Diagnosis and Management of Basal Cell Carcinoma

MALDI imaging mass spectrometry differentiates basal cell carcinoma from trichoblastoma and trichoepithelioma: A proof of principle study

BACKGROUND

Basal cell carcinoma (BCC) comprises a large portion of dermatopathology specimens; however, benign mimics such as trichoblastoma/trichoepithelioma (TB/TE) place accurate diagnosis at risk and consequently lead to inappropriate clinical management and overuse of healthcare resources. This study aims to address the challenges of traditional histopathological evaluation by utilizing matrix-assisted laser desorption ionization imaging mass spectrometry (MALDI IMS).

METHODS AND FINDINGS

Formalin-fixed paraffin-embedded BCC and TB/TE tissue blocks were taken from archival tissue. A cohort of 69 BCC and TB/TE specimens were identified, each having three concordant diagnoses given by Dermatopathologists after a blinded analysis. H&E stained sections of each specimen were imaged for pathological analysis and uploaded to a digital annotation software with the following classifications: BCC, TB, TE, BCC stroma, TB stroma, and TE stroma. Mass spectra were collected from unstained serial sections guided by the areas annotated by the Dermatopathologists on the H&E stained serial sections. Before informatics, the data from the cohort were divided randomly into a training set (n = 55) and a validation set (n = 14). Prediction models were developed using a support vector machine (SVM) classification model from the training set data. The platform predicted BCC and TB/TE in model 2 (tumor nests alone) with a sensitivity of 98.9% (95% CI 98.3-99.4%) and specificity of 88.4% (95% CI 78.4-94.5%) at the spectral level in the validation set. Model 1 (stroma alone) had a sensitivity of 46.1% (95% CI 43.0-49.1%) and specificity of 99.2% (95% CI 97.1-99.9%). A combined model 3 (tumor nests and stroma) had a sensitivity of 90.26% (95% CI 89.1%-91.3%) and a specificity of 97.1% (95% CI 94.6% to 98.7%). The limitations of this study included a small sample set, which included easily identifiable cases obtained from a single tissue source.

CONCLUSIONS

Our study proves that BCC and TB/TE exhibit different proteomic profiles that one can use to enable accurate differential diagnosis. While our findings are not yet validated for clinical use, this merits further research to support IMS as an ancillary diagnostic tool for adequately and efficiently identifying the most common cutaneous malignancy in the United States. We recommend that future studies obtain a more extensive set of histologically challenging cases from multiple institutions and adequate clinical follow-up to confirm diagnostic accuracy.

Current treatment options for locally advanced and metastatic basal cell carcinoma. A narrative review

INTRODUCTION

Although basal cell carcinomas (BCC) are the most common skin cancer and usually considered as 'easy-to-treat,' locally advanced BCC (laBCC) and metastatic BCC (mBCC) are rather exceptional and often more 'difficult-to-treat.' They load a high burden on the quality of life (QoL) of the patients, often elderly and frail individuals. Several management options are possible, varying from supportive therapy without any therapeutic intervention until anti-programmed cell death protein-1 (PD-1) immunotherapy, such as cemiplimab, either administered intravenously or intralesional. In between this spectrum, oral hedgehog inhibitors including vismodegib and sonidegib, electrochemotherapy, different types of radiotherapy, and surgery can be considered. CAR-T cell therapy, anti-LAG therapy, and multiple combination therapies are currently under investigation for laBCC and mBCC.

AREAS COVERED

Current and future treatment options for the management of laBCC and mBCC, limitations of different approaches as well as some practical and financial aspects are presented.

EXPERT OPINION

The management of laBCC and mBCC patients is determined by a multidisciplinary dermato-oncology board, including dermatologists, medical oncologists, radiotherapists, pathologists, and surgeons, as well as the patient's GP. Today, experts recommend keeping as long as possible laBCC and mBCC patients under sequential courses of HHIs, if surgery and/or radiotherapy are not amenable.

Long-term outcomes of reduced-dose bleomycin in electrochemotherapy for basal cell carcinoma in elderly patients

Electrochemotherapy (ECT) is a minimally invasive treatment option for basal cell carcinoma (BCC), which is particularly advantageous in the elderly population. This study evaluated the long-term effects of treating BCC in older patients using ECT with a reduced dose of bleomycin (10,000 IU/m2) and compared the results to patients who received the standard dose of bleomycin (15,000 IU/m2). The retrospective analysis included 116 patients aged over 65 years with 257 histologically confirmed BCCs. Tumors were treated with either the standard dose (n = 82) or the reduced dose (n = 175) of bleomycin. The results showed that the recurrence rate was comparable between the groups, particularly in the first year after treatment. The reduced-dose group exhibited a greater recurrence rate after the first year, which may be attributed to a weaker local immune response due to the de-escalated dose of bleomycin. Nonetheless, administering a standard bleomycin dosage as a salvage treatment in the event of recurrence proved highly effective. These findings suggest that ECT with a reduced bleomycin dose is a viable option for treating BCC in elderly patients, particularly those with shorter life expectancy.

A narrative review on the use of Green synthesized metallic nanoparticles for targeted cancer therapy

Cancer is a leading cause of death worldwide. While traditional and synthetic medical therapies are in place for cancer treatment, their effectiveness is hindered by various limitations, such as toxic side effects, limited availability, and high costs. In recent years, a promising alternative approach has emerged in the form of green-synthesized metallic nanoparticles (MNPs), which offer targeted cancer therapy. These nanoparticles (NPs) have garnered significant attention from cancer researchers owing to their natural or surface-induced anticancer properties, versatility of metals as agents, and eco-friendly nature. This approach may positively impact healthy cells surrounding the cancerous cells. Green-synthesized MNPs have gained popularity in cancer management because of their ease of handling in the laboratory and the affordability of starting materials compared to synthetic methods. This review analyzes green-synthesized MNPs for targeted cancer therapy, highlighting tumor-targeting strategies, synthesis methods, and clinical challenges. Unlike general reviews, it compares plant-, microbial-, and enzyme-mediated synthesis approaches, emphasizing their impact on nanoparticle stability, functionalization, and interactions with the tumor microenvironment for enhanced therapeutic efficacy.

Clinical and experimental aspects of tirbanibulin treatments

Tirbanibulin is a topical medication approved in 2020 as a 5 day topical treatment for actinic keratosis, a precancerous skin lesion characterized by the hyperproliferation of atypical keratinocytes. Tirbanibulin exerts its effects through dual mechanisms: microtubule inhibition, which disrupts cell division, and Src kinase inhibition, which interferes with cancer-associated signaling pathways. Although its primary use is in AK, these mechanisms suggested potential therapeutic applications in a broader range of epithelial cancers. In this literature review, we explored tirbanibulin's application in not only actinic keratosis, but also in squamous cell carcinoma and basal cell carcinoma. We addressed the relevant findings obtained in recent papers to evaluate tirbanibulin's safety, efficacy, side effects, real-life clinical experiences, and its potential in anti-aging and skin lightening therapies on patients. In summary, we highlighted the preclinical and clinical evidence on the use of tirbanibulin as an effective and safe treatment option beyond AK. Graphical Abstract.

Basal Cell Carcinoma: An Old Friend with Multiple Faces

BCC is the most prevalent form of skin cancer, characterized by diverse clinical and pathological subtypes ranging from indolent to highly aggressive forms. While the majority of BCC cases are treated effectively with surgery or local therapies, locally advanced BCC (laBCC) and metastatic BCC (mBCC) pose significant therapeutic challenges. Recent advances in HHIs and immunotherapy have transformed the treatment landscape in such cases. However, resistance and intolerance to these treatments necessitate alternative approaches, including chemotherapy. Platinum-based agents such as cisplatin and carboplatin have shown limited efficacy but remain viable options in rapidly progressive cases. Among the therapeutic innovations to be explored, further lines of immunotherapy as well as combination therapies involving immunotherapy and targeted therapy have been proposed. This review synthesizes the current understanding about BCC subtypes, risk stratification, and emerging treatments, with a particular focus on laBCC and mBCC.

Outcome of basal cell carcinoma excision with 2 mm surgical margin in Japanese patients: A retrospective study of one-step surgery

Background

Basal cell carcinoma is the most common skin malignancy. The standard treatment is surgical excision with predetermined margins. Some argue that the currently recommended surgical margins are excessive, and it is questionable whether such wide surgical margins should be applied to all lesions. We statistically investigated excisions with narrow margins and tried to identify the risk factors for recurrence after one-step surgery.

Methods

Basal cell carcinomas were excised at a single institute in Japan over a six-year period and the recurrence rates were retrospectively analyzed using pathological reports and case notes. We reviewed the microscopic findings of the excised specimens and examined the excisional margin status, tumor subtype, and perineural invasion.

Results

Forty-eight basal cell carcinomas (45 primary and 3 recurrent) that were identified in Japanese patients were included in this study. Among the primary lesions, well-pigmented and well-defined lesions did not show any involvement of the surgical margins, perineural invasion, or development of local recurrence. Recurrent lesions were significantly associated with positive surgical margins (side margin, P<0.01; deep margin, P<0.01) during the primary operation; however, no association was found with local recurrence after re-resection. Significant differences were observed in perineural invasion and the tumor subtype, especially in the aggressive subtype (P<0.05).

Conclusions

A 2 mm margin allows for the safe excision of primary lesions with well-pigmented and well-defined basal cell carcinoma in Japan. Recurrent lesions can be treated with narrow margins by reconstruction after confirmation of a negative margin, instead of performing a common resection with wide margins.

Dermatosis Neglecta and Chilblain Lupus Erythematosus Occurred Post Surgery of Basal Cell Carcinoma: A Case Report

Dermatosis neglecta (DN) is a rare condition, often linked to psychosomatic disorders, with an unclear etiology. Chilblain lupus erythematosus (CHLE) constitutes a rare variant of cutaneous lupus erythematosus, frequently mistaken for idiopathic chilblain due to its chilblain-like lesions. To date, no instances of concurrent DN and CHLE occurring at the site of a skin flap or graft have been documented. Herein, we present a case that the occurrence of DN and CHLE developed on a skin flap at once. The simultaneous occurrence of DN and CHLE on a skin flap is exceptionally rare. Clinicians must exercise heightened vigilance due to the common misdiagnosis of CHLE. Various skin disorders can manifest on skin flaps and grafts post-transplantation. Thus, clinicians must remain vigilant for both recurrence and metastasis during post-operative monitoring, while also attending to patients' mental well-being and the condition of skin flaps.

Molecular Biomarkers in Cutaneous Photodynamic Therapy: A Comprehensive Review

BACKGROUND/OBJECTIVES

Photodynamic therapy (PDT) is widely utilized in dermatology for the treatment of various skin conditions. Despite its effectiveness, the exact biomolecular changes underlying therapeutic outcomes remain only partially understood. This review, through a transversal approach, aims to provide an in-depth exploration of molecular biomarkers involved in PDT, evaluate its underlying mechanisms, and examine how these insights can contribute to enhanced treatment protocols and personalized therapy approaches.

METHODS

A narrative review of the literature was conducted, targeting peer-reviewed articles and clinical trials that focus on PDT and its molecular biomarker effects on dermatological conditions. The databases searched included PubMed, Scopus, and Web of Science, and the inclusion criteria encompassed original research articles, systematic reviews, and meta-analyses in English.

RESULTS

PDT effectively reduces the expression of critical biomarkers such as p53, Cyclin D1, and Ki-67 in AK and other cancerous lesions, leading to reduced cell proliferation and increased apoptosis. Additionally, PDT promotes extracellular matrix remodeling and stimulates collagen production, which has a rejuvenating effect on the skin and a promising role in the treatment of chronic wounds.

CONCLUSIONS

PDT represents a powerful and versatile treatment option for various dermatological conditions due to its ability to target cellular pathways involved in proliferation and apoptosis. Further research into optimizing treatment parameters and combining PDT with other targeted therapies may enhance patient outcomes, reduce resistance, and pave the way for more individualized therapeutic approaches in dermatology.

Combining Phototherapy and Gold-Based Nanomaterials: A Breakthrough in Basal Cell Carcinoma Treatment

Basal cell carcinoma (BCC) is the most common type of skin carcinoma worldwide. BCC development is the result of a complex interaction between environmental, phenotypic, and genetic factors. While conventional treatments such as surgery and topical therapies have demonstrated variable efficacy (some of them with limited efficacy), they are not free of adverse side effects, most of them debilitating. Thus, there is a notable gap in the literature regarding alternative and non-invasive therapeutic options. This review aims to address this gap, exploring the potential of photothermal therapy (PTT) combined with metallic nanoparticles, namely gold nanoparticles (AuNPs), as a minimally invasive treatment approach. Through a comprehensive review of the literature in the period from 2014 to 2024, using experimental investigations, this review seeks to elucidate the intricate interplay between genetic factors, environmental influences, and the tumor microenvironment in BCC disease progression, with PTT as a potential therapeutic strategy. Those studies confirmed an enhanced targeting of cancer cells and selective ablation of tumor tissue, using emerging technologies like PTT. A significant tumor reduction, often exceeding 50%, was observed, with some studies reporting complete elimination of the tumor. The main adverse effects noted were localized skin irritation and transient hyperpigmentation, but these were generally minimal and manageable, highlighting the promise of PTT as an effective treatment. Thus, by leveraging the unique properties of AuNPs to enhance the effectiveness of PTT, the targeting of cancer cells can more precisely occur, reducing collateral damage to healthy tissues. This approach not only aims to achieve better clinical results, but also contributes to the broader knowledge base in the field of BCC research. Continued research and clinical trials will be crucial in refining those techniques and validating their efficacy, ultimately paving the way for more effective and less invasive treatments for BCC.

Cold plasma irradiation inhibits skin cancer via ferroptosis

Cold atmospheric plasma (CAP) has been extensively utilized in medical treatment, particularly in cancer therapy. However, the underlying mechanism of CAP in skin cancer treatment remains elusive. In this study, we established a skin cancer model using CAP treatmentin vitro. Also, we established the Xenograft experiment modelin vivo. The results demonstrated that treatment with CAP induced ferroptosis, resulting in a significant reduction in the viability, migration, and invasive capacities of A431 squamous cell carcinoma, a type of skin cancer. Mechanistically, the significant production of reactive oxygen species (ROS) by CAP induces DNA damage, which then activates Ataxia-telangiectasia mutated (ATM) and p53 through acetylation, while simultaneously suppressing the expression of Solute Carrier Family 7 Member 11 (SLC7A11). Consequently, this cascade led to the down-regulation of intracellular Glutathione peroxidase 4 (GPX4), ultimately resulting in ferroptosis. CAP exhibits a favorable impact on skin cancer treatment, suggesting its potential medical application in skin cancer therapy.

Epidemiology and tumor microenvironment of ocular surface and orbital tumors on growth and malignant transformation

The ocular surface and orbit constitute unique microenvironments in the human body. Current advances in molecular research have deepened our understanding of tumor development in these regions. Tumors exhibit greater heterogeneity compared to normal tissues, as revealed by pathological and histological examinations. The tumor microenvironment (TME) plays a crucial role in the proliferation and progression of cancer cells. Factors from the external environment or the body's own inflammation and microcirculation interact within the TME, maintaining a delicate balance. Disruption of this balance, through uncontrolled signal pathway activation, can transform normal or benign tissues into malignant ones. In recent years, various systemic immunotherapies have been developed for cancer treatment. This study reviews the epidemiology of ocular surface and orbital tumors include squamous cell carcinoma, basal cell carcinoma, sebaceous carcinoma and lymphoma in conjunction with their occurrence, growth, and underlying mechanisms. We propose that by examining clinical histopathological images, we can identify specific and shared microscopic features of tumors. By collecting, classifying, and analyzing data from these clinical histopathological images, we can pinpoint independent diagnostic factors characteristic of tumors. We hope this study provides a basis for future exploration of the mechanisms underlying different ocular diseases.

Body fat percentage vs body mass index in estimating basal cell carcinoma

Background

The role of body mass index (BMI) in basal cell carcinoma (BCC) risk remains controversial, and limited information is available regarding the relationship between other physical measurements and BCC. Several recent studies have found a positive effect of adiposity on improved survival when obesity was determined solely by BMI (the "obesity paradox"). We hypothesize that body fat percentage (BFP) may serve as a more sensitive risk factor for BCC than BMI.

Methods

The study conducted a retrospective analysis of clinical data from two distinct centers in China. Individual patient-level data were obtained from medical record reviews spanning January 1, 2015, to December 31, 2022. Associations with outcomes were analyzed using univariate and stratified analyses and assessed using multiple logistic regression with adjustment for confounding factors. Additionally, we performed a meta-analysis to further test the observations in our study.

Results

A total of 337 patients, ranging in age from 50 to 91 years, with a mean age of 66.88 (standard deviation 10.16), were included. We observed no significant association between BMI and BCC after adjusting for confounders (OR: 0.71, 95 % CI: 0.36-1.40, P = 0.3186). There was also no convincing effect in a meta-analysis (n = 158,741) (OR: 0.99, 95 % CI: 0.93-1.06, P = 0.8). Furthermore, BFP was found to be associated with BCC (OR: 2.64, 95 % CI: 1.17-5.97, P = 0.0196), supported by strong clinical evidence.

Conclusions

Our study supports the hypothesis that BFP is superior to BMI in assessing BCC risk. Multiple logistic regression analyses, coupled with meta-analysis, provided robust evidence that BFP is a sensitive risk factor for BCC, while BMI appears unrelated to risk. According to these findings, routine healthcare practices could benefit from utilizing BFP measurements. The reduction of body fat percentage in low-fat diets may be beneficial for adjuvant treatment of BCC.

Exploring the therapeutic modalities of targeted treatment approach for skin carcinoma: cutting-edge strategies and key insights

INTRODUCTION

Skin carcinoma, including malignant melanoma, basal, squamous, and Merkel cell carcinoma, present significant healthcare challenges. Conventional treatments like surgery and chemotherapy suffer from limitations like non-specificity, toxicity, and adverse effects. The upcoming treatments are dominated by nano-sized delivery systems, which improve treatment outcomes while minimizing side effects. Moving ahead, targeted nanoparticles allow localized delivery of drugs at tumor site, ensuring minimal damage to surrounding tissues.

AREAS COVERED

This review explores various targeting strategies for specific types of skin cancers. The strategies discussed include nanocarrier-mediated targeted delivery with multiple types of ligands like aptamers, antibodies, peptides, and vitamins and their advantages in skin cancer. Upcoming cutting-edge technologies such as smart delivery systems, microneedle-assisted delivery and three-dimensional printed scaffolds have also been discussed in detail. The findings in this review are summarized from databases like PubMed, Scopus, Web of Science, ClinicalTrials.gov, NIH, and articles published between 2005 and 2024 that discuss targeted therapy for skin cancer.

EXPERT OPINION

Specific cancer-targeting strategies promise personalized treatments, improving response rates and reducing need for intensive therapies. The review highlights various challenges, their solution, and economic aspects in this dynamic field. It further emphasizes the potential for specialized strategies to revolutionize skin cancer treatment.

Diagnostic dilemma in pigmented basal cell carcinoma: A case report

Basal cell carcinoma (BCC) is the most common malignant skin tumor, constituting 80% of nonmelanocytic skin tumors. Intermittent exposure to ultraviolet radiation is considered a major risk factor for BCC. This study was done in 2023 at a tertiary care cancer centre in North India. Pigmented BCC is a rare entity, a histopathological and clinical variant of BCC. This entity belongs to the category of nonmelanocytic skin tumors but exhibits increased pigmentation. Increased pigmentation also creates suspicion of melanocytic tumors, seborrheic keratosis, and Discoid Lupus Erythematosus DLE. However, this diagnostic dilemma can be elicited with histopathological analysis and clinical correlation. However, to prevent basal cell carcinoma, the best is to avoid direct sunlight; if it cannot be avoided, use sunscreen.

Basal Cell Carcinoma of the 2nd Digit Treated With the Reverse Cross-Finger Flap: A Case Report

Basal cell carcinoma (BCC) is the most common form of skin cancer but rarely presents on the finger with few cases described in the literature. We present the case of a 77-year-old female with a nine-month history of biopsy-proven BCC on the dorsal aspect of her left index finger. Following the complete surgical excision of the tumor, a two-stage reverse cross-finger flap was performed, resulting in minimal impact on mobility and aesthetics and prompting a discussion on the efficacy of this approach in treating BCC of the hand. We explore the various treatment modalities available for BCCs, underscoring the importance of tailored interventions for optimal patient outcomes. The successful outcome in our case emphasizes the significance of considering alternative surgical techniques in managing uncommon presentations of BCCs, contributing to the evolving armamentarium of options available to hand surgeons.

Therapeutic Approaches for Non-Melanoma Skin Cancer: Standard of Care and Emerging Modalities

Skin cancer encompasses a range of cutaneous malignancies, with non-melanoma skin cancers (NMSCs) being the most common neoplasm worldwide. Skin exposure is the leading risk factor for initiating NMSC. Ultraviolet (UV) light induces various genomic aberrations in both tumor-promoting and tumor-suppressing genes in epidermal cells. In conjunction with interactions with a changed stromal microenvironment and local immune suppression, these aberrations contribute to the occurrence and expansion of cancerous lesions. Surgical excision is still the most common treatment for these lesions; however, locally advanced or metastatic disease significantly increases the chances of morbidity or death. In recent years, numerous pharmacological targets were found through extensive research on the pathogenic mechanisms of NMSCs, leading to the development of novel treatments including Hedgehog pathway inhibitors for advanced and metastatic basal cell carcinoma (BCC) and PD-1/PD-L1 inhibitors for locally advanced cutaneous squamous cell carcinoma (cSCC) and Merkel cell carcinoma (MCC). Despite the efficacy of these new drugs, drug resistance and tolerability issues often arise with long-term treatment. Ongoing studies aim to identify alternative strategies with reduced adverse effects and increased tolerability. This review summarizes the current and emerging therapies used to treat NMSC.

Photodynamic application in diagnostic procedures and treatment of non-melanoma skin cancers

OPINION STATEMENT

Skin tumors commonly seen in dermatology are involved in all layers of the skin and appendages. While biopsy of affected skin remains an essential method to confirm diagnosis and to predicate tumor prognosis, it has its limitations. Recently, photodynamic diagnosis (PDD) has demonstrated high sensitivity in detecting affected skin and mucosal tissues, providing valuable guidance for precision surgery to resect skin and mucosal tumors. In this review, we summarized the literatures concerning the applications of PDD in diagnostic process and treatment of skin and mucosal conditions such as actinic keratoses (AK), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Bowen's disease (BD) and extramammary Paget's disease (EMPD). The findings suggest that PDD holds substantial promise for expanding clinical applications and deserves further research exploration.

Efficacy and Safety of Cemiplimab for the Management of Non-Melanoma Skin Cancer: A Drug Safety Evaluation

Non-melanoma skin cancer includes several types of cutaneous tumors, with basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) as the commonest. Among the available therapeutic options, surgical excision is the mainstay of treatment for both tumors. However, tumor features and patients' comorbidities may limit the use of these techniques, making the treatment challenging. As regards BCC, even if hedgehog inhibitors revolutionized the therapeutic scenario, there are still patients unresponsive or intolerant to these drugs. In this context, cemiplimab has been approved as second-line treatment. As regards SCC, cemiplimab was the first systemic therapy approved. The objective of this manuscript was to investigate the efficacy and safety of cemiplimab for the management of BCC and cSCC. Cemiplimab has a durable and significant effect for the management of BCC and CSCC, with a favorable safety profile. Different specialists including oncologists, radiologists, dermatologists, and surgeons are required to guarantee an integrated approach, leading to the best management of patients. Moreover, the collaboration among specialists will allow them to best manage the TEAEs, reducing the risk of treatment suspension or discontinuation. Certainly, ongoing studies and more and more emerging real-world evidence, will allow us to better characterize the role of cemiplimab for the management of advanced non-melanoma skin cancer.

Fluorescence spectral analysis and logistic regression modeling for diagnosing basal cell carcinoma on head and neck

The optical fluorescence method is distinguished by key features such as non-invasiveness, high sensitivity, and resolution, which are superior to traditional diagnostic approaches. Unlike histopathological examinations and biochemical analyses, optical diagnostic methods obviate the need for tissue sampling, enabling the analysis of virtually unlimited material. The research aims to examine the effectiveness of emission spectra analysis in the diagnosis of basal cell carcinoma (BCC) of the scalp and neck. The analysis was based on data provided by Specialized Hospital No. 2 in Bytom comprising a study sample of 10 patients. For each patient, fluorescence emission spectra were recorded from each of 512 points along a 5 mm line. The results obtained from the histopathological examination, the analysis and morphological evaluation of the tissue, and the diagnosis through microscopic observation were used to define a dichotomous variable (presence or absence of a cancerous lesion), adopted in the study as the modeled variable. The next step of the presented study involved constructing a logistic regression model for identifying cancerous lesions depending on the biochemical indicator's relative fluorescence value (RFV) and emission wavelength (ELW) within the 620 nm to 730 nm range. This wavelength range is often used in fluorescence diagnostics to detect various pathologies, including cancerous lesions. The resulting binary logistic regression model, logit(p)=-33.17+0.04ELW+0.01RFV, indicates a statistically significant relationship between wavelength and relative fluorescence values with the probability of detecting cancer. The estimated model exhibits a good fit and high predictive accuracy. The overall model accuracy is 84.8 %, with the correct classification rates at approximately 96 % for healthy individuals and 74 % for individuals with cancer. These findings underscore the potential of photodynamic diagnostics in cancer detection and monitoring.

Prognostic and predictive biomarkers in head and neck cancer: something old, something new, something borrowed, something blue and a sixpence in your shoe

A biomarker is a measurable indicator of biological or pathological processes or the response to an exposure or intervention and is used to guide management decisions. In head and neck pathology, biomarkers are assessed by histological criteria and immunohistochemical and molecular studies. Surgical resection remains the mainstay of management of many head and neck malignancies. Adjuvant radiotherapy and/or systemic therapy may be administered depending on the presence of adverse prognostic factors identified on histopathological or immunohistochemical examination. In this review, we outline the clinically relevant prognostic and predictive factors in head and neck malignancies including conventionally recognised factors such as tumour size, depth of invasion, lymphovascular and perineural invasion and margin status as well as novel evolving factors such as recurrent genetic rearrangements and assessment of immune checkpoints. Practical issues are discussed to assist with recognising and reporting of these factors. A summary of useful tools such as structured pathology report formats is also included to assist with comprehensive reporting of all clinically relevant parameters, minimise risk and improve workflow efficiencies.

Ultraviolet Radiation Biological and Medical Implications

Ultraviolet (UV) radiation plays a crucial role in the development of melanoma and non-melanoma skin cancers. The types of UV radiation are differentiated by wavelength: UVA (315 to 400 nm), UVB (280 to 320 nm), and UVC (100 to 280 nm). UV radiation can cause direct DNA damage in the forms of cyclobutane pyrimidine dimers (CPDs) and 6-4 photoproducts (6-4PPs). In addition, UV radiation can also cause DNA damage indirectly through photosensitization reactions caused by reactive oxygen species (ROS), which manifest as 8-hydroxy-2'-deoxyguanine (8-OHdG). Both direct and indirect DNA damage can lead to mutations in genes that promote the development of skin cancers. The development of melanoma is largely influenced by the signaling of the melanocortin one receptor (MC1R), which plays an essential role in the synthesis of melanin in the skin. UV-induced mutations in the BRAF and NRAS genes are also significant risk factors in melanoma development. UV radiation plays a significant role in basal cell carcinoma (BCC) development by causing mutations in the Hedgehog (Hh) pathway, which dysregulates cell proliferation and survival. UV radiation can also induce the development of squamous cell carcinoma via mutations in the TP53 gene and upregulation of MMPs in the stroma layer of the skin.

Malignant wound aetiology, diagnosis and management: a case series and literature review

OBJECTIVE

Malignant wounds develop when neoplastic cells invade the skin either locally or by lymphatic and haematogenous spread. They can present as hard-to-heal wounds and underlying causes include: primary skin cancer; metastasis of extracutaneous primary malignancy; malignant transformation of a hard-to-heal wound; iatrogenic injury; and cutaneous forms of cancers of non-skin origin. High clinical suspicion for a malignant wound should be confirmed with skin biopsy. The aim of this case series is to highlight a combination of both clinically clear cutaneous malignancies and not-so-obvious wounds caused by malignancy.

METHOD

This case series examines patients with malignant wounds of varying aetiology and appearance. For each case, we explain the pathophysiology, atypical features, diagnostic approach and treatment. We also discuss types of wound biopsy and general wound management principles.

RESULTS

Among the 11 cases analysed using descriptive statistics, median wound duration before presentation at our clinic was one year, while median age at presentation was 65 years. Our case series included the following diagnoses: cutaneous metastasis of invasive ductal carcinoma of the breast (n=2); cutaneous metastasis of colorectal adenocarcinoma (n=1); Marjolin's ulcer (n=1), basal cell carcinoma (BCC) (n=2), primary cutaneous squamous cell carcinoma (SCC) (n=1), metastatic malignant melanoma (n=1), cutaneous T-cell lymphoma (n=1), cutaneous angiosarcoma (n=1), Kaposi sarcoma (n=1) and recurrent tonsillar SCC with osteoradionecrosis (n=1); one case had both BCC and SCC.

CONCLUSION

Punch and excisional biopsies were the most frequently used diagnostic techniques. Local wound therapy addressed bleeding, malodour, exudate, pain and infection. However, wound healing is usually achieved once the underlying malignancy is treated. In advanced or metastatic disease, palliative wound care aims to prevent exacerbation of existing wounds and focuses on patient comfort.

Nevus Variations in the Jordanian Population: Effects of Age, Medical Conditions, Environment, Congenital, Inherited, and Genetic Factors

Background

Nevi is a common benign proliferation of melanin-producing cells. Many triggers can influence their transformation into either benign or malignant, thus it is important to understand these triggers and their incidence across different populations to take adequate prevention. Here, we aim to examine the different etiologies of nevi changes across the Jordanian population.

Methods

We carried out a cross-sectional observational study focusing on patients seeking dermatological consultation for normal nevi or nevi with minimal changes. Demographic and clinical variables were collected from the patient's case history. Nevi's characteristics were also recorded. A skilled dermatologist assessed nevi morphology and changes using the ABCDE criteria for potential signs of melanoma. Nevi biopsy samples were fixed in formalin and sent for histopathological analysis and were stained with hematoxylin and eosin (H&E).

Results

A total of 231 patients were enrolled, with a majority of females (85%) and a median age of 37. Past medical history was positive in 17% of the samples, with hypertension, endocrine diseases, and diabetes mellitus being the most common. The majority of patients (61%) had fewer than three nevi. Changes in nevus size, configuration, and color were reported in 10% of patients, with multiple changes observed in 36% of patients. Microscopic analysis revealed polypoidal intradermal melanocytic blue nevi as the most common histopathological finding (84%). Positive medical history and the number of nevi were significantly associated with nevi changes.

Conclusion

Our results report that the number of nevi, as well as medical history, is linked to changes in their appearance. Additionally, we provide a detailed account of the various types of observed changes and their occurrence rates.

Differentiation and risk stratification of basal cell carcinoma with deep learning on histopathologic images and measuring nuclei and tumor microenvironment features

BACKGROUND

Nuclear pleomorphism and tumor microenvironment (TME) play a critical role in cancer development and progression. Identifying most predictive nuclei and TME features of basal cell carcinoma (BCC) may provide insights into which characteristics pathologists can use to distinguish and stratify this entity.

OBJECTIVES

To develop an automated workflow based on nuclei and TME features from basaloid cell tumor regions to differentiate BCC from trichoepithelioma (TE) and stratify BCC into high-risk (HR) and low-risk (LR) subtypes, and to identify the nuclear and TME characteristics profile of different basaloid cell tumors.

METHODS

The deep learning systems were trained on 161 H&E -stained sections which contained 51 sections of HR-BCC, 50 sections of LR-BCC and 60 sections of TE from one institution (D1), and externally and independently validated on D2 (46 sections) and D3 (76 sections), from 2015 to 2022. 60%, 20% and 20% of D1 data were randomly splitted for training, validation and testing, respectively. The framework comprised four stages: tumor regions identification by multi-head self-attention (MSA) U-Net, nuclei segmentation by HoVer-Net, quantitative feature by handcrafted extraction, and differentiation and risk stratification classifier construction. Pixel accuracy, precision, recall, dice score, intersection over union (IoU) and area under the curve (AUC) were used to evaluate the performance of tumor segmentation model and classifiers.

RESULTS

MSA-U-Net model detected tumor regions with 0.910 precision, 0.869 recall, 0.889 dice score and 0.800 IoU. The differentiation classifier achieved 0.977 ± 0.0159, 0.955 ± 0.0181, 0.885 ± 0.0237 AUC in D1, D2 and D3, respectively. The most discriminative features between BCC and TE contained Homogeneity, Elongation, T-T_meanEdgeLength, T-T_Nsubgraph, S-T_HarmonicCentrality, S-S_Degrees. The risk stratification model can well predict HR-BCC and LR-BCC with 0.920 ± 0.0579, 0.839 ± 0.0176, 0.825 ± 0.0153 AUC in D1, D2 and D3, respectively. The most discriminative features between HR-BCC and LR-BCC comprised IntensityMin, Solidity, T-T_minEdgeLength, T-T_Coreness, T-T_Degrees, T-T_Betweenness, S-T_Degrees.

CONCLUSIONS

This framework hold potential for future use as a second opinion helping inform diagnosis of BCC, and identify nuclei and TME features related with malignancy and tumor risk stratification.

Advancements in Basal Cell Carcinoma Diagnosis: Non-Invasive Imaging and Multimodal Approach

(1) Background: The aim of this study was to correlate the diagnostic criteria described in dermatoscopy, ultrasonography (US), ex vivo confocal microscopy, and histology to the most common subtypes of basal cell carcinoma (BCC). (2) Methods: We conducted a prospective study including 46 BCC cases, which were analyzed with dermatoscopy using the Delta 30 dermatoscope and Vidix 4.0 videodermoscope, with US using a high-resolution 20 MHz linear probe, with confocal microscopy, along with histopathological analysis. (3) Results: This study categorized BCC by histological subtype, with nodular being the most common (84.8%) and various other subtypes represented. US measurements of tumor thickness correlated strongly with the histopathological depth of invasion index (DI). Dermatoscopy analysis revealed significant associations between specific features and BCC subtypes. The DI was directly related to arborized vessels but inversely related to short, fine telangiectasias, maple-leaf-like areas, and spoke-wheel areas. The presence of ulceration was directly related to the DI. Confocal microscopy images exhibited several characteristics, including fluorescence, nuclear crowding, peripheral palisading, clefting, increased nuclear-cytoplasmic (N/C) ratio, and a "cauliflower-like" appearance. (4) Conclusion: The advanced detection of BCC through imagistic techniques like dermatoscopy, confocal microscopy, and ultrasound improves the diagnosis and may offer valuable insights for treatment in the future by evaluating lesion characteristics.

Recurrent Deeply Invasive Basal Cell Carcinoma

INTRODUCTION

Basal cell carcinoma (BCC) is the most frequent skin malignancy worldwide. The majority of BCCs grow slowly and have a low metastatic potential. However, they can be destructive to surrounding tissues since they are locally invasive.

METHODS

This case report was conducted on a 78-year-old woman complaining of a solid lump on the left side of the neck and nonhealing lesion. Three years earlier, she had BCC on the same site. Clinical and radiographic examinations were made. The biopsy specimens revealed that it is a recurrent BCC. In operating room, during blunt tissue dissection, the arterial wall was damaged. Tumor was overgrown left internal carotid artery near the bifurcation. Infiltrated part of arteria wall was resected, and a synthetic arterial prosthesis was placed.

RESULTS

Follow-up after 4 months showed that the wound was healing well. No complications regarding cardiovascular and other organ systems were seen.

Dermoscopy of very small basal cell carcinoma (≤3mm)

BACKGROUND

Basal cell carcinoma (BCC) dermoscopy is key to lower the biopsy threshold of suspicious lesions. There is a scarcity of published data on the dermoscopy of very small BCC (≤3mm) and its differences from larger BCCs.

OBJECTIVE

To describe and compare dermoscopic features of BCCs measuring ≤3mm, with those from 3 to 10mm.

METHODS

An analytical cross-sectional study, included biopsy-proven BCCs that had dermoscopic photographic images, between January 2017 and December 2022 in a Skin Cancer Center in Medellín, Colombia. Demographic, clinic-pathological and dermoscopic features were compared between very small BCCs (vsBCCs) and a reference group.

RESULTS

A total of 326 BCCs in 196 patients were included, of whom 60% were male. The most common Fitzpatrick phototype was III. vsBCCs accounted for 25% of the lesions (81/326). Face and neck were the most frequent locations (53%), especially in very small tumors. The nodular type was more common in very small tumors than in larger lesions, the superficial type was less frequent, and aggressive types were equally prevalent in both groups. On dermoscopy, very small tumors were statistically more likely to present pigmented structures than reference lesions, especially blue-gray dots (67% vs. 54%), vessels were less frequent, particularly short-fine telangiectasias (SFT) (52% vs. 66%), as were other structures such as shiny white structures (SWS), ulceration, micro-erosions, and scales.

STUDY LIMITATIONS

Latin-American sample, lacks information on dark phototypes CONCLUSIONS: Pigmented structures, especially blue-gray dots, were most common in vsBCCs when compared to larger lesions; SFT, SWS and other findings were less prevalent.

Eccrine Poroma with Concurrent Basal Cell Carcinoma: A Rare Combination

Eccrine poroma (EP) is a benign skin appendicular tumor that differentiates into the terminal sweat duct and is often differentiated from basal cell carcinoma (BCC) and seborrheic keratosis. This report describes a 58-year-old woman who presented with left occipital plaque. Histopathological analysis showed that the tumor cells were located in the lower part of the epidermis. The tumor cells were cuboidal or circular basal-like cells of the same size. The surrounding cells were not arranged in a palisade shape. Scattered tumor clusters composed of basal-like cells were also seen in the dermis, staining basophilic, and the surrounding cells were arranged in a palisade pattern. Immunohistochemistry showed that BerEP4, epithelial membrane antigen EMA, carcinoembryonic antigen CEA, Bcl-2, CD10, CK7 were positive, AR, PAS were negative. According to the pathological examination and immunohistochemical results, a case of eccrine poroma with concurrent basal cell carcinoma was diagnosed.

Skin cancer: understanding the journey of transformation from conventional to advanced treatment approaches

Skin cancer is a global threat to the healthcare system and is estimated to incline tremendously in the next 20 years, if not diagnosed at an early stage. Even though it is curable at an early stage, novel drug identification, clinical success, and drug resistance is another major challenge. To bridge the gap and bring effective treatment, it is important to understand the etiology of skin carcinoma, the mechanism of cell proliferation, factors affecting cell growth, and the mechanism of drug resistance. The current article focusses on understanding the structural diversity of skin cancers, treatments available till date including phytocompounds, chemotherapy, radiotherapy, photothermal therapy, surgery, combination therapy, molecular targets associated with cancer growth and metastasis, and special emphasis on nanotechnology-based approaches for downregulating the deleterious disease. A detailed analysis with respect to types of nanoparticles and their scope in overcoming multidrug resistance as well as associated clinical trials has been discussed.

High-throughput screening and clinical importance of autophagy-associated genes in basal cell carcinoma

Autophagy is a type II programmed cell death mechanism that plays a critical role in preserving cellular homeostasis through the regulation of protein, lipid, and organelle quality control. It has become gradually evident that autophagy plays a fundamental role in the initiation and progression of various types of human cancers. Nevertheless, its significance in non-melanoma skin cancers, particularly in basal cell carcinoma, has not been well documented and remains largely elusive. In this study, we aimed to illuminate the role of autophagy-associated signaling signatures during development and progression of basal cell carcinoma. For the study, a total of 72 autophagy-related genes were screened using a high-throughput qPCR approach integrating Fluidigm 96.96 Dynamic Array™ integrated fluidic circuits (IFC) and BioMark™ HD Real-Time PCR system, which enabled efficient and precise analysis of gene expression patterns. Results were analyzed using Fluidigm's Real-Time PCR Analysis software and 2-ΔΔCt formula was used for the calculation of expression changes. Notably, expression levels of INS, TMEM74 and IFNA2 genes were identified to be prominently altered in BCC comparted to adjacent healthy tissues. However, only IFNA2 expression showed statistically significant change in BCC. Consequently, these findings suggest that IFNA2 might play significant role in the regulation of autophagy in BCC development and progression and can be therapeutically targeted.

Ultrasound Assessment of Skin Tumors Local Recurrence

Skin cancer may recur at or around the surgical site despite wide excisions. Prompt clinical and sonographic detection of local recurrence is important since subjects with relapsing melanomas or nonmelanoma malignancies can be managed efficaciously, with a relevant impact on morbidity and survival. Ultrasound is being employed with increasing frequency in the assessment of skin tumors, but most of the published articles relate to initial pretherapeutic diagnosis and staging. This review aims to offer an illustrated guide to the sonographic evaluation of locally recurring skin cancer. We introduce the topic, then we provide some sonographic tips for patient follow-up, then we describe the ultrasound findings in case of local recurrence, illustrating the main mimickers, and finally, we mention the role of ultrasound in guiding diagnostic and therapeutic percutaneous procedures.

Spice-Derived Phenolic Compounds: Potential for Skin Cancer Prevention and Therapy

Skin cancer is a condition characterized by the abnormal growth of skin cells, primarily caused by exposure to ultraviolet (UV) radiation from the sun or artificial sources like tanning beds. Different types of skin cancer include melanoma, basal cell carcinoma, and squamous cell carcinoma. Despite the advancements in targeted therapies, there is still a need for a safer, highly efficient approach to preventing and treating cutaneous malignancies. Spices have a rich history dating back thousands of years and are renowned for their ability to enhance the flavor, taste, and color of food. Derived from various plant parts like seeds, fruits, bark, roots, or flowers, spices are important culinary ingredients. However, their value extends beyond the culinary realm. Some spices contain bioactive compounds, including phenolic compounds, which are known for their significant biological effects. These compounds have attracted attention in scientific research due to their potential health benefits, including their possible role in disease prevention and treatment, such as cancer. This review focuses on examining the potential of spice-derived phenolic compounds as preventive or therapeutic agents for managing skin cancers. By compiling and analyzing the available knowledge, this review aims to provide insights that can guide future research in identifying new anticancer phytochemicals and uncovering additional mechanisms for combating skin cancer.

Topical Treatments for Basal Cell Carcinoma and Actinic Keratosis in the United States

Skin cancer is an overarching label used to classify a variety of cutaneous malignancies. Surgical excision procedures are the commonly used treatments for these lesions; however, the choice to perform operative intervention may be influenced by other factors. Established research and literature suggest that topical treatments limit the need for surgical intervention and its commonly associated adverse effects, including infection and scarring. In addition, the growing indications for the usage of topical therapies in BCC treatment, as well as their increased availability and therapeutic options, allow for their greater applicability in the dermatology clinic. Certain topical therapies have been highlighted in research, especially those targeting basal cell carcinoma (BCC) and actinic keratosis (AK). There is also a clear correlation between cost and treatment outcomes, considering BCC's ever-growing prevalence and the proportion of excised lesions being reported as malignant. This review will discuss BCC and AK lesion criteria that result in the most successful outcomes using topical treatments, then highlight the various topical treatment options, and finally address their clinical significance moving forward.

Superficial Basal Cell Carcinoma on the Back Region Treated with a Combination of Cryotherapy and 5% Imiquimod Cream: A Case Report

Basal cell carcinoma (BCC) is the most common skin malignancy, consisting of cells in the basal layer epidermis and its appendix. Superficial BCC is the second most common BCC subtype with a predilection on the trunk including the waist and can be treated with cryoimmunotherapy, a combination of cryotherapy and imiquimod cream. Herein, we report a case of superficial BCC in a 60-year-old woman which was triggered by short-wave diathermic (SWD) therapy on the waist one year previously. Superficial BCC was diagnosed based on clinical symptoms, a dermoscopy, and histopathology. The erythematous and hyperpigmented plaque on the waist had well-defined edges and bled easily. There were pseudopods, a blue-grey ovoid nest, haemorrhagic ulceration, and a deeply pigmented border with basaloid cells in the basal layer of the epidermis and palisade cells at the edges. The patient was treated with cryoimmunotherapy consisting of two cycles of a 30-second freeze time and a 5 mm margin, then two weeks later, 5% imiquimod cream was applied to the skin for five consecutive nights, followed by two days off for six cycles (six weeks). Follow-up at three months revealed clinical improvement with reduced lesion size, confirming that cryoimmunotherapy is an effective treatment for the management of superficial BCC with mild side effects.

The clinicopathological analysis of ocular and orbit tumors in southeast of China

Purpose

The purpose of this study is to describe the clinicopathologic characteristics of ocular surface and orbit tumors in the Southeast of China and explore the method to differentiate the benign and malignant masses.

Materials and methods

3468 patients undergoing mass resection from January 2015 to December 2020 were selected as observation subjects and were classified into benign and malignant masses according to postoperative pathology. The clinicopathologic characteristics were collected, including gender, age, pathological tissue signs, and pathological signs. Multivariate Logistic regression analysis of independent risk factors of malignant mass was applied to establish a diagnostic model and the efficacy was evaluated by the subject working characteristics (ROC) curve.

Results

Benign tumors accounted for 91.5% of all cases, and malignant tumors accounted for 8.5%. The most common ocular benign tumors were nevi (24.2%), granuloma (17.1%), and cysts (16.4%). The most common ocular malignant tumors were malignant lymphoma (32.1%) and Basal cell carcinoma (20.2%). As for the histologic origin, melanocytic origin was on the list with 819 (23.6%), mesenchymal 661 (19.1%), epithelial 568 (16.3%), cystic 521 (15.0%), skin adnexal 110 (3.1%), lymphoid 94 (2.8%), and Neural 25(0.8%). Based on the gender, age, tumor location, and the pathological tissue image feature (including differentiation, structural atypia, covering epithelial, keratosis, nest structure/distribution, nuclear atypia, cytoplasmic change and nuclear division), the diagnostic model had predictive value to differentiate the benign and malignant masses.

Conclusion

Most ocular surface and orbit tumors are benign. Tumor diagnosis is relative to the patient's age, gender, tumor location, and pathologic characteristics. We generated a satisfactory diagnostic model to differential diagnosis of benign and malignant masses.

Basal Cell Carcinoma Perineural Invasion and Suggestive Signs of Perineural Invasion-Findings and Perspectives

Basal cell carcinoma (BCC) is a malignant tumor with a rising incidence and is the beneficiary of several innovative evaluation techniques. Histopathology remains the gold standard for assessment, having the possibility of addressing multiple high-risk factors such as perineural invasion (PNI). The current study included a number of 244 BCC patients and targeted the identification of positive PNI and its suggestive signs, and whether they correlated or not with other high-risk tumor signs. PNI was found in 20.1% of patients, with 30.7% of patients having perineural chronic inflammation (PCI), which is a suggestive sign of PNI. PNI was also found in larger tumors, with deeper Clark levels, in high-risk BCCs and high-grade tumors. PNI and PCI are both important for pathology reporting, aiding in treatment choice and further patient management, with possibly positive outcomes concerning morbidity and mortality.

Basal Cell Carcinoma-A Retrospective Descriptive Study Integrated in Current Literature

Basal cell carcinoma (BCC) is considered to be the most common cancer in humans. It has a slow growth rhythm, and for this reason, metastases are rare. For our retrospective study, we selected 180 patients from those who underwent surgery for a variety of skin tumours between January 2019 and August 2022 and whose histopathological examination revealed basal cell carcinoma. All surgeries were performed by plastic surgeons at the "St. John" hospital in Bucharest. The aim of this article is to provide observational data regarding BCC-in terms of histopathology and diagnostic and therapeutic management and to integrate these data into the current knowledge of this pathology.

Immunohistochemical Expression of Chemokine Receptor CXCR3 and its Ligand CXCL 11 in Basal Cell Carcinoma

Introduction

Basal cell carcinoma (BCC) is the most common type of skin cancer worldwide. The pathogenesis of BCC involves interplay between various environmental and genetic factors. It is believed that chemokines play a significant role in the modulation of cancer growth by generating autocrine and paracrine signaling effects. The present study was conducted to elucidate the expression of chemokine, CXCL11, and its receptor CXCR3, and their interaction with tumor cells and peri-tumoral stroma in various subtypes of BCC.

Aim and Objectives

The aim of this study was to evaluate the immunohistochemical expression of chemokine CXCL11 and its receptor CXCR3 in various subtypes of BCC.

Materials and Methods

The study included 40 cases of histopathologically confirmed BCC. Clinical and histopathological features of various tumor subtypes were noted. Immunohistochemistry was performed using antibodies against CXCL11 and CXCR3, and these were assigned scores 0, 1, and 2 on the basis of immunohistochemical expression.

Results

The median age of study participants was 65.0 ± 12.2 years with a male-to-female ratio of 1.5:1. The most common site was face, followed by neck, scalp, and back. The tumor subtypes included in the study were nodular (n = 20), pigmented (n = 8), infiltrating (n = 5), superficial (n = 4), and adenoid (n = 3). On immunohistochemistry, CXCR3 expression was seen in 34 (85%) cases with stromal inflammatory cells immunopositivity in 29 (72.5%) cases and tumor cells immunopositivity in 5 (12.5%) cases. CXCL11 expression was seen in 36 (90%) cases with weak expression in stroma and tumor in 18 cases and strong expression in the rest 18 cases. In individual subtypes, higher immunopositivity for CXCR3 and CXCL11 in tumor cells and peri-tumoral stroma was seen for nodular, infiltrating, and pigmented subtypes, compared to adenoid and superficial subtypes.

Conclusion

Our study shows the enhanced expression of chemokine CXCL11 and its receptor CXCR3 in tumor cells and peri-tumoral stroma of BCC. This expression is greater in tumor cells of aggressive subtypes, i.e. nodular, infiltrating, and pigmented types. This suggests that receptor ligand pathway involving CXCR3 and CXCL11 plays a key role in pathogenesis of BCC, and blocking this pathway may result in inhibition of tumor growth. Thus, these chemokines may serve as future potential targets in developing novel therapeutic regimens against BCC.

A Case of Super-giant Basal Cell Carcinoma Initially Diagnosed as Multiple Traumas

Basal cell carcinoma (BCC), which is relatively easy to diagnose in a clinical setting, is the most common malignant tumor in the skin. Conversely, a giant BCC, a tumor beyond 5 cm in diameter, is a rare disease. In particular, a giant BCC beyond 20 cm in diameter is called a super-giant BCC, which frequently invades into deeper tissues, including the dermis, bones, or muscles. Here, we present a case of a 71-year-old patient who was initially diagnosed with multiple traumas with a large periosteal defect of the head. The ulcer was surrounded by malodorous necrotic tissue and slough, and several bacteria that caused necrotizing fasciitis were detected. Mapping biopsies after extensive debridement yielded BCC, and therefore, he was finally diagnosed with a super-giant BCC. A careful consultation revealed a history of ulcer on the head after a head injury approximately 10 years ago. He underwent radical dissection including the external table of the skull, followed by a free latissimus dorsi muscle flap with a meshed split-thickness skin graft. Because of the slow and chronic development of a super-giant BCC, accurate diagnosis is often difficult. Careful attention should be paid in patients with long-sustained ulcers.

CD56 and smooth muscle actin immunoreactivity in basal cell carcinomas: Are they indicators of differentiation or do they hold a diagnostic use?

BACKGROUND

Basal cell carcinoma (BCC) is the most common cutaneous malignancy and may show various differentiations. The possible pluripotent stem cell lineage of BCCs, whose origins are controversial today, is thought to be the main reason for the different morphologies. The aim of the study is to evaluate the expression of some neuroendocrine and smooth muscle markers of differentiation in BCCs and investigate the relationship between histopathologic subtypes and recurrence.

METHODS

A total of 128 cases diagnosed as BCC in our center were included. Immunohistochemical studies of CD56, synaptophysin, chromogranin-A, smooth muscle actin (SMA), desmin, caldesmon, and Ki67 were applied.

RESULTS

CD56, chromogranin-A, and synaptophysin immunoreactivity were detected in 77.3%, 13.3%, and 0.8% of the cases, respectively. 78.1% showed SMA positivity while no tumor expressed desmin or caldesmon. A correlation between histopathologic recurrence risk groups and CD56 expression was found (p < 0.05).

CONCLUSIONS

CD56 and SMA immunoreactivity is present in the majority of BCCs. However, the available findings do not support neuroendocrine or smooth muscle differentiation. CD56 antigen can be used for prognostic purposes in detecting high recurrence risk tumors. After the investigation of the expression rates of these two antigens in different cutaneous tumors, it may be appropriate to use them for diagnostic purposes in BCCs.

The diagnostic value of imaging techniques for keratoacanthoma: A review

Keratoacanthoma (KA) is a fast-growing skin tumor with solitary KA being the most common type. KAs rarely metastasize and subside spontaneously. Although histopathology is the gold standard for the diagnosis of KA, its histopathological features are sometimes difficult to distinguish from those of other skin tumors. Imaging studies have certain advantages in the preoperative diagnosis of KA; they not only show the exact shape of the lesion but can also accurately determine the extent of the lesion. Combined with histopathological examination, these findings help establish a diagnosis. By summarizing the imaging features of KA, this article aimed to improve radiologists' understanding of the disease and help in the clinical and differential diagnosis of KA.

Clinical case of surgical treatment of advanced basal cell carcinoma of the skin on the face

Introduction. Basal cell carcinoma is the most common type of non-melanocytic malignant tumors of the skin. The main treatment methods for this pathology are local methods such as surgery and radiation. In rare cases, basal cell carcinoma can become locally advanced and / or metastatic.

Aim. To demonstrate the possibility of reconstructive surgery for large defects after removal of locally advanced tumors of the face and describe a rare case of basal cell carcinoma metastasis into the regional lymph nodes.

Clinical case. The article presents a clinical case of treatment of basal cell skin cancer with metastases into the regional lymph nodes. According to the patient, tumor on the skin of the left cheekbone area first appeared in 2007. The patient did not seek medical help. In 2017, the tumor was resected at the local medical facility. In 2018, the patient noted repeat tumor growth. In November of 2021, when the patient first consulted at the Republican Clinical Oncological Dispensary of the ministry of Health of the Bashkortostan Republic, the tumor was 7 × 5 cm. Invasion depth was up to 1.5 cm, infiltration into the temporal and mastication muscles and destruction of the zygomatic bone were observed. On 18.11.2021 at Republican Clinical Oncological Dispensary of the ministry of Health of the Bashkortostan Republic, wide resection of the skin tumor with resection of the zygomatic arch, parotidectomy on the left with defect removal using anterolateral thigh flap was performed. per histological examination, basal cell carcinoma with lymphovascular and perineural invasion and advancement into the masticator muscle and zygomatic bone was diagnosed, as well as carcinoma metastases in 2 lymph nodes with advancement beyond the capsule.

Conclusion. Implementation of revascularization flaps significantly widens choices for surgical treatment of this patient group in a regional oncological dispensary and gives satisfactory esthetic results due to removal of large defects after surgical intervention.

Effects of Photodynamic Therapy on Nav1.7 Expression in Spinal Dorsal Root Ganglion Neurons

OBJECTIVE

The aim of this study was to examine the effects of photodynamic therapy (PDT) on the expression of Nav1.7 in spinal dorsal root ganglion (DRG) neurons.

METHODS

The primary DRG neurons from newborn SD rats were cultured. The cells were identified by neuron-specific enolase immunofluorescence staining. DRG neurons were divided into four groups: control group, photosensitizer group, laser group, and PDT group. The cell viability was detected by a cell counting kit-8 (CCK8) assay. qRT-PCR and Western blotting were used to determine the mRNA and protein expression levels of Nav1.7 in DRG neurons.

RESULTS

The purity of the cultured primary DRG neurons was greater than 90%. Compared with the control group, no significant change was found in the cell viability of the photosensitizer group, while the viability in the laser group and the PDT group was significantly reduced. The mRNA and protein expression levels of Nav1.7 were significantly greater in the laser group and the PDT group than in the control group. At the same time, the mRNA and protein expression levels of Nav1.7 were greater in the laser group than in the PDT group.

CONCLUSION

Both laser and PDT could upregulate the expression of Nav1.7 in DRG neurons, and the promoting effect might be related to the pain induced by clinical treatment. This study provides a research basis for the use of laser and PDT to treat pain. A better understanding of the relationship between Nav1.7 and PDT can help clinicians better manage PDT-related pain.

Goldnanorods-loaded hydrogel-forming needlesfor local hyperthermia applications: Proof of concept

Basal cell carcinoma (BCC) is the most common form of skin cancer and responsible for most of the cancer related morbidities and pose a significant public health concern worldwide. Surgery treatment modality is able to clear the BCC, yet it mostly leads to scar formation. Plasmonic photothermal therapy (PPTT) which involves using gold nanostructures and near-infrared light to kill the BCC cells by local heating is associated with excellent tissue preservation and healing without scarring. Parenteral administration of such gold nanostructures suffers from off-target delivery and side effects. Delivering such phototherapeutics directly to the BCC proved to be an attractive alternative route of administration yet encountered with penetration limitations due to the stratum corneum (SC) fierce barrier. In the current study, we developed and optimised a novel near-infrared light-responsive hydrogel-forming long needle (HFLN) loaded with Gold nanorods (GNRs) as a potential plasmonic photothermal device for localised treatment of nodular BCC. The HFLN was prepared from Gantrez® S-97 and PEG 200 Da and characterized in terms of swelling, insertion and mechanical properties. GNRs were synthesised and tunned using seed-mediated growth method. The integrated devices developed could revolutionise BCC treatment benefiting both patients and healthcare providers.

Design and Validation of a Handheld Optical Polarization Imager for Preoperative Delineation of Basal Cell Carcinoma

Simple Summary

Skin cancer is the most common malignancy in humans. The goal of this study was to design, implement, and clinically test a novel handheld optical polarization imaging (OPI) system for rapid and noninvasive detection of basal cell carcinoma (BCC) margins. The device is compact, lightweight, and can be operated with minimal training. To validate the handheld imager, 10 subjects with biopsy-confirmed BCC were imaged prior to Mohs surgery. The optical images were processed using a spectral encoding method to increase the accuracy of the tumor boundary delineation. Preoperative margin assessment results from the OPI were compared to the surgeon’s clinical evaluation and to the gold standard of histopathology. Our findings indicate that OPI may be a valuable tool for optimizing surgical treatment of skin cancer.

Abstract

Background: Accurate removal of basal cell carcinoma (BCC) is challenging due to the subtle contrast between cancerous and normal skin. A method aiding with preoperative delineation of BCC margins would be valuable. The aim of this study was to implement and clinically validate a novel handheld optical polarization imaging (OPI) device for rapid, noninvasive, in vivo assessment of skin cancer margins. Methods: The handheld imager was designed, built, and tested. For clinical validation, 10 subjects with biopsy-confirmed BCC were imaged. Presumable cancer margins were marked by the study surgeon. The optical images were spectrally encoded to mitigate the impact of endogenous skin chromophores. The results of OPI and of the surgeon’s preoperative visual assessment were compared to clinical intraoperative histopathology. Results: As compared to the previous prototype, the handheld imager incorporates automated image processing and has 10-times shorter acquisition times. It is twice as light and provides twice as large a field of view. Clinical validation demonstrated that margin assessments using OPI were more accurate than visual assessment by the surgeon. The images were in good correlation with histology in 9 out of 10 cases. Conclusions: Handheld OPI could improve the outcomes of skin cancer treatments without impairing clinical workflows.

Management of patients with giant basal cell carcinoma during SARS COV2 outbreak in Italy

Basal cell carcinoma (BCC) is the most frequently occurring type of all cancers, and represents 80% of all skin cancer. The estimated lifetime risk for BCC in the white population is between 33% and 39% for men and 23% and 28% for women. Its incidence doubles every 25 years and is increasing in the young population. Death is uncommon and seems to decrease in the last years, probably due to early and better diagnosis. BCC arises from abnormal and uncontrolled growth of basal cells. It is a slow-growing tumor, therefore usually curable at an early stage with surgery or alternative treatment, such as cryotherapy, laser, photodynamic therapy, retinoids and topical agent like 5-Fluorouracil cream, imiquimod cream, and so forth. Topical treatment of superficial basocellular carcinoma is a viable option, when surgery is not an advisable treatment, especially in the case of giant basocellular carcinoma. In this subtype, imiquimod 5% cream can be a safe and effective treatment, but there are few reports in available literature. We present our case series of eight patients with superficial giant basocellular carcinoma successfully treated with imiquimod 5% cream, which showed clinical improvement after 8 weeks of treatment.

An Up-to-Date Correlation of Epidemiological and Histopathological Characteristics of Basal Cell Carcinoma of the Skin in a County Hospital in Romania

Background and Objectives: Basal carcinoma of the skin (BCC) is part of the nonmelanoma skin cancer (NMSC) family and is the most frequently occurring type of skin cancer in humans. A combination of clinical and histopathological approaches is necessary in order to establish the best treatment regime for patients who have been diagnosed with this type of cancer. The objective of the present study was to establish the statistical value of prediction for certain sociodemographic characteristics (age category and environment of origin) and histopathological parameters of the subjects that could be related to the incidence of diagnosis with certain histopathological subtypes of BCC. Materials and Methods: In order to verify the veracity of the established research hypotheses, we conducted a retrospective study based on the histopathological reports of 216 patients who were treated at the Pathology Department of Mureș Clinical County Hospital. Results: Cystic BCC is higher in patients who are older than 71 years of age, and the superficial multicentric and keratotic subtypes are more frequently diagnosed in urban areas. Patients who have been diagnosed with the superficial multicentric BCC subtype are not usually very old in contrast to the patients who tend to be diagnosed with the cystic BCC subtype. The nodular BCC subtype is positively associated with ulceration (p = 0.004); the superficial multicentric BCC subtype is positively associated with intra- and peritumoral inflammatory infiltrate (p = 0.022, p = 0.034) and negatively associated with ulceration (r = -0.218, p = 0.001). The infiltrative BCC subtype is positively associated with ulceration (p = 0.021), and the keratotic BCC subtype is positively associated with peritumoral inflammatory infiltrate (p = 0.02). Conclusions: Depending on each patient's epidemiological and sociodemographic data, a pattern can be established regarding the appropriate clinical and treatment approaches for that patient, which can be supported based on the implications of the histopathological diagnostic. This can lead to an improvement in the patient's quality of life and increased satisfaction with the provided medical services.

Surgery combined with photodynamic therapy vs. surgery alone for the treatment of non-melanoma skin cancer and actinic keratosis: a retrospective cohort study

BACKGROUND

Photodynamic therapy (PDT) is an effective treatment for some non-melanoma skin cancers (NMSC) and actinic keratosis.

OBJECTIVES

To compare recurrence-free survival (RFS) rates between surgery alone and surgery with postoperative PDT in patients with NMSC in China.

METHODS & MATERIALS

This retrospective cohort study included patients with pathologically confirmed NMSC or actinic keratosis treated by surgical excision with/without PDT. A total of 125 patients were included, including 72 patients (43 females) aged 57-75 years in the surgery alone group and 53 patients (32 females) aged 61-76 years in the surgery+PDT group.

RESULTS

The most common NMSC types were squamous cell carcinoma and basal cell carcinoma, the most common lesion site was the head and neck, and the vast majority of patients had a primary disease and solitary lesions. There were no significant differences between groups in baseline characteristics. RFS rates in the surgery alone and surgery+PDT groups were, respectively, 100.0% and 98.1% at 1 week, 98.6% and 98.1% at 4 weeks, 97.2% and 98.1% at 8 weeks, 97.2% and 98.1% at 12 weeks, and 90.3% and 90.4% at 24 weeks, with no significant differences between groups.

CONCLUSION

Adjuvant PDT after surgical excision of NMSC or actinic keratosis does not provide short-term improvement in RFS, but the results need to be confirmed by a formal randomized controlled trial.