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![Basal cell carcinoma histologic features. (A) Microscopic features of nodular basal cell carcinoma (BCC). Note the large solid lobules of predominant basaloid cells (black arrows) with peripheral palisading and some cystic areas (asterisk; hematoxylin and eosin [H&E] ×20). (B) Microscopic features of micronodular BCC. Note the predominance of small neoplastic basal cell nodules (arrowheads; H&E ×40). (C) Microscopic features of superficial BCC. Note the presence of typical basal cell buds arising from basal layer of epidermis (black arrows) and retraction features (H&E ×40). (D) Microscopic features of infiltrative BCC. Note the trabecular pattern (black arrow) of invading neoplastic cells (H&E ×20). (E) Microscopic features of morpheaform BCC with perineural invasion (inset black arrow). Note the sclerotic stroma and the thin strands (asterisk) of neoplastic basal cells (H&E ×20). (F) Microscopic features of mixed histology BCC. Note the coexistence of nodular (one asterisk) and infiltrative (two asterisks) patterns of the neoplastic basal cells (H&E ×40).](profile/Jose-Lopes-8/publication/282760728/figure/fig1/AS:361256570638337@1463141686804/Basal-cell-carcinoma-histologic-features-A-Microscopic-features-of-nodular-basal-cell.png)
Basal cell carcinoma histologic features. (A) Microscopic features of nodular basal cell carcinoma (BCC). Note the large solid lobules of predominant basaloid cells (black arrows) with peripheral palisading and some cystic areas (asterisk; hematoxylin and eosin [H&E] ×20). (B) Microscopic features of micronodular BCC. Note the predominance of small neoplastic basal cell nodules (arrowheads; H&E ×40). (C) Microscopic features of superficial BCC. Note the presence of typical basal cell buds arising from basal layer of epidermis (black arrows) and retraction features (H&E ×40). (D) Microscopic features of infiltrative BCC. Note the trabecular pattern (black arrow) of invading neoplastic cells (H&E ×20). (E) Microscopic features of morpheaform BCC with perineural invasion (inset black arrow). Note the sclerotic stroma and the thin strands (asterisk) of neoplastic basal cells (H&E ×20). (F) Microscopic features of mixed histology BCC. Note the coexistence of nodular (one asterisk) and infiltrative (two asterisks) patterns of the neoplastic basal cells (H&E ×40).
Source publication
Basal cell carcinoma (BCC) is a heterogeneous malignant neoplasm with different biological and clinical behaviors, often slow growing and rarely metastatic and conveying an excellent prognosis. However, BCC is the most frequent skin cancer worldwide and can cause great morbidity, as most occur in high visible areas of the body, often relapse and ma...
Context in source publication
Context 1
... BCC are classified as nodular, micro- nodular, superficial, infiltrative and morphea- form, but BCC with mixed histology are not unusual (see Table 4 & Figure 1A-F). Other sub- types include basosquamous BCC, fibroepithe- lial BCC (Pinkus tumor or fibroepithelioma of Pinkus), BCC with adnexal differentiation, keratotic BCC and other variants (many w ithout distinctive clinical features) [27,28]. ...
Citations
... In detail, BCC is the most frequent malignancy in the fair-skinned population. Metastatic activity is a rare event in BCC history, as the association with death; however, the progressive growth of the tumor can be invasive and destructive [2]. ...
Non-melanoma skin cancers (NMSCs) are the most common human neoplasms world-wide. In detail, basal cell carcinoma (BCC) is the most frequent malignancy in the fair-skinned population. The incidence of BCC remains difficult to assess due to the poor registration practice; however, it has been increasing in the last few years. Approximately, 85% of sporadic BCCs carry mutations in Hedgehog pathway genes, especially in PTCH, SUFU and SMO genes, which lead to the aberrant activation of GLI transcriptional factors, typically silent in cells of adult individuals. The management of advanced BCC (aBCC), both metastatic (mBCC) and locally advanced BCC (laBCC), not candidates for surgical excision or radiotherapy, remains challenging. The discovery of mutations in the Hh signaling pathway has paved the way for the development of Hh pathway inhibiting agents, such as vismodegib and sonidegib, which have represented a breakthrough in the aBCC management. However, the use of these agents is limited by the frequent occurrence of adverse events or the development of drug resistance. In this review, we thoroughly describe the current knowledge regarding the available options for the pharmacological management of aBCCs and provide a forward-looking update on novel therapeutic strategies that could enrich the therapeutic armamentarium of BCC in the near future.
... Although slowly growing and rarely metastatic with excellent prognosis, BCC can cause extensive local tissue destruction with high morbidity. 1 The pathogenesis of BCC is underpinned by interaction between genetic, site specific, environmental and immunologic factors. 2 BCC forms as an immunogenic tumor supported by the intra-and peritumoral inflammatory infiltrate of the BCC microenvironment, characterized by a strong predominance of T lymphocytes, mainly CD4+ Thelper (Th) cells with a variable number of CD8+ T cytotoxic/ suppressor (Tc) cells, Langerhans cells, natural killer (NK) cells and immature dendritic cells (DC). 3 BCC is effectively treated by standard surgical excision, Mohs micrographic surgery, radiotherapy, and/or superficial field therapies. 4 However intralesional chemotherapy is also a therapeutic option when patients cannot or will not undergo surgery. ...
Basal cell carcinoma (BCC) is the most common malignant skin tumor. While slowly growing, it can cause major skin disfigurement. Therefore, novel cosmetically acceptable treatment options, other than surgery require investigation. to evaluate efficacy and safety of intralesional methotrexate (MTX) as a convenient modality for BCC treatment clinically and pathologicaly. A total of 20 patients with BCC of any clinical variant underwent intralesional MTX injection at a maximum 1 mL of 25 mg/mL MTX per session. Histopathological assessments were performed before and 1 month after treatment. 40% of patients showed >50% clinical improvement after 1–4 sessions. Intralesional MTX is a suitable and safe treatment modality for BCC and may be used as an adjuvant to surgery.
... 8 Although BCC rarely metastasizes, it can destroy local tissue and recur. 9 It occurs mainly due to the accumulation of ultraviolet radiation in sunlight. [10][11][12] Previous studies have found that almost all BCCs are constitutively activated by the Hedgehog (Hh) signaling pathway, whereas intermittent UV radiation plays a dominant role in the carcinogenesis of BCC. 13 The Hh/Gli signaling pathway was originally discovered in Drosophila. ...
Objective
Basal cell carcinoma (BCC) is the most common type of cancer with a growing incidence rate over recent decades. The increasing economic burden and incidence of BCC have generated major interest in developing targeted therapies for this disease. The critical role of the Hedgehog (Hh) pathway in the pathogenesis of BCC has become evidently demonstrated. The purpose of this study was to observe the expression of PTCH1 and Gli1 in BCC and further evaluate their relationship with clinicopathological features.
Methods
This retrospective study included 84 patients with BCC. Information of 84 patients with pathologically diagnosed BCC (including location, sex, tumor size, pathological type, and depth of invasion) were collected, and tissue paraffin blocks were collected for immunohistochemical staining. Western blot analysis for PTCH1 and Gli1 were also performed. The staining intensity and percentage of stained cells were expressed as a histochemical score (HSCORE).
Results
PTCH1 and Gli1 were overexpressed in BCC compared with adjacent normal epidermis. Our study found that the expression of PTCH1 and Gli1 in BCC in exposed sites was significantly higher than in non-exposed sites. Moreover, no significant difference was observed in sex, Breslow thickness, tumor size or pathological type (P>0.05).
Conclusion
PTCH1 and Gli1 were overexpressed in BCC. Higher PTCH1 and Gli1 expression were in exposed sites lesions. Our study suggests that UV radiation may be associated with aberrant activation of the Hh-PTCH1-Gli1 intercellular signaling pathway in BCC. The molecular mechanism of UV-related PTCH1 and Gli1 differential expression deserves more rigorous research in the future.
... Management of high-risk BCCs [3] frequently requires a surgical approach, necessitating expertise, time and resources to assess surgical margins with pathology. Mohs surgery with complete margin control for high risk BCCs results in high cure rates of 96-99% [4,5] but the preparation of frozen pathology is complex and time intensive [6,7]. In global settings, tissue processing and reading by a pathologist (instead of the Mohs surgeon) may occur off-site, further prolonging the procedure. ...
Background:
Novel solutions are needed for expediting margin assessment to guide BCC surgeries. Ex-vivo fluorescence confocal microscopy (FCM) is starting to be used in freshly-excised surgical specimens to examine BCC margins in real-time. Training and educational process are needed for this novel technology to be implemented into clinic.
Objective:
To test a training and reading process, and measure diagnostic accuracy of clinicians with varying expertise level in reading ex-vivo FCM images.
Methods:
An international 3-center study was designed for training and reading to assess BCC surgical margins and residual subtypes. Each center included a lead dermatologic/Mohs surgeon (clinical developer of FCM), and 3 additional readers (dermatologist, dermatopathologist, dermatologic/Mohs surgeon), who use confocal in clinical practice. Testing was conducted on 30 samples.
Results:
Overall, the readers achieved 90% average sensitivity, 78% average specificity in detecting residual BCC margins, showing high and consistent diagnostic reading accuracy. Those with expertise in dermatologic surgery and dermatopathology showed the strongest potential for learning to assess FCM images.
Limitations:
Small dataset, variability in mosaic quality between centers.
Conclusion:
Suggested process is feasible and effective. This process is proposed for wider implementation, to facilitate wider adoption of FCM to potentially expedite BCC margin assessment to guide surgery in real-time. This article is protected by copyright. All rights reserved.
... The surgical removal of non-melanoma skin cancers (NMSCs) is guided by the pathologic examination of margins. 1,2 The clearance of margins is confirmed either with postoperative permanent pathology for standard surgical excision or with intra-operative frozen pathology of each staged excision during Mohs micrographic surgery (MMS). However, the preparation of histopathology is time consuming, labour-intensive and requires separate laboratory infrastructure. ...
... Basal cell carcinoma (BCC) is the most common cutaneous malignant neoplasia in lightskinned populations [1,2] representing a growing public health care problem [3,2]. BCC is usually characterized by slow growth and low metastatic potential although it might be associated with severe morbidity due to its ability to enlarge progressively and to destroy adjacent tissues [4]. ...
Several immune-related markers have been implicated in basal cell carcinoma (BCC) pathogenesis. The BCC inflammatory infiltrate is dominated by Th2 cytokines, suggesting a specific state of immunosuppression. In contrast, regressing BCC are characterized by a Th1 immune response with IFN-γ promoting a tumor suppressive activity. IL-23/Th17-related cytokines, as interleukin (IL)-17, IL-23 and IL-22, play a significant role in cutaneous inflammatory diseases, but their involvement in skin carcinogenesis is controversial and is poorly investigated in BCC. In this study we investigated the expression of IFN-γ, IL-17, IL-23 and IL-22 cytokines in BCC at the protein and mRNA level and their modulation during imiquimod (IMQ) treatment or photodynamic therapy (PDT). IFN-γ, IL-17, IL-23 and IL-22 levels were evaluated by immunohistochemistry and quantitative Real Time PCR in 41 histopathologically-proven BCCs (28 superficial and 13 nodular) from 39 patients. All BCC samples were analyzed at baseline and 19 of 41 also during medical treatment (9 with IMQ 5% cream and 10 with MAL-PDT). Association between cytokines expression and clinico-pathological variables was evaluated. Higher levels of IFN-γ, IL-17, IL-23 and IL-22 were found in BCCs, mainly in the peritumoral infiltrate, compared to normal skin, with the expression being correlated to the severity of the inflammatory infiltrate. IFN-γ production was higher in superficial BCCs compared to nodular BCCs, while IL-17 was increased in nodular BCCs. A significant correlation was found between IFN-γ and IL-17 expression with both cytokines expressed by CD4+ and CD8+ T-cells. An increase of all cytokines occurred during the inflammatory phase induced by IMQ and at the early time point of PDT treatment, with significant evidence for IFN-γ, IL-23, and IL-22. Our results confirm the role of IFN-γ and support the involvement of IL-23/Th17-related cytokines in BCC pathogenesis and in the inflammatory response during IMQ and MAL-PDT treatments.
... Basal cell carcinoma is the most common skin cancer [5][6][7]. Several clinical variants of basal cell carcinoma have been described. Albeit, uncommonly reported basal cell carcinoma can also present as a small red dot (red dot basal cell carcinoma) [1,4]. ...
Red dot basal cell carcinoma is a unique variant of basal cell carcinoma. Including the three patients described in this report, red dot basal cell carcinoma has only been described in seven individuals. This paper describes the features of two males and one female with red dot basal cell carcinoma and reviews the characteristics of other patients with this clinical subtype of basal cell carcinoma. A 70-year-old male developed a pearly-colored papule with a red dot in the center on his nasal tip. A 71-year-old male developed a red dot surrounded by a flesh-colored papule on his left nostril. Lastly, a 74-year-old female developed a red dot within an area of erythema on her left mid back. Biopsy of the lesions all showed nodular and/or superficial basal cell carcinoma. Correlation of the clinical presentation and pathology established the diagnosis of red dot basal cell carcinoma. The tumors were treated by excision using the Mohs surgical technique. Pubmed was searched with the keyword: basal, cell, cancer, carcinoma, dot, red, and skin. The papers generated by the search and their references were reviewed. Red dot basal cell carcinoma has been described in three females and two males; the gender was not reported in two patients. The tumor was located on the nose (five patients), back (one patient) and thigh (one patient). Cancer presented as a solitary small red macule or papule; often, the carcinoma was surrounded by erythema or a flesh-colored papule. Although basal cell carcinomas usually do not blanch after a glass microscope slide is pressed against them, the red dot basal cell carcinoma blanched after diascopy in two of the patients, resulting in a delay of diagnosis in one of these individuals. Dermoscopy may be a useful non-invasive modality for evaluating skin lesions when the diagnosis of red dot basal cell carcinoma is considered. Mohs surgery is the treatment of choice; in some of the patients, the ratio of the area of the postoperative wound to that of the preoperative cancer was greater than 12:1, demonstrating a significant lateral spread of the tumor beyond the observed clinical margins of the neoplasm. In conclusion, in a patient with a personal history of actinic keratosis or nonmelanoma skin cancer, the appearance of a new red dot in a sun-exposed site should prompt additional evaluation of the skin lesion to exclude or establish the diagnosis of red dot basal cell carcinoma.
This study aimed to identify the optimal combination of the stacked ensemble (SE) and the heterogeneous ensemble feature selection (HETR-EFS) technique for classifying HNSCC recurrence patterns. Four SE classification models were developed based on various EFS techniques, using GBM meta-classifiers in each case. The results showed that implementing the SE technique consisting of five base classifiers on the heterogeneous ensemble feature (HETR-EF) subset achieved better performance than other EF subsets and HETR-EFs. Thus, learning SE technique having five base classifiers on HETR-EFs is clinically appropriate as a prognostic model for classifying and predicting HNSCC patients' recurrence data. The SE technique, which combines base classifier models, is clinically appropriate for classifying and predicting HNSCC patients' recurrence data. The study highlights the importance of finding a machine learning algorithm that performs best given varied distributions, as not all algorithms are equally created.
Resumo Existem dois grupos de neoplasias cutâneas: os melanomas e os não melanoma. Estes são os tipos mais frequentes. O melanoma apesar da menor incidência é o que está associado ao maior número de mortes. O presente estudo tem como objetivo relatar um caso de um Carcinoma Basocelular (CBC) Nodular Pigmentado como um diagnóstico diferencial para o Melanoma Nodular. Uma Paciente de 73 anos apresentou-se ao Centro de Especialidades de um município paraibano para avaliação de um nevos em dorso nasal. Ao exame físico a lesão possuía corpo superior perolado com telangiectasias e corpo inferior melanocítico. Para que se faça um diagnóstico diferencial com o melanoma nodular, é importante usar a regra do ABCDE. Palavras-chave: Carcinoma Basocelular; Melanoma; Neoplasias Cutâneas; Diagnóstico Diferencial. Abstract There are two groups of cutaneous neoplasms: melanomas and non-melanomas. These are the most frequent types. Melanoma despite the smallest number of dealth is more associated with the number of fatality. The present study aims to report a case of pigmented basal cell carcinoma (BCC) as a differential diagnosis for nodular melanoma. A 73-year-old woman went to a Specialties Center in a Paraíba city, with the proposal to do an evaluation of a nasal dorsum nerve. On the physical examination of the injure had a pearly upper body with telangiectasias and a lower melanocytic body. To make a differential diagnosis with nodular melanoma, it is important to use the ABCDE rule.
Plain-language-summary
Cutaneous basal cell carcinoma (cBCC) is the most common malignancy diagnosed in the human population. cBCC presents an increasing incidence which, in the near future, will be higher than all other cancers combined. The majority of cBCC are located in the head and the neck. A diversity of management modalities is currently available; nonetheless, surgical excision remains the main modality of treatment. cBCC rarely metastasises and presents a low mortality rate. cBCC morbidity is influenced by local invasion and destruction, especially in the face, where function and aesthetics are major issues. Easy accessibility to the face and skin on the neck makes cBCC an important issue for otorhinolaryngology head and neck surgeons who must be aware and committed in its management, as the main modality of treatment continues to be surgical. The aim of this review is to present a brief and practical overview of head and neck cBCC management for ear, nose and throat (ENT) surgeons, discussing key issues about its epidemiology, risk factors, diagnosis and pathogenesis.
