Customized double-shell immobilization device combined with VMAT radiation treatment of basosquamous cell carcinoma of the scalp.

Malignancies with a superficial involvement of the scalp/skull present technical challenges for radiation-treatment-planning, such as achieving skin coverage with the prescribed dose and with the desirable conformity, homogeneity, and lower brain dose. We report a radiotherapy treatment technique for a patient diagnosed with diffuse basosquamous cell carcinoma of the scalp and adjacent skull-bone. This study presents the plan's quality parameters, patient's dosimetry, and patient's outcome. The patient was treated using volume-modulated-arc therapy (VMAT) and a double-shell-bolus full-head device (DSBFD) designed for patient immobilization and better skin coverage. A VMAT plan was generated using an Eclipse treatment-planning system for a prescribed dose of 60 Gy in 30 fractions. The treatment plan was analyzed to determine the conformity index (CI), the homogeneity index (HI), the target-coverage, and the dose to the organs-at-risk (OARs). Skin-doses were measured using optically stimulated luminescence (OSL) dosimeters. Clinical follow-up was performed by the radiation oncologist during and after the course of radiotherapy. With regard to planning target volume (PTV) coverage, the V95 was 99%. The measured and calculated dose to the skin was in the range 100-108% of the prescribed dose. The mean brain-PTV dose was 711 cGy. The CI and HI were 1.09 and 1.08, respectively. The mean positioning accuracy for the patient over the course of treatment was within 2 mm. The measured accumulated skin dose and planning dose was agreed within 2%. Clinical examination of the patient 6 months after radiotherapy showed good response to the treatment and a 90% reduction in scarring. The DSBFD technique combined with RapidArc treatment was useful in terms of the target dose distribution and coverage. Daily patient alignment was found very precise, reproducible and less time-consuming.

Radiation-induced lichen sclerosus of the vulva : First report in the medical literature.

A 67-year-old woman presented with a firm plaque in the perineal region, 16 months after diagnosis of a high-grade basaloid squamous cell carcinoma of the vagina and treatment by external beam radiation therapy and vaginal cuff brachytherapy. The differential diagnosis included radiation-induced morphea, radiation dermatitis, or, possibly, radiation-induced lichen sclerosus. Biopsy findings, including special staining, confirmed the diagnosis of radiation-induced lichen sclerosus. To our knowledge, this is the first report of radiation-induced lichen sclerosus of the vulvar region.

Palliative combined treatment for unresectable cutaneous basosquamous cell carcinoma of the head and neck.

A case is presented of a patient with a skin basosquamous cell carcinoma of the frontal region infiltrating the cerebral tissue and with a widespread unresectable regional metastatic ulceration of the left parotid region. The patient underwent combined palliative treatment: surgical coverage of the ulceration by means of a pectoralis mayor flap transposition and radiotherapy. After 18 months of follow-up, no signs of tumour progression were noted, the patient is currently free from pain, no increase in trismus was seen, and a slight gain in weight was recorded. Unresectable cancer is mainly treated by concurrent chemoradiation; radiotherapy, however, is contraindicated in deep neoplastic ulcerations with exposure of large vessels. The data reported suggest that surgical coverage of an unresectable neoplastic ulcer is feasible, and combined with early administration of radiation permits a palliative approach in an otherwise untreatable condition.

Outcomes after radiotherapy for basaloid squamous cell carcinoma of the head and neck: a case-control study.

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) is an uncommon, high-grade variant of squamous cell carcinoma (SCC) of the head and neck. Its poorer prognosis compared with common SCC remains controversial. The authors investigated the outcomes of patients with BSCC who received radiotherapy and compared them with the outcomes of patients with SCC. METHODS: From 1994 to 2004, 1007 patients received radiotherapy for head and neck carcinoma with lymph node involvement. The histologic types consisted of 51 BSCC, 431 poorly differentiated SCC (PSCC), and 525 well or moderately differentiated SCC (WMSCC). A case-control analysis was performed with BSCC matched against both PSCC and WMSCC to compare disease-control and survival rates. RESULTS: Patients with BSCC received treatment modalities similar to those received by patients with SCC: They received induction chemotherapy (12%) or concurrent chemotherapy (33%), and a median radiation dose of 70 Gray. Posttreatment viable tumor was present in 44%, 13%, and 28% of neck dissection specimens from patients with BSCC, PSCC, and WMSCC, respectively. The 5-year disease-free survival rates (63%, 77%, and 76%, respectively) and overall survival rates (85%, 70%, and 71%, respectively) demonstrated no statistically significant differences for BSCC, PSCC, or WMSCC, respectively. CONCLUSIONS: In this study, a poorer prognosis could not be demonstrated for irradiated patients with BSCC compared with either PSCC or WMSCC. All patients in this study had positive lymph node status, and the majority of patients (84%) had oropharyngeal cancer. The BSCC cohort did have a relatively high rate of viable tumor in their posttreatment neck dissections, and they had a relatively high rate of distant disease. On the basis of the high rate of lung metastases and the possibility of efficient salvage, the authors recommend obtaining a chest computed tomography scan during initial staging and follow-up.

Basaloid squamous cell carcinoma of the soft palate: case report.

Basaloid squamous cell carcinoma (BSCC) is a histologically distinct variant of squamous cell carcinoma. It occurs in various sites of the head and neck region and is believed to carry a dismal prognosis. The palate is a very rare site of BSCC development and only three cases have been reported in the international literature. In this report, we present a case of basaloid squamous cell carcinoma of the soft palate. The therapeutic strategy and histological findings are described in detail, including immunohistochemistry with the use of involucrin, an agent used for the first time for BSCC diagnosis. In addition, a brief review of the literature is presented.

Basaloid squamous carcinoma of the anal canal with an adenoid cystic pattern: histologic and immunohistochemical reappraisal of an unusual variant.

Two cases of a distinctive variety of basaloid squamous carcinoma (BSC) of the anal canal are described. Both occurred in female patients who presented with bleeding per rectum. Histologic evaluation of the tumors showed lobules and aggregates of medium-sized basaloid cells with distinctive peripheral palisading and focal areas of central, comedo-necrosis. Accompanying dysplasia of the overlying squamous mucosa was absent. However, the microscopic pattern was dominated by the presence of eosinophilic, hyaline, paucicellular basement membrane-like material around and within tumor nests. This appearance together with microcystic spaces simulated that of an adenoid cystic carcinoma. Immunohistochemistry of the tumors revealed the following profile: CK7, CK5/CK6, 34betaE12 positive, CK14 focally positive but CK20 negative. The following were all negative: EMA, CEA, smooth muscle and muscle-specific actin, calponin, and S-100. The tumor cells exhibited diffuse nuclear positivity with p63. The eosinophilic basement membrane hyaline material was positive for collagen type IV and also for laminin. BSC of the anal canal with an adenoid cystic pattern is an infrequently encountered and reported variant, although it is seen more often in the aerodigestive tract. There may be an increased propensity for BSC with an adenoid cystic pattern to metastasize to the liver, but the number of cases encountered are too small to be definitive. The histologic differential diagnosis is true salivary gland-type adenoid cystic carcinoma and basal cell adenocarcinoma. Immunohistochemistry and awareness of this unusual pattern of BSC will facilitate the correct diagnosis being reached.

Basaloid squamous cell carcinoma of the larynx: a case report.

Basaloid squamous cell carcinoma (SCC) is a very rare, high grade, and aggressive variant of SCC, with a predilection for the upper aerodigestive system. Treatment should include surgery of the primary tumor and dissection of the cervical lymph nodes, followed by radiotherapy. We present a 50-year-old man with basaloid SCC of the supraglottic larynx, which was initially misdiagnosed as SCC. Supraglottic laryngectomy with bilateral radical neck dissection was performed, and radiotherapy was applied postoperatively. During a follow-up of 26 months, no evidence for recurrence was found. Basaloid SCC should be considered in the differential diagnosis of upper aerodigestive system malignancies because it has a distinct prognostic significance compared to conventional SCC.

Cutaneous basosquamous carcinoma infiltrating cerebral tissue.

Basosquamous carcinoma of the skin is a rare malignancy with specific histopathological features of both basal cell carcinoma and squamous cell carcinoma. Some authors believe that basosquamous carcinoma is a variant of basal cell carcinoma, while others suggest that this tumour may behave more aggressively. We present a 44-year-old female patient who was diagnosed with a basosquamous carcinoma histopathologically. She had extensive ulcero-vegetative lesions, involving the anterior half of the scalp, the left orbit and the left side of the face. With this case we aim to emphasize the aggressive nature of basosquamous carcinoma and review the literature.

What is the current role of radiation therapy in the treatment of skin carcinomas?

AIMS AND BACKGROUND: In recent years several radiation therapy units have recorded a decline in the number of referrals for the treatment of skin carcinomas. This study aims to ascertain whether this decline has also affected the radiation therapy unit of Trieste and, if so, to consider the possible reasons. METHODS: We retrospectively reviewed all cases of non-melanoma skin cancer treated in our unit from January 1986 to December 1999. A database was created that would allow rapid and controlled data entry and a sufficiently simple query system. RESULTS: The total number of irradiated skin cancers was 2,219:1,863 basal cell carcinomas, 276 squamous cell carcinomas, and 80 basosquamous carcinomas. The distribution curves for the number of cases treated every year were similar: each of the three types showed a slow and gradual reduction in the number of patients referred for radiotherapy. CONCLUSIONS: For most authors surgery remains the treatment of choice for skin carcinomas. However, radiation therapy can also yield excellent results in terms of local control, cosmesis and functionality. In our view the indications for radiation therapy are poor general health, elderly age, the presence of diseases that are a contraindication for surgery, location of the tumor in the head region, and tumor size between 1 and 5 cm.

Invading basal cell carcinoma of the jaw: an under-evaluated complex entity.

Basal cell carcinoma (BCC) is a locally invasive neoplasm, rarely metastatic, yet capable of significant local destruction and disfigurement. Invasion into the bone is uncommon and only a few cases of invasion into facial bones, but never to the mandible or maxilla, have been described. We report three patients with BCC lesions invading their jaws, as a consequence of which either their mandible or maxilla had to be partially resected. This resulted in facial mutilation which required comprehensive multi-disciplinary therapy to restore function and esthetics. Such therapy requires a combination of modalities offered by both plastic and maxillofacial surgeons, as well as oral and dental rehabilitators.