1
|
Karki S, Parajuli A, Bhattarai B, Kumari K, Harrylal KA, Bhatta P, K. C. M, Sharma S. Neglected Fungating Giant basal cell carcinoma: A case report and literature review. Clin Case Rep 2024; 12:e8765. [PMID: 38601171 PMCID: PMC11004263 DOI: 10.1002/ccr3.8765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024] Open
Abstract
Key Clinical Message Gaint fungating BCC is rare and aggressive. Early health-seeking behavior may result in positive outcomes. Abstract Fungating giant basal cell carcinoma (BCC) is a rare and aggressive form of BCC infrequently reported in the literature. We present a giant BCC case in an old female from a rural area with a poor socioeconomic profile.
Collapse
Affiliation(s)
- Susmin Karki
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Asmita Parajuli
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Bhawesh Bhattarai
- Department of SurgeryTribhuvan University Institute of MedicineKathmanduNepal
| | - Khusbu Kumari
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | | | - Pramish Bhatta
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Milan K. C.
- Department of SurgeryTribhuvan University Institute of MedicineKathmanduNepal
| | - Samit Sharma
- Department of Plastic SurgeryTribhuvan University Institute of MedicineKathmanduNepal
| |
Collapse
|
2
|
Ueda T, Kuro A, Kunieda S, Ozaki Y, Suzuki K, Hihara M, Komai H, Kakudo N. Giant Basal Cell Carcinoma in the Inguinal Region Invading the Femoral Vessels. EPLASTY 2022; 22:ic5. [PMID: 35611151 PMCID: PMC9108537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Takayuki Ueda
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Atsuyuki Kuro
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Sakurako Kunieda
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Yujiro Ozaki
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Kenji Suzuki
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Masakatsu Hihara
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Hiroyoshi Komai
- Department of Vascular Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| |
Collapse
|
3
|
Sala ACA, Crespo ACF, Stelini RF, Leite O, Moraes AM, Velho PENF, Souza EM, Cintra ML. Chronic Venous Insufficiency as a Predisposing Factor for Basal Cell Carcinoma on Legs. Ann Vasc Surg 2020; 68:185-191. [PMID: 32422291 DOI: 10.1016/j.avsg.2020.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/17/2020] [Accepted: 04/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The main risk factor associated with basal cell carcinomas (BCCs) is believed to be exposure to ultraviolet radiation (UVR). In the case of lower limb BCC, the frequency is higher in women, possibly because of greater exposure of the leg to UVR. Chronic venous insufficiency (CVI), also more common in women, may have some association with leg BCCs. METHODS We retrospectively evaluated the histopathological features of leg BCCs removed between 1993 and 2017 in a tertiary referral center. The patients' clinical data were obtained from medical records, considering, in particular, CVI. RESULTS We selected 149 patients with leg BCCs, predominately occurring in elderly Caucasian women. Of those, 71 had a clinical diagnosis of CVI in whom the clinical tumor size and frequency of recurrences were significantly higher than patients without CVI. There was an association between clinical diagnosis of CVI and histological findings of (1) follicular induction in epidermis and (2) distal sweat duct hyperplasia. CONCLUSIONS CVI, besides the already known UVR exposure, is probably associated with leg BCCs and may determine a worse BCC course.
Collapse
Affiliation(s)
| | | | | | - Oriete Leite
- Department of Dermatology, Medical School, Unicamp, Campinas, SP, Brazil
| | | | | | | | | |
Collapse
|
4
|
Vaca-Aguilera MR, Guevara-Gutiérrez E, Barrientos-García JG, Tlacuilo-Parra A. Giant basal cell carcinoma: clinical-histological characteristics of 115 cases. Int J Dermatol 2019; 58:1430-1434. [PMID: 30972736 DOI: 10.1111/ijd.14455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/21/2019] [Accepted: 03/12/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Giant basal cell carcinoma (GBCC) is a tumor ≥5 cm in size, with aggressive biological behavior, that represents 1% of basal cell carcinomas (BCC), and studies regarding it are scarce. Our objective was to investigate the clinical-histopathological characteristics of GBCC and the risk factors associated with its development. METHODS A retrospective study over 8 years included patients with the clinical and histopathological diagnosis of GBCC. Age, sex, localization, size, evolution time, risk factors, and histological variants were compared to conventional BCC. Descriptive and inferential statistics were used, and a value of P < 0.05 was considered statistically significant. RESULTS Of 5958 patients with BCC, 115 (2%) of them corresponded to GBCC. The average patient age was 73 ± 11 years, and the male sex (52%) and localization on the head and neck (63%) predominated. Average tumor size was 6.6 ± 2.2 cm, evolution time was 96 ± 86 months, and high-grade histological variants (51%) predominated. The group with GBCC had higher age (P < 0.01), greater frequency in the male sex (P = 0.01), longer evolution time (P < 0.01); a greater prevalence of risk factors (24% vs. 16%, P = 0.01), antecedents of other types of cancer (P = 0.03), and of burns (P = 0.03); and a greater frequency of high-grade histological variants (51% vs. 29%, P < 0.01). CONCLUSIONS This is the largest series of GBCC published to date. Findings are similar to those previously reported, although the prevalence found here was greater.
Collapse
Affiliation(s)
- Martha R Vaca-Aguilera
- Dermatology Department, Instituto Dermatologico de Jalisco, "Dr. José Barba Rubio", Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
| | - Elizabeth Guevara-Gutiérrez
- Dermatology Department, Instituto Dermatologico de Jalisco, "Dr. José Barba Rubio", Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
| | - Juan G Barrientos-García
- Dermatology Department, Instituto Dermatologico de Jalisco, "Dr. José Barba Rubio", Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
| | - Alberto Tlacuilo-Parra
- Medical Research Division, UMAE Hospital de Pediatria CMNO, IMSS, Guadalajara, Jalisco, Mexico
| |
Collapse
|
5
|
Di Lorenzo S, Zabbia G, Corradino B, Tripoli M, Pirrello R, Cordova A. A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1284-1288. [PMID: 29199268 PMCID: PMC5726147 DOI: 10.12659/ajcr.905671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patient: Female, 82 Final Diagnosis: Giant basal cell carcinoma Symptoms: Anemia Medication: — Clinical Procedure: — Specialty: Plastic Surgery
Collapse
Affiliation(s)
- Sara Di Lorenzo
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Giovanni Zabbia
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Bartolo Corradino
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Massimiliano Tripoli
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Roberto Pirrello
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| |
Collapse
|
6
|
Yazdani Abyaneh MA, Engel P, Slominski A, Ragsdale B, Agag R, Cramer D, Carlson JA. Giant Basal Cell Carcinomas Express Neuroactive Mediators and Show a High Growth Rate: A Case-Control Study and Meta-Analysis of Etiopathogenic and Prognostic Factors. Am J Dermatopathol 2017; 39:189-194. [PMID: 27759693 DOI: 10.1097/dad.0000000000000640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Giant basal cell carcinomas (GBCCs), (BCC ≥ 5 cm), are often painless, destructive tumors resulting from poorly understood patient neglect. OBJECTIVES To elucidate etiopathogenic factors distinguishing GBCC from basal cell carcinoma (BCC) and identify predictors for disease-specific death (DSD). METHODS Case-control study examining clinicopathologic and neuroactive factors (β-endorphin, met-enkephalin, serotonin, adrenocorticotropic hormone, and neurofilament expression) in GBCC and BCC. Systematic literature review to determine DSD predictors. RESULTS Thirteen GBCCs (11 patients) were compared with 26 BCCs (25 patients). GBCC significantly differed in size, disease duration, and outcomes; patients were significantly more likely to live alone, lack concern, and have alcoholism. GBCC significantly exhibited infiltrative/morpheic phenotypes, perineural invasion, ulceration, and faster growth. All neuromediators were similarly expressed. Adenoid phenotype was significantly more common in GBCC. Adenoid tumors expressed significantly more β-endorphin (60% vs. 18%, P = 0.01) and serotonin (30% vs. 4%, P = 0.02). In meta-analysis (n ≤ 311: median age 68 years, disease duration 90 months, tumor diameter 8 cm, 18.4% disease-specific mortality), independent DSD predictors included tumor diameter (cm) (hazard ratio (HR): 1.12, P = 0.003), bone invasion (HR: 4.19, P = 0.015), brain invasion (HR: 8.23, P = 0.001), and distant metastases (HR: 14.48, P = 0.000). CONCLUSIONS GBCC etiopathogenesis is multifactorial (ie, tumor biology, psychosocial factors). BCC production of paracrine neuromediators deserves further study.
Collapse
Affiliation(s)
- Mohammad-Ali Yazdani Abyaneh
- *Albany Medical College, Albany, NY; †Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; ‡VA Boston Healthcare System Geriatric Research, Education and Clinical Center, Boston, MA; §Department of Dermatology, University of Alabama at Birmingham, VA Medical Center, Birmingham, AL; ¶Western Pathology, Inc., San Luis Obispo, CA; ‖Department of Plastic Surgery, Albany Medical College, Albany, NY; **Loyola Stritch School of Medicine, Maywood, IL; and ††Department of Pathology, Albany Medical College, Albany, NY
| | | | | | | | | | | | | |
Collapse
|
7
|
Takahashi A, Hara H, Aikawa M, Ochiai T. Dermoscopic features of small size pigmented basal cell carcinomas. J Dermatol 2015; 43:543-6. [PMID: 26458728 DOI: 10.1111/1346-8138.13173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022]
Abstract
Dermoscopic images of histologically proven pigmented basal cell carcinomas (BCC) were retrospectively assessed to compare the dermoscopic features of BCC of 3 mm or less in diameter (n = 6) with BCC of 4-6 mm in diameter (n = 11). All lesions lacked the presence of a pigment network. BCC with a diameter of 3 mm or less had fewer positive dermoscopic features compared with the 4-6 mm in diameter BCC. Multiple blue-gray globules and large blue-gray ovoid nests were frequently present. Dermoscopy is a useful tool for early diagnosis of pigmented BCC, even when they are small.
Collapse
Affiliation(s)
- Asuka Takahashi
- Department of Dermatology, Nihon University Hospital, Tokyo, Japan
| | - Hiroyuki Hara
- Department of Dermatology, Nihon University Hospital, Tokyo, Japan.,Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| | - Miwa Aikawa
- Department of Dermatology, Nihon University Hospital, Tokyo, Japan
| | - Toyoko Ochiai
- Department of Dermatology, Nihon University Hospital, Tokyo, Japan
| |
Collapse
|
8
|
Basal cell carcinoma in asians: a retrospective analysis of ten patients. J Skin Cancer 2012; 2012:741397. [PMID: 22830031 PMCID: PMC3398648 DOI: 10.1155/2012/741397] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 05/10/2012] [Indexed: 11/17/2022] Open
Abstract
Background. Few studies have been done that characterize basal cell carcinoma (BCC) in Asians because this tumor is relatively uncommon in this population group. Objective. To characterize BCC in Asians. Methods. We retrospectively examined fifteen patient variables and eight tumor variables of ten Asian patients with BCC and compared these results to those of thirty matched Caucasian controls with BCC. Results. Asians developed their first BCC at an older age than the age of first BCC in Caucasian controls (68.9 years versus 58.3 years; P < 0.05). During their lifetime, Asians had fewer BCCs than the number of BCCs in Caucasian controls (1.11 versus 5.41; P < 0.02), despite a similar estimated lifetime daily sun exposure (hours/day) for both groups. Compared to BCCs in Caucasian controls, a higher percentage of BCCs in Asians were clinically pigmented (50.0% versus 3.3%; P < 0.01). Conclusion. Asians develop BCCs later in life and develop fewer BCCs over their lifetime than Caucasians, despite similar estimated lifetime daily sun exposure. This finding is probably due to skin pigmentation in Asians being more protective of ultraviolet light than skin pigmentation in Caucasians.
Collapse
|
9
|
Kirzhner M, Jakobiec FA. Clinicopathologic and immunohistochemical features of pigmented Basal cell carcinomas of the eyelids. Am J Ophthalmol 2012; 153:242-252.e2. [PMID: 21982104 DOI: 10.1016/j.ajo.2011.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/12/2011] [Accepted: 07/13/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the clinical and microscopic features of pigmented basal cell carcinomas (pBCC) of the eyelid. DESIGN Retrospective observational case series collected at one institution. METHODS An analysis of clinical records, photographs, and histopathologic characteristics of 257 BCCs with a review of the literature. The frequencies of clinically pigmented, and of microscopically pigmented but clinically nonpigmented, BCCs were determined. Cytochemical stains (Fontana-Masson, Prussian blue) and immunohistochemical probes (S-100, microphthalmia-associated transcription factor [MiTF], HMB-45, MART-1, CK20, synaptophysin, chromogranin, CD1a, Ki-67) were then employed and the findings correlated with the degree of clinical pigmentation. RESULTS Histopathologically, 13 of 257 cases (5.06%) were found to have pigment; of these 13, 6 (all white patients) had clinically apparent pigmentation (2.33%), either focal or diffuse. Eight of 13 lesions developed on the lower eyelids. All stained positively for melanin but negatively for iron. MiTF highlighted numerous melanocytic nuclei in the tumor lobules, while MART-1 and HMB-45 revealed the dendritic shapes of the entrapped melanocytes. There was a subtotal blockage of melanin transfer to the surrounding basaloid cells. Intralobular S-100-positive cells included CD1a-positive Langerhans cells, while CK20 did not identify any Merkel cells. CONCLUSIONS Only 1 of 6 lesions was uniformly clinically pigmented, whereas the other 5 were only focally brown-black. The clinical pigmentation was imparted by varying densities and distributions of melanocytes with arborizing dendrites, which were present in all BCCs. Melanophages within the stroma and basaloid cell melanization also contributed to pigmentation. No behavioral or biologic differences in pBCC were documented compared with clinically nonpigmented lesions.
Collapse
Affiliation(s)
- Maria Kirzhner
- David G. Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Room 321, 243 Charles St, Boston, MA 02114, USA
| | | |
Collapse
|
10
|
Zoccali G, Pajand R, Papa P, Orsini G, Lomartire N, Giuliani M. Giant basal cell carcinoma of the skin: literature review and personal experience. J Eur Acad Dermatol Venereol 2011; 26:942-52. [DOI: 10.1111/j.1468-3083.2011.04427.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
11
|
TAKENOUCHI T. Key points in dermoscopic diagnosis of basal cell carcinoma and seborrheic keratosis in Japanese. J Dermatol 2010; 38:59-65. [DOI: 10.1111/j.1346-8138.2010.01093.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
Lan CCE, Wu CS, Cheng CM, Yu CL, Chen GS, Yu HS. Pigmentation in basal cell carcinoma involves enhanced endothelin-1 expression. Exp Dermatol 2005; 14:528-34. [PMID: 15946241 DOI: 10.1111/j.0906-6705.2005.00320.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Basal cell carcinoma (BCC) is the most prevalent malignant skin tumor. In Asian patients, marked pigmentation in BCC lesions is often observed. Recently, endothelins (ETs) have been implicated to participate in the pigmentation process of BCC. Therefore, we set out to investigate the involvement of ET in the pigmentation process of BCC and the potential regulators in the pigmentation pathway. We explored the effects of an established BCC cell line on melanocytes. The growth factor profiles of BCC culture supernatant and effects of supernatant on melanocytes were documented. Potential regulators involved in the pigmentation pathway were also studied. The immunohistochemical staining of pigmented and non-pigmented BCC specimens was performed to confirm our in vitro findings. Our results showed that BCC supernatant contained significant amount of ET-1, basic fibroblast growth factor, and nerve growth factor. Furthermore, BCC supernatant stimulated melanin formation of cultured melanocytes. Addition of ET-receptor antagonist abrogated the melanogenic effect of BCC supernatant on melanocytes. Introduction of UVB irradiation decreased the ET-1 secretion by BCC cells. Immunohistochemical staining of the pigmented facial BCC specimens showed prominent expression of ET-1 on pigmented BCC, while the non-pigmented facial BCC specimens showed little ET-1 reactivity. Tumor necrosis factor-alpha (TNF-alpha) staining showed little expression on BCC specimens, regardless of pigmentation status. In summary, our results indicate that enhanced ET-1 expression in pigmented BCC plays an important role in the hyperpigmentation of this tumor. Moreover, this enhanced ET-1 cascade showed little correlation with UV irradiation and TNF-alpha expression in our study.
Collapse
Affiliation(s)
- Cheng-Che E Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | |
Collapse
|
13
|
|
14
|
The effects of sunlight on the skin of Asians. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s1568-461x(01)80039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
15
|
Lao LM, Kumakiri M, Kiyohara T, Kuwahara H, Ueda K. Sub-populations of melanocytes in pigmented basal cell carcinoma: a quantitative, ultrastructural investigation. J Cutan Pathol 2001; 28:34-43. [PMID: 11168750 DOI: 10.1034/j.1600-0560.2001.280104.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pigmentation is a characteristic clinical feature of basal cell carcinomas (BCCs) in Japanese patients. The pathogenesis of melanin pigment in pigmented BCCs is poorly understood. METHODS We have combined the techniques of morphometric analysis and electron microscopy to assess accurately the morphologic aspects of melanocytes that occurred in pigmented and non-pigmented areas of pigmented BCCs. RESULTS In the pigmented areas melanocytes were not only located along the basal membrane but also interspersed between tumor cells in the central parts of the tumor nest, and had large and numerous dendrites. Those in a supra-basal location displayed some degree of degeneration due to mitochondrion and melanosome swelling. In the non-pigmented areas melanocytes were only basally located, showed fewer dendrites, and frequently showed abortive melanosomes. However, melanocytes in these two different portions were in the active state of melanogenesis and proliferation. Ultrastructural cytomorphometric analysis also showed significant differences in most of the nuclear and cell parameters including nuclear and cell area, the nuclear/cell area ratio, cell perimeter and cell form factor between these two types of melanocytes. Particularly melanocytes in the pigmented areas were twice the cell size of the latter. In addition, the melanosomes remained almost completely in the apoptotic tumor cells, and the phagocytosis of the melanosome-containing apoptotic cells by the neighboring tumor cells appeared to be followed by the formation of the melanosome complexes. CONCLUSIONS These findings suggest that different populations of melanocytes are probably present in pigmented BCCs, and repeated cycles of phagocytosis of melanosome-containing apoptotic cells may represent the predominant way of forming large melanosome complexes. The present morphological observation and quantitative analysis provide a morphological basis for further studies to interpret other pathologic changes in pigmented BCCs.
Collapse
Affiliation(s)
- L M Lao
- Department of Dermatology, Fukui Medical University, Japan
| | | | | | | | | |
Collapse
|
16
|
Kore-eda S, Horiguchi Y, Ueda M, Toda K, Imamura S. Basal cell carcinoma cells resemble follicular matrix cells rather than follicular bulge cells: immunohistochemical and ultrastructural comparative studies. Am J Dermatopathol 1998; 20:362-9. [PMID: 9700374 DOI: 10.1097/00000372-199808000-00007] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To detail the histogenetic relationship between basal cell carcinoma (BCC) and hair follicles, we immunohistochemically compared BCC cells to follicular matrix cells and follicular bulge cells using a panel of monoclonal antibodies against melanocytes, cytokeratins, subepidermal extracellular matrix components, and bullous pemphigoid (BP) sera, as well as using electron microscopy. Cytokeratin expression patterns were not consistent with the variety in types of cytokeratins and in cases of BCC. The distribution of some extracellular matrix components was not only linear along the interfaces of BCC tumor nests and stroma, and follicular matrix and follicular papilla; granular deposits were also seen in the stroma and follicular papilla, whereas they were only linearly distributed along the follicular bulge. The BP antigens and integrin alpha 6, which were absent in BCC and follicular matrix, were expressed in the follicular bulge area. Electron microscopically, hemidesmosomes were poorly organized in these three tissues, but the lamina densa was incomplete in BCC and follicular matrix, whereas the lamina densa in the follicular bulge area was continuous. These morphologic similarities between BCC and follicular matrix cells, and coexistence of melanocytes in the BCC tumor nest strongly suggest the differentiation of BCC toward the follicular matrix cells.
Collapse
Affiliation(s)
- S Kore-eda
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Japan
| | | | | | | | | |
Collapse
|
17
|
Egawa K, Honda Y, Inaba Y, Ono T. Pigmented viral warts: a clinical and histopathological study including human papillomavirus typing. Br J Dermatol 1998; 138:381-9. [PMID: 9580787 DOI: 10.1046/j.1365-2133.1998.02112.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although clinical, histological and viral correlations have recently been established among pigmented warts, homogeneous intracytoplasmic inclusion bodies and related types of human papillomavirus (HPV) (HPV 65, 4 and 60), the causes of the pigmentation remain unknown. In this study, comparative histological and histochemical analyses were performed with 53 pigmented (34 HPV 65-induced, 12 HPV 4-induced and seven HPV 60-induced) and 73 non-pigmented warts (27 HPV 2-induced, 23 HPV 1-induced, 12 HPV 63-induced, six unknown HPV-type induced and five HPV 60 induced) to clarify the causes of the pigmentation. Electron microscopy was also used to examine the pigmented warts. Many melanin blockade melanocytes were identified in all of the pigmented warts with Masson-Fontana staining and electron microscopy, and increased melanin in keratinocytes was also noted in 22 pigmented warts, suggesting that the dispersion of melanin granules in the dendrites of the melanin blockade melanocytes and the increased melanin granules in keratinocytes are the primary contributors to the pigmentation of the warts. The homogeneous intracytoplasmic inclusion bodies might also play a part in the darkening of the warts, as only the cases which had the inclusion bodies as well as the melanin blockade melanocytes were clinically pigmented. Although melanin blockade melanocytes were seen in a few cases of HPV 1- and HPV 2-induced warts in which the homogeneous inclusion bodies were not observed, the warts were not clinically pigmented. Melanin blockade melanocytes were not seen in any of the HPV 63-induced non-pigmented warts. In conclusion, the pigmented warts were associated with one of the related types of HPV (HPV 65, 4 and 60), and the pigmentation of the lesions is thus thought to be caused primarily by melanin blockade melanocytes. The homogeneous intracytoplasmic inclusion bodies might also play a part in the darkening of the lesions. This is the first report dealing with the pigmentary disorder associated with specific types of HPV.
Collapse
Affiliation(s)
- K Egawa
- Department of Dermatology, University School of Medicine, Kumamoto, Japan.
| | | | | | | |
Collapse
|
18
|
Tanaka K, Iyama K, Kitaoka M, Ninomiya Y, Oohashi T, Sado Y, Ono T. Differential expression of alpha 1(IV), alpha 2(IV), alpha 5(IV) and alpha 6(IV) collagen chains in the basement membrane of basal cell carcinoma. THE HISTOCHEMICAL JOURNAL 1997; 29:563-70. [PMID: 9279559 DOI: 10.1023/a:1026428010104] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Type IV collagen, the major component of basement membrane, consists primarily of alpha 1(IV) and alpha 2(IV) chains. Recently, other types of collagen IV chains, i.e. alpha 3(IV), alpha 4(IV), alpha 5(IV) and alpha 6(IV) chains, have been identified by protein chemistry and molecular cloning. We have examined the diversity of the assembly of alpha (IV) chains of the basement membrane surrounding tumour nests of basal cell carcinomas, in tissues from 11 patients, by immunohistochemical analysis using specific monoclonal antibodies to six alpha (IV) chain. The immunostaining profile of each chain differed with respect to the histological subtypes of basal cell carcinoma. In the morphea-like subtype, which was more invasive, alpha 1(IV) and alpha 2(IV) chains were discontinuously stained, and alpha 5(IV) and alpha 6(IV) chains were entirely absent. However, in the superficial subtype, which was non-aggressive, alpha 1(IV), alpha 2(IV), alpha 5(IV) and alpha 6(IV) chains were well stained compared with the other subtypes of basal cell carcinoma. In addition, in the solid subtype, which showed slow growth and ulceration, alpha 1(IV) and alpha 2(IV) chains were continuously stained, and alpha 5(IV) and alpha 6(IV) chains were discontinuous or absent. The assembly of alpha 5(IV) and alpha 6(IV) chains into the basement membrane was inhibited in the solid and morphea subtypes of BCC. This differential expression of type IV collagen chains seems to be associated with the invasive potential of basal cell carcinoma.
Collapse
Affiliation(s)
- K Tanaka
- Department of Dermatology, Kumamoto University School of Medicine, Japan
| | | | | | | | | | | | | |
Collapse
|
19
|
Yamamoto S, Johno M, Kayashima K, Matsunaga W, Ono T. Giant basal cell carcinoma associated with systemic amyloidosis. J Dermatol 1996; 23:329-34. [PMID: 8675823 DOI: 10.1111/j.1346-8138.1996.tb04025.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A large basal cell carcinoma, 39 x 26 cm in size, is presented as second in size only to the largest basal cell carcinoma documented (40 x 30 cm), reported by Beck and co-workers (1). A 61-year-old Japanese male visited our clinic with a huge ulcerating tumor on the back. He had hidden the tumor for the previous 30 years. The tumor was histologically confirmed as basal cell carcinoma. The condition was associated with anemia, hypoproteinemia, and dyspnea, and with systemic amyloidosis in the skin, in the lymph nodes, and in the intestinal canal. On admission, the tumor had metastasized to the regional lymph nodes, and, about two years after the first operation, there were metastases to bone and lung, leading to death due to respiratory failure.
Collapse
Affiliation(s)
- S Yamamoto
- Department of Dermatology, Kumamoto University School of Medicine, Japan
| | | | | | | | | |
Collapse
|
20
|
Betti R, Inselvini E, Gualandri L, Crosti C. Basal cell carcinomas of the auricular region: a study of 23 cases. J Dermatol 1995; 22:655-8. [PMID: 8537551 DOI: 10.1111/j.1346-8138.1995.tb03893.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Basal cell carcinomas (BCCs) of the auricular region are not frequently reported, especially in the Japanese literature. Predisposing conditions such as sun exposure or frostbite are possibly involved in their development. In this study, we report our cases of auricular BCCs, discussing the obtained results, the possible significance of predisposing conditions, and the correlation with the histologic subtypes involved. Among 1094 patients with BCCs, auricular tumors were observed in 23 patients (2.1%), 4 women and 19 men. All of them were present on the external sun-exposed auricular side. Histologic patterns were nodular and micronodular (13 cases) and infiltrative (10 cases). No differences were observed between sexes. The relative degree of elastosis was higher in men than in women. Frostbite was recorded in 4 cases. The ear is an anatomical region that is heavily exposed to sun-light and equally prone to frostbite. Our data showed that all the lesions were located on the auricular region more or less exposed to sunlight. There was a recorded previous history of predisposing factors in most cases, and the high degree of elastosis suggests the involvement of these predisposing factors. Moreover, the high prevalence of infiltrative subtypes observed in our survey suggests a possible correlation between some histologic subtypes, sun-exposure, and frostbite. The differences between the relatively high number of auricular BCCs reported in the literature in contrast with the Japanese observations suggest the involvement of social or local conditions.
Collapse
Affiliation(s)
- R Betti
- Clinica Dermatologica IV, Ospedale San Paolo, Milano, Italy
| | | | | | | |
Collapse
|
21
|
Betti R, Inselvini E, Perotta E, Crosti C. Pre-existing cutaneous changes in basal cell carcinomas of the lower extremities. J Dermatol 1994; 21:738-40. [PMID: 7798430 DOI: 10.1111/j.1346-8138.1994.tb03279.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Basal cell carcinomas (BCCs) of the lower extremities are not frequently reported. Some pre-existing or predisposing conditions are thought to be implicated in their development. In this study, we investigated the possible relationships between pre-existing cutaneous changes and the development of BCCs of the lower extremities, possible sex and age differences, and the histologic patterns involved. Among 1053 patients with BSSc, BCCs of the lower extremities were observed in 48 (4.5%): 25 men and 23 women. Lesions appeared on the thighs (16 cases), the lower legs (27 cases), or the feet (5 cases). Histologic patterns were nodular and micronodular (18 cases), superficial (27 cases), or infiltrative (3 cases). No differences were observed between sexes. The relative degree of elastosis was higher in the lower limbs of women than of men (2.25 vs 1.53). Pre-existing cutaneous changes were observed in 7 cases. The frequency of these BCCs of the lower limbs and the higher degree of elastosis observed in the women seem to be related to sun exposure. The histologic pattern seems not to be affected by environmental factors but rather characteristic of body site. Pre-existent cutaneous changes are not thought to be possible etiologic factors.
Collapse
Affiliation(s)
- R Betti
- Clinica Dermatologica IV, Ospedale San Paolo, Milano, Italy
| | | | | | | |
Collapse
|
22
|
Nogita T, Kamikawa T, Kawashima M. Significance of pre-existent conditions in basal cell carcinoma on the lower extremities. Int J Dermatol 1993; 32:350-3. [PMID: 8505161 DOI: 10.1111/j.1365-4362.1993.tb01471.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Basal cell carcinoma (BCC) rarely appears on the lower extremities; over 85% appear on the head and neck. CASE REPORTS Five patients had BCC on the lower extremity. Histologically, this was of the superficial type. One patient developed a lesion of actinic keratosis. RESULTS The presence of pre-existent cutaneous changes of BCC arising on the lower extremities was studied. Among 40 tumors reported in Japan, 10 cases (25%) had pre-existent cutaneous changes. This value is significantly higher than those of BCC over the whole body in both Japanese and Caucasian. CONCLUSIONS Pre-existent cutaneous changes, thus, are thought to be a possible etiologic factor in the pathogenesis of BCC on the lower extremities.
Collapse
Affiliation(s)
- T Nogita
- Department of Dermatology, Tokyo Women's Medical College, Japan
| | | | | |
Collapse
|
23
|
Nogita T, Mitsuishi T, Nagayama M, Kawashima M. Basal cell carcinoma arising on the ear of a young adult. J Dermatol 1992; 19:127-9. [PMID: 1619109 DOI: 10.1111/j.1346-8138.1992.tb03194.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
24
|
Abstract
Basal cell carcinoma (BCC) originating from an epidermoid cyst which existed for about 50 years was seen in a 78-year-old Japanese male. Nests of basal cell carcinoma were connected with the epidermoid cyst, partially replacing the cyst wall.
Collapse
Affiliation(s)
- I Ikeda
- Department of Dermatology, Kumamoto University Medical School, Japan
| | | |
Collapse
|
25
|
Ono T, Egawa K, Yamamoto S, Arao T. Pigmented basal cell carcinoma developing on the lower extremities--three cases masquerading as malignant melanoma. J Dermatol 1989; 16:325-9. [PMID: 2600270 DOI: 10.1111/j.1346-8138.1989.tb01273.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Three cases of pigmented basal cell carcinoma were reported which needed to be differentiated from malignant melanoma based on their location and clinical features. Clinicopathologically, they were characterized by a large number of melanophages in the stroma, blockade melanocytes in the parenchyma, and phagocytosis of melanosomes in tumor cells as well as a large number of intraparenchymal melanophages. Two cases were characterized by the aggregation of melanophages in cystic spaces caused by stellate atrophy.
Collapse
|
26
|
|
27
|
Kikuchi I, Ogata K, Tajiri A. A basal cell epithelioma on another basal cell epithelioma. J Dermatol 1984; 11:199-202. [PMID: 6384317 DOI: 10.1111/j.1346-8138.1984.tb01465.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|