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Eccrine porocarcinoma, sharing many features with other skin tumours, is diagnostically challenging. A conventional biopsy might be misleading and surgical excision becomes a primary diagnostic tool and a treatment method. However, the data on surgical safety margins are not consistent. We present a systematic review analysing the surgical margins of porocarcinoma in the head and neck area, which was conducted across the PubMed, Cochrane, and Web of Science databases including studies published from inception to November of 2023. In this systematic review, the PRISMA-ScR checklist was used, and a Cohen's Kappa coefficient of 0.92 was applied, indicating very good agreement between reviewers. Out of 529 identified articles, 18 studies yielding 20 cases in total were selected for a thorough analysis. Nine (45%) cases were observed in the facial regions, eight (40%) on the scalp, and three (5%) on the neck. The primary treatment of choice was wide local excision with safety margins ranging from 3 to 22 mm (mean: 10.1). It demonstrated that surgical margins do not differ by age or anatomic regions, with the main point of reference being the tumour size. As observed, the bigger the tumour, the wider the safety margins were. However, the limited disclosure of surgical safety margins in analysed case reports impeded our ability to define the minimum safety margins. Further investigation and a consensus on recommended safety margins are required.
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In this review, we examine current literature analyzing the impact of surgical treatment on the QoL in patients with head and neck BCC. A comprehensive literature review was performed using the main databases. As many as six out of 322 articles were selected for the final analysis. The selected articles were published in the period between 2004 and 2021, most published within the last two years. All analyzed studies were prospective. Five out of six studies evaluated NMSC consisting of both BCC and SCC, and only one study selectively evaluated the impact of surgical treatment on QoL in patients with craniofacial BCC. Authors of the selected studies reported that QoL improves following the surgery; however, the effect on QoL varies. Patients' age, gender, marital status, education level, and employment status had a stronger correlation with QoL postoperatively, especially during the late follow-up period. Younger patients were more bothered by appearance-related issues. One study concluded that elderly patients did not experience a statistically significant improvement in QoL. This literature review demonstrated that there is no clear consensus on the use of a single disease-specific QoL measurement tool. Furthermore, there is a lack of studies assessing the impact of surgical treatment on QoL exclusively in patients with head and neck BCC and studies analyzing the multivariate correlation between QoL and tumor type, size, anatomic site, and treatment outcomes.
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BACKGROUND: Malignant melanoma is becoming more common among middle-aged individuals all over the world. Melanoma metastasis can be found in various organs, although metastases to the spleen and stomach are rare. Herein we present a rare metastatic multifocal melanoma, clinically and histologically mimicking lymphoma, with metastases of multiple organs. CASE SUMMARY: A 46-year-old Caucasian male with a history of nodular cutaneous malignant melanoma was presented with nausea, general weakness, shortness of breath, abdominal enlargement, and night sweating. The abdominal ultrasound revealed enlarged liver and spleen with multiple lesions. Computed tomography demonstrated multiple lesions in the lungs, liver, spleen, subcutaneous tissue, bones and a pathological lymphadenopathy of the neck. Trephine biopsy and the biopsy from the enlarged lymph node were taken. Tumor cells showed diffuse or partial positivity for melanocytic markers, such as microphthalmia - associated transcription factor, S100, HMB45 and Melan-A. The tumor harbored BRAF V600E mutation, demonstrated by immunohistochemical labelling for BRAF V600E and detected by real-time polymerase chain reaction test. Having combined all the findings, a diagnosis was made of a metastatic multifocal melanoma of the stomach, duodenum, liver, spleen, lungs, lymph nodes and bones. The patient refused treatment and died a week later. CONCLUSION: This case report highlights the clinical relevance of rare metastatic multifocal melanoma of multiple organ systems.
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INTRODUCTION AND OBJECTIVES: Basal cell carcinoma is the most common locally invasive malignant epidermal neoplasm in humans and its incidence has increased over the last decades worldwide, especially among the Caucasian population. Basal cell carcinoma accounts for about 75% of all skin cancers. Incidence data on basal cell carcinoma is sparse because traditional cancer registries often do not register these tumours. In Lithuania, patients with skin cancer and melanoma were traditionally treated in centralized oncological institutes. From 2006, the Centre of Dermatovenereology at Vilnius University Hospital Santaros Klinikos (Vilnius, Lithuania) provides modern diagnostic and treatment facilities to oncodermatological patients. The objective of the study was to evaluate epidemiological and clinical data of basal cell carcinoma at the Centre of Dermatovenereology during the last 15 years. MATERIALS AND METHODS: Medical documentation of the cases of histologically-proven basal cell carcinoma diagnosed between 2000 and 2015 was analyzed. Epidemiological and clinical evaluation according to the patients' age, sex, and place of residence, as well as tumour localization, its histological type, and treatment options was performed. RESULTS: After the skin lesion biopsy and histopathological examination, a total of 847 basal cell carcinomas were confirmed to 782 patients. During the study period, the total annual number of newly diagnosed basal cell carcinomas rose steadily in our centre: 2.7% between 2000 and 2003, 6.5% between 2004 and 2006, 13.6% between 2007 and 2009, 27.6% between 2010 and 2012, and 49.6% between 2013 and 2015. The biggest part of patients (28.4%) were 70-79 years old, 4.6% - younger than 40, 7.3% - 40-49, 17.1% - 50-59, 27.2% - 60-69, 14.1% - 80-89, and 1.3% ≥90 years old. The average patient age was 66.0 (±13.6). Of these patients, 62.0% were female and 38.0% male; 63.6% were from the capital city, 18.3% from other cities, and 18.2% from rural areas. Basal cell carcinomas occurred most often in the face region 49.0%, followed by the trunk - 29.4%, the scalp and neck - 10.9%, arms and legs - 7.7%, in 2.9% location was not specified and the whole body - 0.1%. The predominant histological type of basal cell carcinomas was nodular (60.6%), other diagnosed types were superficial (22.9%), infiltrative/morpheaform (8.0%), mixed nodular and infiltrative (1.7%), pigmented (0.2%), rare types (micronodular, infundibulocystic, ductal and mixed) - 0.6%; the type was not specified in 6.0% of cases. Nodular, superficial, and infiltrative types were the most common morphological types in all body sites: respectively, in the face - 67.5%, 12.5%, 9.4%; in the scalp and neck region - 77.2%, 14.1%, 5.4%; in the trunk - 49.8%, 37.3%, 7.2%; in extremities - 41.5%, 43.1%, 7.7%. The nodular type was more common among the elderly and its incidence increased with age (p = 0.009), meanwhile, superficial basal cell carcinomas prevailed among younger patients (<40 years), and its incidence decreased with age (p < 0.001). Also, the nodular type was usually found in the areas of the face (p < 0.001) and the scalp and neck (p = 0.045), and the superficial type - in the areas of the trunk (p < 0.001) and extremities, specifically in the hand (p = 0.022). Basal cell carcinomas were mostly treated with surgical excision (79.6%), photodynamic therapy (5.5%; in our centre, this treatment option is available from 2007), and other/combined methods (14.9%). CONCLUSIONS: The results showed that the number of newly diagnosed basal cell carcinomas increased continuously between 2000 and 2015. Basal cell carcinomas in our centre occurred most often among the patients aged 70-79 years. This tumour was more often diagnosed in female than male patients. Most of basal cell carcinomas were located on the chronically sun-exposed skin, such as the face region, and were of the nodular histological type, which is more common among the elderly, while the superficial type is more prevalent among younger patients. The most commonly used treatment option for basal cell carcinoma was surgical excision. Acknowledgment of the tendency of the rising number of basal cell carcinomas, healthcare resources, highlights the need for an effective skin cancer prevention strategy in Lithuania.
