible. Oral rehabilitation is a pivotal factor in the restoration of function and esthetics. The aim of this study was to report a clinical case of successful prosthetic rehabilitation of a 57-year-old woman who presented with marginal mandibulectomy and a significant reduction in maximal mouth opening after treatment for XP. With her reduced opening and considerable loss of structure and tissue, she had difficulty speaking, swallowing, and altered esthetics. The oral rehabilitation was performed with complete maxilla denture and mandible overdenture retained by 2 implants. This case demonstrates that the rehabilitation with mandible overdentures and complete maxilla dentures provide function and esthetic improvement in the mutilated area for XP patients with marginal mandibulectomies.

Conjunctival leiomyosarcoma in a patient with xeroderma pigmentosum: 5-year follow-up without recurrence

Conjunctival leiomyosarcoma is a very rare soft tissue malignancy. Herein, we describe a conjunctival leiomyosarcoma case in a patient with another rare disease, xeroderma pigmentosum. The 27-year-old single-eyed xeroderma pigmentosum patient complained of exophytic mass covering the ocular surface in her left eye. A vascular, hemorrhagic mass covering the entire ocular surface of the left eye was identified on the examination. Thus, total mass excision surgery was performed. The pathological diagnosis was compatible with conjunctival leiomyosarcoma. Additional chemotherapy, radiotherapy, or surgery were not accepted by the patient. No recurrence or metastasis was observed during the 5-year follow-up. Both primary conjunctival leiomyosarcoma and xeroderma pigmentosum are very rare diseases. Conjunctival masses in xeroderma pigmentosum patients should be approached carefully, and histopathological examination is warranted. For conjunctival leiomyosarcoma, early diagnosis, localized, unspread disease, and complete resection provide the best prognosis.

Eyelid reconstruction in a child with xeroderma pigmentosum

CLINICAL CASE

Seven-year-old male patient, affected by xeroderma pigmentosum (XP) who was referred to ophthalmology due to the presence of numerous tumours in his left eye that affected the eyelids and conjunctiva. He had a tumour in his lower eyelid that affected the free edge, creating a secondary ectropion, and several lesions with a melanocytic appearance in conjunctiva. A resection of the eyelid tumour and the conjunctival lesions were performed by placing a skin graft and amniotic membrane, respectively, as covering.

DISCUSSION

XP patients have high probability of developing eye tumours. A thorough ophthalmic examination is necessary to establish an early diagnosis.

Orbital myiasis complicating squamous cell carcinoma in xeroderma pigmentosum

Ophthalmomyiasis is a rare infection seen in susceptible individuals. We report a case of orbital myiasis in squamous cell carcinoma (SCC) in a patient of xeroderma pigmentosum. On presentation, reddish brown ulcerated mass with numerous maggots in orbit were seen. Computed tomography scan showed the presence of soft tissue lesion without any bony destruction. Following debridement, emergency exenteration with sacrifice of eyelid skin was performed. The diagnosis of SCC was confirmed on histopathologic evaluation. The maggots belonged to family Calliphoridae and secondary bacterial infection with Klebsiella organism was identified. Management issues included extensive involvement requiring exenteration, non-availability of skin graft, delayed secondary healing and recurrence of pigmented lesions in skin lining of orbit. The skin grafting was avoided as it can harbour the neoplasm.

[Conjunctival melanoma and xeroderma pigmentosum, a rare association]

Ocular involvement in the xeroderma pigmentosum (XP) can be located on the eyelids, conjunctiva or cornea. Malignant melanoma of the conjunctiva is a rare tumor, and even more so in children. Only five cases associated with XP have been published since 1960. We report a sixth case occurring in a girl aged 14. Surgical treatment consisted of an orbital exenteration extended to the eyelids and the evolution is marked by a good healing of the orbital cavity without local recurrence after four months.

Anaesthetic management of patients with Xeroderma pigmentosum. A series of three cases

Xeroderma pigmentosum is a rare autosomal recessive disorder with clinical and cellular hypersensitivity to ultraviolet radiation and defective DNA repair. Skin cancer, mainly on the face, head or neck is very common. Inhalational anaesthetic agents and muscle relaxants are best avoided due to the possibility of inducing DNA damage and prolonged effects of muscle relaxants. These patients may have a difficult airway. These patients may have immature brain development which may render them sensitive to synergistic effect of benzodiazepines and opioids as seen in the first case. Total intravenous anaesthesia is preferred. Nonsteroidal anti inflammatory agents and opioids for multimodal analgesia may be beneficial.

Two extreme conditions of xeroderma pigmentosum

Two atypical cases of xeroderma pigmentosum are reported. One of these cases with lung metastasis of squamous cell carcinoma in the first decade of life and the other with late onset disease (XP) in fifth decade of life. Lung metastasis of squamous cell carcinoma in first decade of life in patients with xeroderma pigmentosum has never been reported in the literature to our knowledge. Late onset of the disease in fifth decade is also a rare condition. Clinicians should be more alert for the internal organ metastases to improve the survival of the patients and should never forget that xeroderma pigmentosum has got a wide range of clinical presentation.

Atypical fibroxanthoma and squamous cell carcinoma of the conjunctiva in xeroderma pigmentosum

Patients with xeroderma pigmentosum (XP) have defective DNA repair and a high predisposition to developing abnormalities and neoplasia in the sun-exposed areas of the skin and mucous membranes. The most common tumors reported in patients with XP are squamous cell carcinomas, basal cell carcinomas, and melanomas. Atypical fibroxanthoma (AFX) is a pleomorphic tumor that arises predominantly in the sun-damaged skin of the head and neck regions of the elderly. We describe a unique case of a 6-year-old African American boy with XP who developed an atypical fibroxanthoma and 2 squamous cell carcinomas in the conjunctiva. The clinical and histopathologic findings of AFX are discussed.

Xeroderma pigmentosa--a disfiguring disease

Xeroderma pigmentosa is a rare inherited autosomal recessive disease with the inability to repair DNA damage caused by UV light. Recognized in the late 1800 by Maritz Kaposi it has been reported world wide and in all races with an over prevalence of 1-4 per million population. Kunwar et al. Those affected are extremely sensitive to the UV portion of the light and have a 2000-fold increased risk of skin cancer in the sun exposed skin. Basal cell carcinoma is the most commonly associated carcinoma followed by Squamous cell carcinoma and Melanoma. The pigmentation on the face and the rest of the body can be horribly disfiguring. The recurring cancer occurring on the face and repeated surgical treatment for the ulcerations have important social and psychological implications not encountered with other cancers. We report two cases of BCC and melanoma. The first case is of BCC of the face in a teenaged girl coexisting with xeroderma pigmentosa. The second case presented with melanoma of the scalp in a 10 year old female child. The details of these cases are presented and the management.

Early results of penetrating keratoplasty following limbal stem cell transplantation

PURPOSE

To describe the early results of penetrating keratoplasty (PKP) in patients who had earlier received limbal transplantation (LT).

METHODS

Prospective, non-comparative interventional case series comprising of four patients with limbal stem cell deficiency (LSCD) due to chemical injury (Cases 1, 2, 4) and xeroderma pigmentosum (Case 3). Cadaveric kerato-limbal allografts or living-related conjunctival-limbal allografts were done in four eyes followed by PKP for visual rehabilitation 3-4.5 months later. The following details were noted: demographics, primary aetiology, type of limbal transplant (cadaveric or living-related), immunosuppression, vision and ocular surface stability before and after LT and PKP, surgical complications and outcome of PKP.

RESULTS

Three eyes received living-related conjunctival-limbal allotransplantation and one received cadaveric kerato-limbal allograft. Duration of follow up after PKP ranged from 4 to 11 months. Visual acuity improved in the early postoperative period in all patients but reduced in 2 due to endothelial rejection and after trans-scleral cyclophotocoagulation for medically uncontrolled glaucoma. The ocular surface remained stable in all patients. All patients were started on immunosuppression on the first postoperative day. This was continued till the last follow-up visit. Post-PKP complications were punctate epithelial keratopathy, corneal allograft rejection and secondary glaucoma (one patient each).

CONCLUSION

Satisfactory visual rehabilitation is possible after PKP following LT without compromising ocular surface stability. However, a prolonged and close follow-up is warranted to avert complications.

Phenol intoxication in a child

Phenol preparations are used in dermatology and plastic surgery for the treatment of acne and during chemical face peeling. At this institution, phenol peeling is used in addition to mechanical dermabrasion for the elimination of subclinical premalignant lesions of patients having xeroderma pigmentosum. As the phenol peel is performed, most surgeons concentrate on skin results, ignoring systemic complications. Local histological changes and systemic toxicity have been seen during applications. Cardiac arrhythmias and even sudden death have been reported. The high incidence of cardiac arrhythmias after topical application of phenol preparations is demonstrated. The case of an 11-year-old boy with a diagnosis of xeroderma pigmentosum who underwent mechanical dermabrasion and chemical peeling with phenol and then developed severe cardiac arrhythmias is reported. A serious systemic toxic effect on cardiac rhythm from cutaneously applied phenol occurred in this case.

Case of xeroderma pigmentosum with well differentiated squamous cell carcinoma in the eye

A seven year old female child presented with complaints of increased freckling over the face since the age of two years and a rapidly growing mass over the right eye. She underwent excisional biopsy of the mass over the eye which on histopathological examination was diagnosed as squamous cell carcinoma.

Resurfacing the dorsum of the hand in a patient with Xeroderma pigmentosum

BACKGROUND

One of the most effective treatment methods of Xeroderma pigmentosum (XP) is full resurfacing of the exposed areas with skin grafts.

OBJECTIVE

Introduction of a different surgical technique in order to minimize the undamaged skin removal in XP patients in whom multiple surgical procedures will often be necessary.

METHOD

A special undulant incision of the graft margins around the metacarpal heads was performed.

RESULTS

Both aesthetic and functional results were obtained.

CONCLUSION

Although conservative surgical resection is primarily preferred in XP patients, in cases in whom radical surgical intervention is necessary, in order to minimize undamaged skin, surgical technique of choice should be individualized.

[Anesthesia for a patient with xeroderma pigmentosum]

The anesthetic management of a patient with xeroderma pigmentosum is described. A 17-year-old woman underwent tracheostomy because of progressive recurrent nerve palsy. The operation was performed uneventfully under general anesthesia using propofol and fentanyl. Xeroderma pigmentosum (XP) is an autosomal recessive disease that is characterized by hypersensitivity to sunlight with a high incidence of skin cancer and exhibits variable neurological abnormalities. Classical types of XP have a defect in nucleotide excision repair (NER). It has been reported that volatile anesthetics such as halothane deranged NER in cells obtained from an XP patient. Thus, general anesthesia using volatile agents should be avoided, if possible, because inhalation anesthetics may worsen the symptoms of XP.

Multi-layer amniotic membrane graft for pterygium in a patient with xeroderma pigmentosum

BACKGROUND

Xeroderma pigmentosum (XP) is a rare, autosomal recessive, premalignant condition of the skin, and is reported to be associated with ocular surface disorders such as conjunctival malignancy and pterygium. Herein, we report a case of successful management of pterygium with multi-layer amniotic membrane graft (AMG) in a young XP patient.

CASE

An 11-year-old Japanese girl, who had been diagnosed as having XP, was referred to us for treatment of her bilateral pterygium. Surgical intervention was attempted for a temporal, presumably fast-growing pterygium in her left eye. Multi-layer amniotic membrane grafting was performed.

OBSERVATIONS

The surgery-induced pain and irritation disappeared within a day. The limbal conjunctival autograft survived on the AMG and re-epithelialization over the AMG was completed in 2 weeks. Best corrected visual acuity improved from 20/32 to 20/16 one month postoperatively. During the 1-year follow-up period, no recurrence was noted.

CONCLUSIONS

The present case exemplifies that AMG as an adjunct to primary pterygium resection is effective even in a young patient with XP. In addition, multi-layer AMG, which we first demonstrated in this report, seems to be useful for protecting bare sclera and extraocular muscles from mechanical injury.

Conjunctival necrobiotic granuloma in xeroderma pigmentosum

PURPOSE

We report clinical and histopathologic findings of a conjunctival lesion associated with xeroderma pigmentosum.

METHODS

A Saudi girl with known xeroderma pigmentosum presented with pain and photophobia of the right eye and an elevated temporally located perilimbal mass.

RESULTS

The mass was resected successfully and has not recurred during 1-year follow-up. Histopathologic examination of the tissue showed a necrobiotic granuloma with associated histiocytic infiltration. The patient had no systemic disease, lipid was not detected in the histiocytic lesion, no Touton giant cells were present, and there was no evidence of elastolysis.

CONCLUSION

Ocular malignancies occur in association with xeroderma pigmentosum, but benign lesions that mimic a malignancy may occur.

Squamous cell carcinoma of the lower lid in a 19-month-old girl with xeroderma pigmentosum

Squamous cell carcinoma (SCC) of the skin usually occurs in older patients and commonly develops from actinic keratosis. Patients with xeroderma pigmentosum (XP) can acquire SCC at an early age. To our knowledge the youngest reported patient with XP and SCC was 8 years of age. We report a 19-month-old Lebanese girl with XP who presented clinically because of a rapidly growing mass of the medial part of her right lower lid that was biopsied and found to be squamous cell carcinoma. The mass was surgically excised with no evidence of recurrence after 2 years of follow-up. We describe our clinical experiences with this patient and have reviewed the available literature concerning XP and malignancy.

New tumor formation on split-thickness skin grafted areas in xeroderma pigmentosum

Xeroderma pigmentosum is a relatively rare systemic disease transmitted through an incomplete sex-linked recessive gene. It is characterized by malignant skin degeneration. One of the most effective treatment choices for the malignant changes is full-face resurfacing with skin grafts. Grafts harvested from areas that have some freckles may show malignant degeneration by ultraviolet exposure. The authors present a patient whose face was resurfaced with a split-thickness skin graft and was admitted due to new tumor formation on her resurfaced face.

Otorhinolaryngological aspects of Xeroderma pigmentosum

OBJECTIVE

to evaluate the probable presence of otorhinolaryngological pathology accompanied by head and neck region skin findings in patients with Xeroderma pigmentosum.

METHODS

a total of 19 patients with Xeroderma pigmentosum were investigated for otorhinolaryngological findings. The patients gave their anamnesis and underwent physical examination, audiological tests and endoscopic examination.

RESULTS

various malignancies developed in 14 patients on the sun-exposed areas of the head and neck region. Multiple malignancies were found in six of them. There was no other pathological condition secondary to this rare clinical entity.

CONCLUSION

Xeroderma pigmentosum causes skin lesions. Some otolaryngological findings such as rhinitis, sinusitis etc. were thought to be coincidental.

p53 mutations in skin and internal tumors of xeroderma pigmentosum patients belonging to the complementation group C

Fifty-eight skin biopsies and three primary internal tumors from patients affected by the rare hereditary disease xeroderma pigmentosum (XP) were studied by an improved PCR-single strand conformation polymorphism analysis to detect the mutations of the tumor suppressor gene p53. The results from cutaneous XP tumors, including 27 squamous cell carcinomas and 6 basal cell carcinomas, show a very high level (86%) of p53 mutations. The analysis of mutations found in XP skin cancers according to the complementation group of the patients shows that tandem CC-->TT transitions are a characteristic of XP-C patients with a frequency much higher in their skin tumors (85%) compared with tumors in XP patients who do not belong to group C (33%). In all XP-C biopsies, mutations were due to replication of unrepaired DNA lesions on the nontranscribed strand of the p53 gene, substantiating the preferential repair in vivo of the transcribed strand of this gene in human tissues. For the first time, we were able to analyze three primary internal tumors (a neuroendocrine tumor of the thyroid, a gastric adenocarcinoma, and a glioma of the brain) of young XP children. All of them contained one mutation on the p53 gene, which were different from the ones found in the XP skin tumors and could have resulted from unrepaired lesions caused by oxidative damage.

Xeroderma pigmentosum variant or pigmented xerodermoid

We describe herein a 29-year-old patient who was recognized as having a xeroderma pigmentosum variant or pigmented xerodermoid in the early adult life since sunlight sensitivity caused degenerative changes in the skin and cutaneous carcinomas. The patient had 11 skin tumours removed over an interval of two years, of which four proved to be squamous cell carcinoma, one basal cell carcinoma and six precancerous conditions. Then the patient was treated with isotretinoin at a dosage of 2 mg per kilogram of body weight per day for two years. During two years of treatment with isotretinoin a further three tumours were removed givind a histological result of basal cell carcinoma and Bowen's diseases. The patient tolerated well this low dosage retinoid treatment. Only 50 or so of these patients are described in the world literature.

The role of dermabrasion and chemical peels in the treatment of patients with xeroderma pigmentosum

We describe our experience with two patients with xeroderma pigmentosum who underwent periodic trichloroacetic acid chemical peels. One also received a full-face dermabrasion. The effect of chemical peeling was more transient than dermabrasion but was associated with less morbidity. Both chemical peeling and dermabrasion provided a prophylactic effect against the development of skin malignancies; the latter had a more pronounced effect.

Penetrating keratoplasty in xeroderma pigmentosum. Case reports and review of the literature

Xeroderma pigmentosum is an uncommon inherited disorder characterized by hypersensitivity to ultraviolet radiation, with defective repair of DNA damage caused by short-wavelength radiation. Corneal complications of this disorder may require penetrating keratoplasty for visual rehabilitation. Surgery is rarely undertaken in these eyes due to multiple associated problems involving the ocular surface and the lids. We report three cases of successful penetrating keratoplasty in xeroderma pigmentosum and review nine cases reported earlier. Successful grafts were achieved in all 12 eyes initially. Persistent superficial punctate keratopathy was observed in one eye and graft rejection episodes in five eyes. However, graft failure occurred due to an untreated rejection episode in only one eye. Another eye was treated by exenteration for recurrent ocular malignancies. This report highlights the encouraging results of penetrating keratoplasty in carefully selected patients of xeroderma pigmentosum with corneal pathology.

[Multiple melanoma in xeroderma pigmentosum]

Xeroderma pigmentosum comprises a heterogeneous group of autosomal recessive hereditary diseases, which are characterized by a number of clinical characteristics and an abnormal DNA repair mechanism. Patients affected show a high frequency of mucocutaneous malignant tumors, especially squamous cell carcinomas and basal cell carcinomas. We report on a 65-year-old patient who successively developed a total of 15 malignant melanomas, 1 squamous cell carcinoma and 1 lymph node metastasis of a malignant melanoma. The clinical diagnosis of xeroderma pigmentosum was confirmed by the complementation analysis, which defined our patient as xeroderma pigmentosum of the complementation group D.

[Xeroderma pigmentosum--case report]

The authors presented a case of a boy aged 16, in whom xeroderma pigmentosus was diagnosed 6 years earlier. The boy was referred to the clinic on account of a quickly growing tumor of conjunctiva and cornea of his right eye. During 2-year follow-up, in spite of two surgical excision, the tumor relapsed and finally enucleation of the eyeball was performed. Histopathological examination revealed melanoma malignum. The clinical aspects of prophylaxis, early diagnosis and treatment of xeroderma pigmentosum are discussed.

Exuberant epibulbar tumor penetrating into the orbit in xeroderma pigmentosum

The clinical and histopathological findings are described in a 10-year-old girl with xeroderma pigmentosum and multiple ophthalmic complications, including the eyelids, conjunctiva, orbit, cornea and iris; some of these complications took an unusual form. Histological examination following right orbital exenteration revealed an epibulbar squamous cell carcinoma penetrating the orbit and building a noose all around the ocular globe with subsequent strangulation. Moreover, a palpebral squamous cell carcinoma developed-independently from the right lower lid and, unconnected with the epibulbar tumor, penetrated to the orbit.

Xeroderma pigmentosum: resurfacing versus dermabrasion

Three patients of Xeroderma Pigmentosum (XP) have been managed for recurrent tumours. Improvement in pigment pattern was observed at both the donor as well as the recipient sites. An attempt has been made to prevent further occurrence of tumours over the exposed parts of the body by resurfacing and also by dermabrasion. A comparative study of the two procedures is being carried out and the preliminary results are discussed. Deep dermabrasion appears to be preferable as a prophylactic procedure.

Facial resurfacing in xeroderma pigmentosum with monoblock full-thickness skin graft

A case of xeroderma pigmentosum with multiple skin tumors on the face that was treated with total excision and replacement of face skin except the eyelids with a monoblock full-thickness abdominal skin graft is reported. The quality and tumor-free features of the monoblock full-thickness skin graft in xeroderma pigmentosum are indicated. Despite the increased morbidity of the donor region, the radical surgical approach advocated here has improved the prognosis in the case reported.

Microsurgical facial reconstruction of a xeroderma pigmentosum patient after skin tumor resection: case report

Microsurgical reconstruction of the face completely destroyed after malignant skin tumor excisions in a xeroderma pigmentosum patient is reported. The patient's left cheek was reconstructed using a free latissimus dorsi flap and the nose using a free forearm flap with a base of iliac bone graft. There has been no recurrence of tumor at or surrounding the transferred flap site over two years postoperative follow-up.

Facial resurfacing in xeroderma pigmentosum: are we spoiling the ship for a ha'p'orth of tar?

A case of xeroderma pigmentosum (XP) is reported whose treatment included sub-total excision of facial skin and resurfacing in aesthetic units with grafts of relatively undamaged buttock skin. The principle of resurfacing is logical and supported by this and other reports which are reviewed. Though control was achieved in the grafted areas, tumours continued to develop in adjacent ungrafted skin. The importance of radical excision of exposed skin in severe cases of XP is emphasised.