Characterization of Basosquamous Cell Carcinoma: A Distinct Type of Keratinizing Tumour.

Basosquamous carcinoma is a rare clinical entity, which comprises 1.7-2.7% of all skin carcinomas. It is described as a basal cell carcinoma with features of squamous differentiation. To date, studies of the epidemiology of basosquamous carcinoma have been few and small in size. We report here the most extensive series of basosquamous carcinomas published to date, highlighting the differences between basosquamous carcinoma and other keratinizing tumours. Patients undergoing surgical excision for keratinizing tumours were enrolled in this study. Age, sex and tumour characteristics were recorded. A total of 1,519 squamous cell carcinomas, 288 basosquamous carcinomas and 4,235 basal cell carcinomas were collected. Basosquamous features were compared with those of basal cell and squamous cell carcinomas. For basosquamous carcinomas, 70.5% were located on the head and neck, particularly on the nose, forehead and cheeks, and represented almost 10% of the keratinizing tumours on the ears. Significant differences were found between basosquamous carcinoma and basal cell or squamous cell carcinomas. Basosquamous carcinoma should be considered a distinct type of keratinizing tumour with different anatomical, sex and age distributions.

Clinical and epidemiological analysis of basosquamous carcinoma: results of the multicenter study.

Basosquamous carcinoma (BSC) is a rare non-melanoma skin cancer that shares the characteristic features of both basal and squamous cell carcinomas (BCC, SCC). Our research enables better characterization of BSC in comparison to high-risk subtypes of BCC and SCC. Paper includes a retrospective analysis of BSC cases regarding sex, age, number of tumors and anatomical distribution in comparison to BCC and SCC evaluating the differences and defining the implications. Histologically confirmed carcinomas recorded between 1999 and 2019 were studied. 181 diagnosed BSC cases were identified, making this study the largest cohorts of BSC patients reported worldwide. Most cases were reported on head and neck. Analysis of facial anatomic distribution shows that most commonly affected sites were the nose (43%) and the cheek (25%). The age at excision of metatypical BCC was higher than those of low-risk BCC (P < 0.05), however similar to high-risk BCC (P = 0.20). We revisited that the concept of BSC is the most similar to high-risk subtypes of BCC. Patients with diagnosed BSC have higher risk of second nonmelanoma skin cancer. Therefore, the frequency of follow-up examination should be adjusted to the individual risk of another skin cancer.

Basal Cell Carcinoma in Cases with or without Xeroderma Pigmentosum.

INTRODUCTION: Basal cell carcinoma is the most common form of cancer in humans and comprises the vast majority of skin cancers. It predominantly affects fair-skinned individuals, and its incidence is rapidly increasing. The objective of the study is to identify the epidemiology, its topography and different histological subtypes of basal cell carcinoma in patients with or without Xeroderma Pigmentosum. METHODS: A cross-sectional descriptive study was conducted at Manipal Teaching Hospital, Pokhara from Jan 2009 to Dec 2016. Ethical approval was taken from MEMG/IRC/GA. The study included patients with a confirmed diagnosis of basal cell carcinoma irrespective of their age and sex. RESULTS: This study showed 77 individuals with 91 biopsies of BCC including 5 cases of Xeroderma Pigmentosum. The predominant histological subtype was nodular with 41 (53.94%) cases, followed by the 14 (18.42%) cases of pigmented and 10 (13.15%) cases baso-squamous subtype. The most frequent sites of involvement were the head and neck, with predominance in the nasal and orbital region. The mean age was 57.68 years but the basal cell carcinoma in cases of Xeroderma Pigmentosum was seen more in younger age groups. There were 43 (55.84 %) male patients and 34 (44.16 %) female patients with a male to female ratio of 1.26:1. CONCLUSIONS: Nodular and pigmented varieties were the most frequent subtypes with nose being the commonest site of involvement. Basal cell carcinomas in cases of Xeroderma Pigmentosum were noted in younger age group with multiple lesions.

Basosquamous carcinoma of the head and neck: clinical and histologic characteristics and their impact on disease progression.

OBJECTIVES: Basosquamous carcinoma (BSC) is a rare tumor entity, and the most common onset is in the head and neck region (BSC-HN). The data on diagnosis, treatment, and especially risk assessment concerning disease course and outcome are deficient or inconsistent. This study aimed to evaluate risk factors for local relapse (LR) and lymph node metastasis (LNM) and their impact on progression-free survival (PFS). MATERIALS AND METHODS: In a retrospective monocentric study, patients with BSC-HN treated between 1999 and 2011 were analyzed regarding clinical and histologic characteristics. Prognostic parameters for LR, LNM, and PFS were evaluated. In total, 89 patients (55 male, 34 female, mean age of 71.8 years) with a mean follow-up time of 47.7 months (range 12-112) were included. RESULTS: LR occurred in four patients (4.5%), LNM occurred in five patients (5.6%). Patients with LNM had a significantly shorter PFS time (16.1 months) compared with patients without LNM (154.2 months; P < .001). Tumor depth and size (T classification), incomplete resection, localization at the ear, deep maximal vertical infiltration, muscle and vessel invasion all showed significant (P < .05) associations with LR, LNM, and shorter PFS time. BSC showed more histologic features of basal cell carcinoma (BCC), especially with regard to BerEP4 expression. CONCLUSION: While histology shows some typical characteristics of BCC, the biologic behavior and aggressiveness of BSC are similar to those of cutaneous squamous cell carcinoma. This is the first study to show that LR and, especially, LNM indicate a higher risk of an unfavorable outcome.

Validation of claims data algorithms to identify nonmelanoma skin cancer.

Health maintenance organization (HMO) administrative databases have been used as sampling frames for ascertaining nonmelanoma skin cancer (NMSC). However, because of the lack of tumor registry information on these cancers, these ascertainment methods have not been previously validated. NMSC cases arising from patients served by a staff model medical group and diagnosed between 1 January 2007 and 31 December 2008 were identified from claims data using three ascertainment strategies. These claims data cases were then compared with NMSC identified using natural language processing (NLP) of electronic pathology reports (EPRs), and sensitivity, specificity, positive and negative predictive values were calculated. Comparison of claims data-ascertained cases with the NLP demonstrated sensitivities ranging from 48 to 65% and specificities from 85 to 98%, with ICD-9-CM ascertainment demonstrating the highest case sensitivity, although the lowest specificity. HMO health plan claims data had a higher specificity than all-payer claims data. A comparison of EPR and clinic log registry cases showed a sensitivity of 98% and a specificity of 99%. Validation of administrative data to ascertain NMSC demonstrates respectable sensitivity and specificity, although NLP ascertainment was superior. There is a substantial difference in cases identified by NLP compared with claims data, suggesting that formal surveillance efforts should be considered.

Basosquamous cell carcinoma in organ transplant patients: a clinicopathologic study.

BACKGROUND: Basosquamous cell carcinoma (BSCC) is a poorly known tumor showing pathological features of both basal and squamous cell carcinomas. BSCC has never been specifically studied in organ transplant recipients (OTRs). OBJECTIVE: We sought to study the clinicopathologic features of BSCC in OTRs and compare them with BSCC from nongrafted patients. METHODS: Tumors diagnosed as BSCC were re-evaluated pathologically and immunohistochemically for the expression of the human epithelial antigen to confirm the diagnosis. The clinicopathologic features of BSCC in OTRs were compared with 30 BSCC obtained from nongrafted patients. RESULTS: In our cohort of 3520 OTRs, 12 patients (0.34%) developed BSCC after a mean postgraft delay of 13.2 years, ie, later than other skin carcinomas. As compared with control patients, the age of OTRs with BSCC and the tumor thickness were significantly lower. BSCC were located on the head/neck in both groups in more than 75% of cases. No metastases developed in OTRs (mean follow-up 2.8 years). During the follow-up period (mean 16 years), OTRs with BSCC developed up to 220 additional premalignant and malignant skin tumors. After the diagnosis of BSCC, two patients developed lymph node metastasis of distinct squamous cell carcinoma. LIMITATIONS: This is a single-center, retrospective study. CONCLUSIONS: BSCC is a rare tumor, even in OTRs who are at high risk of carcinomas. Its incidence (0.34%) is comparable with that of cutaneous lymphomas and melanomas, and much lower than that of other nonmelanoma skin cancers. Contrary to previous reports, BSCC do not seem to behave more aggressively than other nonmelanoma skin cancers.

[Metatypical basal-cell carcinoma (MTC) or basosquamos carcinoma (BSC): surgical therapy]. / Carcinoma a cellule basali metatipiche (MTC) o carcinoma basosquamoso (BSC): terapia chirurgica.

AIM: Nonmelanoma skin cancer (NMSC) is the most common cancer in the world with an incidence 18-20 times greater than that of malignant melanoma. Basal cell carcinoma, which probably arises from immature pluripotential cells, is the most common malignant tumor of the skin in Caucasian. It occurs mostly on sun-exposed areas such as neck and face. MATERIAL OR STUDY: We performed a retrospective study of 327 consecutive patients, diagnosed for metatypical basal cell carcinoma. Tumors were analyzed and measured from the surgeon, excision margins were marked on the basis of palpable or visual alteration of the burden. The minimum surgical margin was equal to the short axis of the ellipse. Therapy was made according to guidelines. RESULTS: A relevant difference came out between two genders. 213 Males (65%) were affected in comparison with only 114 females (35%). Concerning areas affected, first is cervico-facial area with a prevalence of 220 cases (67.3%), second trunk 33 cases (10.1%), third other areas 29 cases (8.86%), fourth limbs 32 cases (9.80%), fifth scalp with 13 cases (4%). DISCUSSION AND CONCLUSIONS: Diagnosis is based on histological analysis. Histologically MTC is divided into two subtypes: intermediated and mixed. In the intermediate form transitional zones and tumor islets are found together, thus combining features of BCC and SCC In mixed subtype typical basal cells coexist with areas of conglomerated squamous cells, squamous pearls could be present.

[Cutaneous carcinoma of the face. Clinical and histopathological forms. Retrospective study of 308 cases]. / Carcinoamele cutanate ale fetei--forme clinice si his- topatologice. Un studiu retrospectiv PE 308 cazuri.

UNLABELLED: Cutaneous carcinomas are the most frequent malignant tumors, the majority of them being located on the face, scalp and back. AIM: To assess the clinical presentation and pathology aspects of the patients with face skin carcinomas admitted to our clinic. MATERIAL AND METHODS: The retrospective study was carried out on a series of 308 patients diagnosed and treated for cutaneous carcinoma of the face in the Department of Oral and Facial Surgery of lasi over a period of 5 years (January 2006 - December 2010). The following parameters were analyzed: demographic data, size and location of the tumor, clinical presentation, and pathology aspects. RESULTS: Basal cell carcinoma accounted for 75.97% of the cases, the nodular, superficial and morphea types being the most common. As to the microscopic aspects, the nodular/solid, superficial, and basosquamous (metatypical) types were the most frequent. The squamous-cell carcinoma represented 18.18%, mainly in the ulcero-vegetant and nodular forms. The moderately and well differentiated forms prevailed. Carcinomas of the skin adnexes as well as Merkel cell carcinomas were the most rare (4.22% and 0.65%, respectively). CONCLUSIONS: The face is the most common location of the cutaneous carcinomas requiring early diagnosis and treatment as a key factor to favorable long term outcome.

Basaloid squamous cell carcinoma of the head and neck: report of 18 cases.

OBJECTIVE: To evaluate the clinical course and pathological characteristics of basaloid head and neck squamous cell carcinoma. METHOD: Retrospective study of 18 cases of basaloid head and neck squamous cell carcinoma. Epidemiological, clinical and histological data were analysed and the Kaplan-Meier test used to estimate survival rates. RESULTS: The majority of lesions were at an advanced stage. These lesions were primarily localised in the larynx, hypopharynx and oropharynx. Routine pre-therapeutic assessment of squamous cell carcinoma was performed. Pathological diagnosis was difficult, although immunostaining was extremely useful. Positive staining for KL1, MNF 116 and 34ßE12 and negative immunostaining for chromogranin and synaptophysin were also important factors in obtaining a definitive diagnosis. In the majority of cases, treatment involved surgery and radiotherapy. The five-year survival rate was 5 per cent. CONCLUSION: Basaloid squamous cell carcinoma is an uncommon head and neck lesion, with a challenging histological diagnosis. These lesions must be carefully monitored due to their aggressive course, and require multimodality treatment.

Recurrence of basosquamous carcinoma after Mohs micrographic surgery.

BACKGROUND: The recurrence rate of basal cell carcinoma (BCC) after Mohs micrographic surgery (MMS) is well documented. Only little is published concerning the recurrence rate in relation to the different histologic subgroups. OBJECTIVE: To analyze the recurrence rate of the different histologic groups and subgroups after MMS. SUBJECTS AND METHODS: We investigated 1,000 cases of epidermal tumors in a private center of MMS including BCC, squamous cell carcinoma and basosquamous carcinoma (BSC) treated by MMS from 1998 to 2007 in a retrospective study. The cases where analyzed regarding the histologic groups and subgroups. The mean follow-up time was 59.55 months. RESULTS: The recurrence rate of epidermal tumors in this study was about 2.5% and comparable to that in the literature. Interestingly we observed a relatively high incidence and recurrence rate of BSC compared to other studies. CONCLUSION: BSC seems to be highly aggressive and subject to recurrence even after MMS. The classical approach to stop further excision once the excision is total should be reevaluated.

Clinicopathologic study of malignant eyelid tumours.

BACKGROUND: Early diagnosis of malignancy of eyelids can save the visual system from metastasis. The study was carried out to determine its pattern of prevalence, which will be a milestone for the ophthalmologists to design a clinical strategy for early intervention. METHODS: Retrospectively, we studied 155 eyelid cases from 2000 to June 2009 carried out through histopathologic confirmation. The cases other than malignancy were excluded. RESULTS: A total of 37 malignant eyelid tumours were seen. There were 40.6 per cent male cases. Sebaceous gland carcinoma was the commonest (40.5 per cent) finding, followed by squamous cell carcinoma (27 per cent), basal cell carcinoma (24.3 per cent), basosquamous carcinoma (5.4 per cent) and malignant melanoma (2.7 per cent). CONCLUSIONS: As the most common tumour in the region, sebaceous gland carcinoma might be due to geographical and environmental variations and requires immediate consultation and histopathologic diagnosis of lid lesions above 40 years of age for treatment strategies.

Bidirectional association of anogenital and oral cavity/pharyngeal carcinomas in men.

OBJECTIVE: To test the hypothesis of a bidirectional association of anogenital and oral cavity/pharyngeal human papillomavirus (HPV)-associated cancers in men. DESIGN: Population-based epidemiological study using the Surveillance, Epidemiology, and End Results cancer database. SETTING: Population-based cancer study involving patients receiving care in the United States. PARTICIPANTS: The study included 47,308 men 20 years and older with an index oral cavity/pharyngeal or anogenital cancer. MAIN OUTCOME MEASURE: Second primary HPV-associated cancers (anogenital or oral cavity/pharyngeal) or HPV-unrelated cancers (prostate, bladder, or colon). RESULTS: The standardized incidence ratio (SIR) was elevated for both anogenital cancer following oral cavity/pharyngeal cancer (SIR, 1.9; 95% confidence interval [CI], 1.2-2.7) and oral cavity/pharyngeal cancer following anogenital cancer (SIR, 3.0; 95% CI, 2.1-4.2). The increase in SIR was most pronounced for tonsillar cancer following anal cancer (SIR, 8.4; 95% CI, 2.7-19.6). The risk of second primary HPV-associated cancers did not vary significantly by age, race, year of diagnosis, or geographic location but was greater among never-married men, particularly for anal cancer following oral cavity/pharyngeal cancer (SIR, 6.5; 95% CI,1.8-16.7 in never-married men, but SIR, 1.6; 95% CI, 0.7-3.1 in ever-married men) and for tonsillar cancer following anogenital cancer (SIR, 13.0; 95% CI, 3.5-33.2 in never-married men, but SIR, 3.8; 95% CI, 1.0-9.7 in ever-married men). Other than a slightly increased risk of tongue cancer following colon cancer (SIR, 1.3; 95% CI, 1.1-1.6), there was no increased risk of oral cavity/pharyngeal or anogenital cancer following HPV-unrelated cancers or vice versa. CONCLUSION: The association between index and second primary anogenital and oral cavity/pharyngeal cancers, strongest in never-married men, supports the influence of sexual behavior on the risk of HPV-associated head and neck cancers.

Incomplete primary excision of cutaneous basal and squamous cell carcinomas in the Bay of Plenty.

AIM: To investigate factors associated with pathologically reported incomplete primary excision of squamous and basal cell carcinomas. METHODS: All Medlab Bay of Plenty histology reports were obtained for all primarily excised cutaneous basal and squamous cell carcinomas of the skin for the Tauranga and Western Bay of Plenty regions covering the period 1 January through 30 June 2001. Data were analysed according to surgical training, site of lesion, pathology, and location of positive margin involvement. RESULTS: 1833 non-melanoma skin cancer excisions occurred during the 6-month study-including 1126 basal cell carcinomas, 705 squamous cell carcinomas, and 2 basosquamous carcinomas. 257 (14%) were reported as incompletely excised. There was no difference in rates of positive margin involvement for gender or histology. Proportionately, excisions from the nose and ear revealed the highest incomplete excision rates. General practitioners excised 1003 lesions, with a 16% incomplete excision rate. Consultant surgeons excised 695 lesions, with a 12% incomplete excision rate. Surgical registrars excised 123 lesions, incompletely excising 8%. These data are statistically significant (p <0.01). Tumour was most often found at lateral (rather than deep) margins. CONCLUSION: The incidence of non-melanoma skin cancer is known to be very high in the Bay of Plenty. Pathologically reported incomplete excision rates are nevertheless comparable with other studies. Of all skin cancers, those on the head and neck are most commonly associated with incomplete excision. Trained surgeons have significantly higher complete excision rates.

Basaloid squamous carcinoma of the larynx.

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) is a distinct variant of squamous cell carcinoma that was first described by Wain et al in 1986. Since then, about 160 cases have been reported in the literature. Only 40 cases have been described in the larynx. METHODS: Four cases of BSCC of the larynx treated in our department between 1986 and 2000 are presented. The clinical features, biological behavior, and histopathological and immunohistochemical characteristics of this uncommon tumor are described, and the relevant literature is reviewed. RESULTS: The main clinical presentation did not differ from other histological types of laryngeal carcinoma. The clinical course, however, was much more aggressive. All the patients received aggressive therapy including radical surgery and radiation. Two patients received chemotherapy. Two of the 4 patients presented died of distant metastasis shortly after diagnosis and treatment. CONCLUSIONS: The finding of this study with a limited number of patients supports previous reports suggesting that BSCC is a highly aggressive tumor that presents in older population with male predominance. The frequency of associated regional as well as distant metastases suggests that aggressive treatment is indicated and that systemic chemotherapy should be contemplated.

Epidemiology of nonmelanoma skin cancer: clinical issues, definitions, and classification.

There are many forms of nonmelanoma skin cancer, although the term usually refers to the most common forms, basal and squamous cell carcinomas of the skin. The definitions of basal and squamous carcinomas depend on histopathologic features, and clinical diagnoses are often reliable. Various classification schemes have been proposed, including those based on clinical or histologic appearance, etiology, or prognosis. The public health burden of these tumors has not been fully defined and includes mortality, morbidity, social impact, and cost. Measures of morbidity include incidence and measures of impairment, disability, and handicap. Other issues involving etiology, management, prevention, and early detection remain to be investigated further.

Incidence of skin cancer among Nagasaki atomic bomb survivors (preliminary report).

Among a total of 65,268 Nagasaki atomic bomb survivors recorded in the Scientific Data Center of Atomic Bomb Disaster, Nagasaki University School of Medicine, 140 cases with skin cancer were collected from 31 hospitals in Nagasaki City from 1961 through 1987. Subsequently, these cases of skin cancer in Nagasaki atomic bomb survivors were statistically analyzed in relation to the estimated distance from the hypocenter by age, sex, histology and latent period. The results were as follows: 1. A high correlation was observed between the incidence of skin cancer and the distance from the hypocenter. 2. The incidence of skin cancer in Nagasaki atomic bomb survivors now appears to be increasing in relation to exposure distance. 3. Among 140 cases, basal cell epithelioma was observed in 67 cases (47.9%) and squamous cell carcinoma in 43 cases (30.7%).