Carcinoma basocelular en el Área Sur de Salud de Tenerife. Características clínico-patológicas fundamentales y estado de los bordes tras exéresis / Basal Cell Carcinoma in the Southern Health Area of Tenerife. Key Clinical and Pathological Factors and Margin Status After Excision

Antecedentes y objetivo El tratamiento de elección inicial del carcinoma basocelular (CBC) es la escisión quirúrgica. Esta debería ser completa para reducir el riesgo de recidiva. Nuestro objetivo es conocer las características de los CBC en nuestra área de salud, el porcentaje de márgenes afectos, y los factores de riesgo para una resección quirúrgica incompleta. Material y métodos Estudio observacional retrospectivo de los CBC intervenidos en el Área de Salud del Hospital Universitario Nuestra Señora de Candelaria entre el 1 de enero de 2014 y el 31 de diciembre de 2014. Recogemos datos demográficos, clínicos e histológicos, servicio responsable, abordaje quirúrgico y estado de los márgenes. Resultados Se diagnosticaron 966 CBC correspondientes a 776 pacientes, siendo el 9% biopsias, el 89% escisiones y el 2% rebanados. La mediana de edad fue de 71 años y el 52% eran hombres. La localización más frecuente fue la cara (59,1%). Se analizaron los márgenes quirúrgicos en 506 CBC. El 17% presentó afectación de márgenes. El porcentaje de márgenes afectos fue significativamente mayor en los tumores de la cara (22% cara vs. 10% otra localización) y en los de subtipo histológico de alto riesgo (OMS) (25% subtipo de alto riesgo vs. 15% bajo riesgo). Conclusiones Las características de nuestros pacientes con CBC se asemejan a las descritas previamente. La localización facial y el subtipo histológico son factores de riesgo para la resección incompleta del CBC. Por lo tanto, el abordaje quirúrgico inicial de los CBC con estas características ha de planearse de forma cuidadosa (AU)

Background and objective Surgical excision is the treatment of choice for basal cell carcinoma (BCC). Complete excision with clear margins is important for reducing the risk of recurrence. The aims of this study were to describe the characteristics of BCCs in our health care area, calculate the percentage of positive margins after surgical excision, and determine the risk factors for incomplete excision. Material and methods Retrospective observational study of BCCs that were surgically removed at Hospital Universitario Nuestra Señora de Candelaria, in Santa Cruz de Tenerife, Spain, between January 1, 2014 and December 31, 2014. Information was collected on demographic, clinical, and histologic variables, surgical approach, margin status, and the department responsible. Results In total, 966 BCCs were diagnosed in 776 patients. Nine percent of tumors with complete data were biopsied, 89% were surgically excised, and 2% were removed by shave excision. The median age of patients with excised tumors was 71 years and 52% were men. BCCs were most often located on the face (59.1%). Surgical margins were analyzed in 506 cases, 17% of which had positive margins. Incomplete excision was significantly more common in tumors located on the face (22% vs. 10% for other locations) and in high-risk subtypes according to the World Health Organization classification (25% vs. 15% for low-risk subtypes). Conclusions The characteristics of BCCs in our health care area are similar to those described elsewhere. Facial location and histologic subtype are risk factors for incomplete excision. Careful surgical planning is therefore important in the initial management of BCCs with these characteristics (AU)

[Translated article] Basal Cell Carcinoma in the Southern Health Area of Tenerife: Key Clinical and Pathological Factors and Margin Status After Excision / Carcinoma basocelular en el Área Sur de Salud de Tenerife: Características clínico-patológicas fundamentales y estado de los bordes tras exéresis

Background and objective Surgical excision is the treatment of choice for basal cell carcinoma (BCC). Complete excision with clear margins is important for reducing the risk of recurrence. The aims of this study were to describe the characteristics of BCCs in our health care area, calculate the percentage of positive margins after surgical excision, and determine the risk factors for incomplete excision. Material and methods Retrospective observational study of BCCs that were surgically removed at Hospital Universitario Nuestra Señora de Candelaria, in Santa Cruz de Tenerife, Spain, between January 1, 2014 and December 31, 2014. Information was collected on demographic, clinical, and histologic variables, surgical approach, margin status, and the department responsible. Results In total, 966 BCCs were diagnosed in 776 patients. Nine percent of tumors with complete data were biopsied, 89% were surgically excised, and 2% were removed by shave excision. The median age of patients with excised tumors was 71 years and 52% were men. BCCs were most often located on the face (59.1%). Surgical margins were analyzed in 506 cases, 17% of which had positive margins. Incomplete excision was significantly more common in tumors located on the face (22% vs. 10% for other locations) and in high-risk subtypes according to the World Health Organization classification (25% vs. 15% for low-risk subtypes). Conclusions The characteristics of BCCs in our health care area are similar to those described elsewhere. Facial location and histologic subtype are risk factors for incomplete excision. Careful surgical planning is therefore important in the initial management of BCCs with these characteristics (AU)

Antecedentes y objetivo El tratamiento de elección inicial del carcinoma basocelular (CBC) es la escisión quirúrgica. Esta debería ser completa para reducir el riesgo de recidiva. Nuestro objetivo es conocer las características de los CBC en nuestra área de salud, el porcentaje de márgenes afectos, y los factores de riesgo para una resección quirúrgica incompleta. Material y métodos Estudio observacional retrospectivo de los CBC intervenidos en el Área de Salud del Hospital Universitario Nuestra Señora de Candelaria entre el 1 de enero de 2014 y el 31 de diciembre de 2014. Recogemos datos demográficos, clínicos e histológicos, servicio responsable, abordaje quirúrgico y estado de los márgenes. Resultados Se diagnosticaron 966 CBC correspondientes a 776 pacientes, siendo el 9% biopsias, el 89% escisiones y el 2% rebanados. La mediana de edad fue de 71 años y el 52% eran hombres. La localización más frecuente fue la cara (59,1%). Se analizaron los márgenes quirúrgicos en 506 CBC. El 17% presentó afectación de márgenes. El porcentaje de márgenes afectos fue significativamente mayor en los tumores de la cara (22% cara vs. 10% otra localización) y en los de subtipo histológico de alto riesgo (OMS) (25% subtipo de alto riesgo vs. 15% bajo riesgo). Conclusiones Las características de nuestros pacientes con CBC se asemejan a las descritas previamente. La localización facial y el subtipo histológico son factores de riesgo para la resección incompleta del CBC. Por lo tanto, el abordaje quirúrgico inicial de los CBC con estas características ha de planearse de forma cuidadosa (AU)

The importance of flaps in reconstruction of locoregionally advanced lateral skull-base cancer defects: a tertiary otorhinolaryngology referral centre experience.

BACKGROUND: The aim of the study was to identify the value of extensive resection and reconstruction with flaps in the treatment of locoregionally advanced lateral skull-base cancer. PATIENTS AND METHODS: The retrospective case review of patients with lateral skull-base cancer treated surgically with curative intent between 2011 and 2019 at a tertiary otorhinolaryngology referral centre was made. RESULTS: Twelve patients with locoregionally advanced cancer were analysed. Lateral temporal bone resection was performed in nine (75.0%), partial parotidectomy in six (50.0%), total parotidectomy in one (8.3%), ipsilateral selective neck dissection in eight (66.7%) and ipsilateral modified radical neck dissection in one patient (8.3%). The defect was reconstructed with anterolateral thigh free flap, radial forearm free flap or pectoralis major myocutaneous flap in two patients (17.0%) each. Mean overall survival was 3.1 years (SD = 2.5) and cancer-free survival rate 100%. At the data collection cut-off, 83% of analysed patients and 100% of patients with flap reconstruction were alive. CONCLUSIONS: Favourable local control in lateral skull-base cancer, which mainly involves temporal bone is achieved with an extensive locoregional resection followed by free or regional flap reconstruction. Universal cancer registry should be considered in centres treating this rare disease to alleviate analysis and multicentric research.

Fatores associados à ressecção incompleta do câncer não melanoma / Factors associated with incomplete resection of non-melanoma cancer

Introdução: Analisar fatores associados e taxa de positividade de margem cirúrgica após ressecção primária de Câncer de Pele Não Melanoma (CNM). Métodos: Estudo transversal, quantitativo, realizado mediante a revisão de prontuários de pacientes submetidos à ressecção cirúrgica de carcinoma basocelular (CBC) e espinocelular (CEC) de pele. Foram estudadas as seguintes variáveis: idade, tipo de câncer, localização, diâmetro, variante histológica, presença de ulceração, presença e ressecção de lesões associadas e presença de comprometimento de margens cirúrgicas. Resultados: Foram inclusos 183 paciente no estudo. Destes, 130 eram CBC (71%) e 53 eram CEC (29%). A taxa global de comprometimento de margem foi de 13,1%, sendo 21 CBC (16%) e 3 CEC (5,66%). Margens cirúrgicas positivas estiveram mais associadas a lesões do tipo CBC (p<0,05) e em lesões localizadas em nariz e pálpebra (p<0,05). Presença de ulceração, diâmetro das lesões e variante histológica não foram associadas a uma maior taxa de ressecções incompletas. Conclusão: Nossa taxa global de ressecção incompleta de Câncer de Pele (CNM) apresenta-se semelhante ao encontrado na literatura. Lesões por CBC ou localizadas em nariz e pálpebra têm maiores taxas de positividade de margem após ressecção primária (AU)

Introduction: To analyze associated factors and surgical margin positivity rate after primary resection of Non-Melanoma Skin Cancer (NMC). Methods: A cross-sectional, quantitative study was carried out by reviewing medical records of patients submitted to surgical resection of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin. The following variables were studied: age, type of cancer, location, diameter, histological variant, presence of ulceration, presence and resection of associated lesions, and presence of surgical margins involvement. Results: 183 patients were included in the study. Of these, 130 were BCC (71%) and 53 were SCC (29%). The overall rate of margin involvement was 13.1%, of which 21 were CBC (16%) and 3 SCC (5.66%). Positive surgical margins were more associated with BCC lesions (p <0.05) and lesions located in the nose and eyelid (p <0.05). Presence of ulceration, lesion diameter and histological variant were not associated with a higher rate of incomplete resections. Conclusion: Our overall rate of incomplete resection of Skin Cancer is similar to that found in the literature. Lesions by BCC or located in the nose and eyelid have higher rates of margin positivity after primary resection (AU)

[Puncture cryodestruction of recurrent facial area basaliomas with ultrasound scan and surgery monitoring].

Ultrasound scan allows determining tumor border in the area of inflammatory infiltrate, creating a three-dimensional plan of the operation, performing accurate pointing injecting cryoprobes as well as managing a monitor of cryoablation. As a result the frequency of repeated recurrences of infected recurrent tumors in difficult anatomical areas of the face decreased to 4%.

Management of high-risk and advanced basal cell carcinoma

Despite that basal cell carcinoma (BCC) is curative in the vast majority of cases, some patients are at high risk of recurrence and, in a few patients, lesions can progress to a point unsuitable for local therapy and prognosis is quite poor. The aim of the present work is to review clinical and pathologic characteristics as well as classical and new treatment options for high-risk, metastatic and locally advanced BCC. Surgery and radiotherapy remain the selected treatments for the majority of high-risk lesions. However, some patients are located on a blurry clinical boundary between high-risk and locally advanced BCC. Treatment of these patients is challenging and need an individualized and highly specialized approach. The treatment of locally advanced BCC, in which surgery or radiotherapy is unfeasible, inappropriate or contraindicated, and metastatic BCC has changed with new Hedgehog pathway inhibitors of which vismodegib is the first drug approved by FDA and EMA (AU)

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Intracranial basal cell carcinoma with extensive invasion of the skull base.

Intracranial invasion of basal cell carcinoma is very rare. A case of a 71-year-old male patient is presented with extensive invasion of middle and posterior fossae, with nearly complete destruction of the petrous bone, involving cerebellopontine angle and cranial nerves by recurrent basal cell carcinoma of the auricular region on the right side. The clinical manifestation was cerebrospinal fluid otorrhoea, facial nerve palsy and trigeminal nerve impairment with hypoesthesia. The patient underwent surgery by combined retroauricular and temporal approach to the skull base. Adjuvant radiation of residual tumor and former tumor recurrence region was performed. MRI studies performed annually show no progress of the tumor. Our patient reports a good quality of life without new neurological deficits 6 years after surgery. Attention should be paid to the malignant nature of basal cell carcinoma making follow up care necessary. In indicated cases in which incomplete excision cannot be excepted and risk factors exist, follow up with CT or/and MRI should be performed to evaluate the infiltrative and invasive character of aggressive basal cell carcinoma and to rule out bone or cerebral infiltration.

Eyelid desmoplastic trichilemmoma: 2 case reports and review.

Desmoplastic trichilemmomas (DTs) are a rare variant of trichilemmomas first described in 1985. Since then, 11 cases involving the eyelid have been reported. Two cases of this study raise this total to 13. DTs are often clinically confused with basal cell carcinoma and must be proven by biopsy to obtain the correct diagnosis. These lesions are more commonly present in patients older than 50 years. Despite the fact that they are benign, they are often associated with basal cell carcinomas and as such should be managed carefully, requiring excisional biopsy with frozen borders or Mohs controlled margins.

MicroRNA-203 inhibits the progression of esophageal squamous cell carcinoma with restored epithelial tissue architecture in vivo.

MicroRNA (miR)-203 has been shown to induce squamous differentiation of epidermal stem cells through the suppression of p63. The aim of this study was to assess the tumor suppressor effect of miR-203 in esophageal squamous cell carcinoma (ESCC) with focus on the regulation of the cell fate decisions and organization of tumor tissue architecture in vivo. Our investigation establishing stable clones from ESCC cell lines with induced miR-203 expression resulted in significant growth inhibition in a mouse xenograft model. Small foci were observed in xenograft tumors with stratified squamous differentiation in conjunction with restored baso-apical polarity. The expression of the basement membrane protein laminine was localized at the center of the foci and the basal cell marker p75NTR was expressed in the innermost layer. The expression of ki67 and p63 was co-localized at the center layers, while involucrin was expressed in the outer layers. Flow cytometry revealed that the p75NTR-positive cells expressing p63 and Bmi1 were well maintained, while the expression of p63 was suppressed in the p75NTR-negative cells. Our cDNA microarray analysis demonstrated the upregulation of genes involved in regulating tissue architecture, such as BMP-4 and ZO-1 in the mir-203 transfectant. Investigation using surgically removed ESCC specimens revealed that the expression of miR-203 significantly correlated with a favorable prognosis. These results demonstrated that miR-203 regulated both basal and supra-basal cell components to induce differentiation with restored epithelial tissue architecture, leading to significant tumor growth inhibition in vivo. Those results suggest the use of miR-203 as a novel therapeutic and diagnostic target in patients with ESCC.

Various tumors in the nasal vestibule.

Various types of diseases can involve the nasal vestibule. Diagnosis and treatment of a nasal vestibular mass is often challenging due to the anatomical features of the nasal vestibule. Here, we present four cases with nasal vestibular masses. Two cases were diagnosed as squamous papillomas. The others were a trichofolliculoma and pseudoepitheliomatous hyperplasia with hyperkeratosis. Our aim was to discuss the characteristics of each disease and the considerations thought to be necessary for diagnosis and treatment of nasal vestibular tumors from these cases and the related literature.

Trichofolliculoma: a rare variant of hair follicle hamartoma.

Trichofolliculoma is a rare hair follicle hamartoma, which is often regarded as a hair follicle tumor. Mostly, it presents as a papule or nodule, involving the skin of the face and scalp area. A central, dilated keratin plugged ostium with vellus hair(s) is often present. We report a 19-year-old woman with typical clinical and histopathological findings of trichofolliculoma.

Umbilicated nodule over eyebrow.

Trichofolliculoma is a pilosebaceous follicle hamartoma in which several hairs are formed within single pilosebaceous unit and protrude out of single orifice. Herein we report a 45-year-old woman with a trichofolliculoma of the eyebrow.

Systemic therapy for inoperable and metastatic basal cell cancer.

Cutaneous basal cell carcinoma (BCC) is the most common human malignancy. The majority of cases are cured with local therapies and advanced disease is quite rare. However, locally advanced (inoperable) and metastatic basal cell carcinoma may occur more often than previously thought. Surgery, and other local therapies, is the primary treatment for BCC. However, some resections can be extensive and carry significant morbidity or disfigurement. The prognosis for locally advanced and metastatic BCC is quite poor, and cytotoxic chemotherapies offer limited benefit. Aberrations in the sonic hedgehog (HH) signaling pathway are common in BCC. Novel molecular therapies targeted against this pathway, such as vismodegib (GDC-0449), have shown dramatic activity in advanced basal cell carcinoma. The role of these in nevoid basal cell carcinoma syndrome (Gorlin) syndrome is still under investigation. However, systemic therapies are not curative and require long-term treatment and should not be used in place of curative procedures. Evaluation by experienced physicians and/or by a multidisciplinary tumor board for possible curative/definitive surgery with or without radiation is recommended before initiation of systemic therapy. Clinical trial enrollment also is recommended. Comorbid conditions as well as social circumstances may be factors when deciding on an optimal therapy, in particular with oral agents. Patients treated with HH pathway inhibitors require regular physician monitoring to assess for side effects, benefit, and compliance. Patients of child-bearing potential must be strongly counseled regarding the risk of birth defects and need for birth control. Primary and secondary resistance to HH pathway inhibitors is only beginning to be described.