Surgical management of giant skin tumor - A case report.

INTRODUCTION: Malignant non-melanoma skin cancers (NMSC) are of two main types: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). In rare occasions, some of the malignant skin lesions show histopathological characteristics of both BCC and SCC and are known as basosquamous carcinomas (BSC). In some cases of large tumors, extensive reconstructive surgery might be needed to correct the skin defect after the primary excision. PRESENTATION OF CASE: We report a case of a 76-year-old Bulgarian male patient who presented with a neglected giant cutaneous tumor with more than a 15-year history of a growing mass in the right deltoid area. On physical exam an enormous exophytic ulcerated and crusted skin lesion measuring around 11×11cm was found. Wide local excision of the lesion with 10-mm resection margins and partial resection of the underlying deltoid muscle were performed due to signs of infiltration. A full-thickness total skin graft from the left inguinal area was harvested to cover the skin defect. Final histopathological examination showed metatypical carcinoma with mixed characteristics of SCC and BCC - BSC, with infiltration of the fatty tissue, deltoid muscle and clear margins of resection, staged as T4R0. Two and a half years after surgery there are no signs of upper arm motor dysfunction and no evidence of local recurrence and distant metastasis on a follow-up PET/CT. DISCUSSION: Following current National Comprehensive Cancer Network's guidelines for primary treatment of BCC, surgical candidates should undergo standard excision with wider surgical margins, postoperative margin assessment and second intention healing, linear repair, or skin graft. Therapeutic strategy for non-operable cases includes administration of radiotherapy or system therapy in the face of Hedgehog pathway inhibitors and programmed cell death protein 1 inhibitor. They can provide an alternative solution to unresectable or difficult-to-treat locally advanced cases of BSC. CONCLUSION: Similarly to BCC and SCC, the first-line treatment option for BCS is surgical excision, but surgical margins should be wider than those for low-risk BCC due to the infiltrative growth pattern of this tumor. Favorable esthetic outcome requires precise planning of the reconstructive technique.

Nanoparticles as drug carrier system of 5-fluorouracil in local treatment of patients with superficial basal cell carcinoma.

PURPOSE: To develop an alternative nonsurgical treatment for basal cell carcinoma using colloidal systems as drug carriers. We investigated the possibility of polybutylcyanoacrylate nanoparticles loaded with 5-fluorouracil (5-FU) to be applied in local treatment of patients with basal cell carcinoma. PATIENTS AND METHODS: 32 patients (mean age 74 years, range 56-90) with histologically confirmed superficial basal cell carcinoma were treated with 5-FU-loaded polybutyl-cyanoacrylate nanoparticles. The nanoparticles were prepared by anionic polymerization of butyl-2-cyanoacrylate monomer for use as drug delivery system. The preparation of 5-FU-loaded polybutylcyanoacrylate nanoparticles was carried out by adsorption of the drug on the surface of previously prepared nanoparticles. This preparation was applied once a day for 35-40 days. The effect of treatment on the immunological parameters, measured by phytohaemagglutinin (PHA)-induced DNA synthesis of T lymphocytes and also their number in the peripheral blood were analyzed in 28 of 32 treated patients and compared against a group of 24 healthy individuals (controls). RESULTS: 31 of 32 patients achieved histologically confirmed complete tumor resolution. Treatment did not cause significant changes both in the number of T lymphocytes and PHA-induced DNA synthesis of T lymphocytes of the treated patients. CONCLUSION: Local treatment with 5-FU-loaded nanoparticles provides a nonsurgical treatment alternative in patients with superficial basal cell carcinoma. This effective and well tolerated method is preferred by patients who are not surgical candidates or who prefer nonsurgical treatment.

Nonmelanoma skin cancers and risk of subsequent malignancies: a cancer registry-based study in Bulgaria.

Analysis of new primary tumors following nonmelanoma skin cancers (NMSC) has a public health and risk assessment interest, as well as potential implications for etiologic inference. The aim of this study is to evaluate the risk of the second primary tumors occurrence after NMSC development. A cohort of 2620 cases (1335 males and 1285 females) with nonmelanoma skin cancers registered in Bulgarian National Cancer Registry in 1993 was examined. The follow-up period represented a total of 15,856 person-years at risk. Over this period 128 (83 in men, 45 in women) new secondary tumors were established. After NMSC appearance, both genders show higher risk for the second primary tumors occurrence. This risk is greater for men. For both sexes after NMSC development there is increased risk for occurrence of second primary cancers of head and neck, thyroid, lung, larynx, bladder, colon, as well as cutaneous malignant melanoma, non-Hodgkin's lymphoma and leukemias. The results of considering only basal cell carcinomas show an elevated risk in patients of both sexes for appearance of second primary tumors of head and neck, bladder, larynx, lung and colon as well as non-Hodgkin's lymphoma and cutaneous malignant melanoma. The results of considering only squamous cell carcinomas show an increased risk in persons of both sexes for development of second primary cancers of head and neck, skin, thyroid, lung, stomach, as well as leukemias, non-Hodgkin's lymphoma and cutaneous malignant melanoma. The association between NMSC and subsequent increased risk for appearance of second primary skin and visceral tumors determine the necessity of monitoring the patients with NMSC.

Clinical stages of cutaneous malignant melanoma in Bulgaria.

The aim of the study was to investigate the distribution of the newly diagnosed cases with cutaneous malignant melanoma by clinical stages in Bulgaria over the period 1993-1995 as a reason for improving both mclanoma prevention and control. Over the period 827 new cases with cutaneous malignant melanoma are registered in the country. A representative sample of 671 cases has been taken. The cases with a localized melanoma (Stage I and II) were prevalent - 509 (75.8% of all studied cases). The thick melanomas (Stage IIB) were most frequently encountered among the primary lesions. They were 207 cases (30.8%). The thin melanomas (Stage IA) were only 41 (6.1%). The proportion of the cases with nodal and in-transit metastases (Stage III) -122 (18.2%) and the proportion of the cases with distant metastases (Stage IV) -40 (6.0%) were quite high. The analysis of the results shows that the cases with cutaneous malignant melanoma in Bulgaria are detected quite late. The cases with early-diagnosed melanoma are prevalent among women, young persons and urban population, and the cases with advanced melanoma are more frequent among men, persons older than 50 and rural population.

The role of trauma in the melanoma formation.

PURPOSE: Mechanical trauma and its importance for cutaneous malignant melanoma (CMM) formation are still a disputable problem. The aim of the present study was to analyse the relationship between the mechanical trauma on preexisting pigmented skin lesions as a risk factor for development of CMM. MATERIALS AND METHODS: A comprehensive analytical case-control study was conducted covering 156 patients with histologically proven CMM and a control group of 156 individuals without oncological diseases. The study was performed using a specially developed questionnaire containing personal data and questions referring to the character and particularities of the trauma and later changes in the preexisting pigmented skin lesion. RESULTS: The results revealed that a history for trauma on a preexisting pigmented skin lesion was associated with elevated, still not statistically significant, risk for CMM formation. Cases with only acute traumas did not reveal risk for tumor formation. CONCLUSION: The data from this study show that the role of mechanical injury, though uncertain, cannot be entirely neglected. Additional studies are necessary to clarify this question. Until then, trauma, particularly a repeated one, should be considered as a factor associated with increased risk for CMM formation.