[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%.

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.

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.

The "jigsaw puzzle" advancement flap for reconstruction of a retroauricular surgical defect.

Repairing retroauricular defects is quite challenging. Although direct observation of the repaired defect is not possible, choosing the wrong reconstruction might result in serious deformity of the auricle that will be easily noticed. An 89-year-old man presented with a large basal cell carcinoma tumor on his right retroauricular area adjacent to the mastoid-auricle border. The clinical tumor size was 17 × 17 mm. The tumor was excised in one stage, using the Mohs micrographic surgery technique. The final defect size was 20 × 20 mm. The surgical defect was reconstructed by a "jigsaw puzzle"-like flap.

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.

[Our experience in nasal reconstruction with local nasal and regional flaps]. / Nazal rekonstrüksiyonda lokal nazal ve bölgesel flep uygulamalarimiz.

OBJECTIVES: In this study, we evaluated the patients, who underwent nasal reconstruction with local nasal or regional flaps and compared our approach with the algorithms of nasal reconstruction in literature. PATIENTS AND METHODS: Twenty-seven patients (15 males, 12 females; mean age 68.7 years; range 42 to 86 years) who underwent nasal reconstruction with local nasal or regional flaps due to excision of skin cancers on the nose, between November 2007 and December 2009 were included in this study. The demographic data (age, sex and occupation), the location, histopathologic type, subtype and size of the tumor, the size and thickness of the defect area, the reconstruction technique and complications were recorded. All patients were photo-documented pre-, intra- and postoperatively, and were followed up at regular intervals. RESULTS: Basal cell carcinoma was detected in 23 patients and squamous cell carcinoma was detected in four patients. The tumors were most frequently located on the nasal dorsum (n=8, 29%) and the side walls (n=6, 22%). The tumor size was >15 mm in 14 (52%) patients. The size of the nasal defect was >20 mm in 18 (66%) patients. Reconstruction was performed with local nasal flaps in 10 patients and with regional flaps in 17 patients. CONCLUSION: The surgical flaps for nasal reconstruction should be selected individually. The ideal technique of nasal reconstruction should be determined based on the location, size, and thickness of the nasal defects, the preferences of the patients and the surgeon's experience.

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.

Two cases of neoplasia of basal cell origin affecting the axillary region in anseriform species.

Neoplasms of the skin are occasionally seen in domestic birds but are uncommon in nondomestic birds. An 8-year-old male hooded merganser (Lophodytes cucullatus) was presented with bilateral axillary ulcerative lesions that improved but did not resolve with empiric antibiotic and antifungal therapy. Skin biopsies were taken, and bilateral feather folliculomas were diagnosed on histopathologic examination. The duck was euthanatized because of the poor prognosis. A 9-year-old Indian runner duck (Anas platyrhynchos) was presented with an ulcerative lesion, with pseudomembrane and serocellular crust affecting the axillary region. This mass was diagnosed as a basosquamous carcinoma. The mass was surgically excised, and no recurrence was observed. Feather folliculomas are usually considered benign neoplasms in domestic birds and may be primarily ulcerative, exudative, bilateral, and symmetric in location. Basosquamous carcinoma may have a similar gross appearance. It is unknown if the axillary region may be an area with increased incidence of neoplasia in birds. This appears to be the first report of feather folliculoma and basosquamous carcinoma in Anseriforme species. Feather folliculomas and other neoplasms, such as basosquamous carcinoma, should be considered as a differential diagnosis in ulcerative or proliferative skin lesions in birds.

Desmoplastic trichoepithelioma versus morphoeic basal cell carcinoma: a critical reappraisal of histomorphological and immunohistochemical criteria for differentiation.

AIMS: It is often difficult to differentiate between cases of desmoplastic trichoepithelioma (DTE) and morphoeic basal cell carcinoma (MBCC) because both lesions have many features in common. The aim was to clarify which criteria for differentiation offer the best basis for diagnosis. METHODS AND RESULTS: Nineteen cases of DTE were compared histologically and immunohistochemically with 18 cases of MBCC (using CD34, CD10, cytokeratin (CK) 20, androgen receptor, Bcl-2, Ki67 and p53 immunohistochemistry). Sensitivity, specificity and positive and negative likelihood ratios were calculated. Convincing diagnostic evidence for DTE was identified for the following features: symmetry, good circumscription, depression in the lesion's centre. However, these features are applicable only to excisional specimens, not to specimens taken by punch biopsy. Signs of infundibular, follicular or sebaceous differentiation, calcification, osteoma, association with a melanocytic naevus, and absence of solar elastosis below the lesion provided equally robust diagnostic evidence for DTE. Immunohistochemically, only staining of Merkel cells with CK20 and negativity of aggregations with androgen receptors were diagnostically convincing for DTE. Ki67 and p53 revealed significant differences, but a lower positive likelihood ratio. CONCLUSION: Histopathologistics need to identify with confidence subtle signs of infundibular, follicular and sebaceous differentiation because these features are dependable criteria to differentiate DTE from MBCC. Immunohistochemistry for androgen receptors and CK20 is helpful, but interpretation is difficult in some DTEs when few cells are immunopositive for these markers.

Fluorescence imaging for the demarcation of basal cell carcinoma tumor borders.

BACKGROUND: Basal cell carcinoma (BCC) is a common malignancy accounting for 80% of all nonmelanoma skin cancers. Mohs micrographic surgery (MMS) is considered superior to alternative treatments, but the procedure is time consuming and costly. Alternative simpler techniques to facilitate accurate tumor demarcation are therefore in demand. Fluorescence imaging following application of 5-aminolevulinic acid is a noninvasive diagnostic technique that gives rapid information about the superficial extent of the skin tumor. OBJECTIVE: To ascertain whether fluorescence imaging improves the clinical tumor border assessment by investigating the consistency between tumor size determination by MMS, clinical assessment, and fluorescence imaging. METHODS: Eighteen patients with histologically verified nodular BCCs on the face scheduled for MMS were included in the study. The night before the surgical procedure, 5-aminolevulinic methyl ester cream was applied to the lesion. The following morning, tumor borders were determined clinically (clinical size), after illumination with Wood's light (fluorescence size), and by the tumor defect left on the skin surface following removal of the MMS specimen (Mohs size). RESULTS: The median tumor sizes were 93.05 mm2 (Mohs size), 61.05 mm2 (clinical size), and 72.75 mm2 (fluorescence size). The interclass correlation coefficients between Mohs size and fluorescence size was 0.984 and Mohs size and clinical size was 0.752. CONCLUSION: Tumor border estimation by fluorescence imaging and clinical assessment underestimate the genuine tumor size determined by MMS; however, the fluorescence size showed a higher degree of consistency with the Mohs size than did the clinical size.

Imiquimod: a review of basal cell carcinoma treatments.

Basal cell carcinoma (BCC) is regarded as the most prevalent malignant skin tumor in whites. A variety of surgical and nonsurgical interventions are available to treat BCC. In recent years, an immune response modifier drug, imiquimod, has been approved in treating superficial BCC (sBCC). The objective of the authors was to review the published literature to evaluate outcomes such as efficacy, safety, and quality of life associated with imiquimod treatment among patients with sBCC. A MEDLINE search of the literature was performed to identify studies published between January 1, 1995 and March 31, 2008 that evaluated imiquimod efficacy, safety, and quality of life in treating BCC. Overall, imiquimod 5% cream was associated with increased clinical and histologic clearance among patients with sBCC as compared to placebo. The findings from short-term cost effectiveness studies suggest that use of imiquimod 5% cream can be more cost-effective than surgical interventions such as excision surgery among patients with superficial BCC. Future studies evaluating long term cost effectiveness of imiquimod treatment are warranted.

Malignant proliferating trichilemmal tumor of the scalp: a case report.

BACKGROUND: Malignant proliferating trichilemmal tumor is a rare skin tumor that affects mainly older women. It mimicks differential squamous cell carcinoma and its biological behavior is unpredictable. OBJECTIVE: To report on a new case of malignant proliferating trichilemmal tumor of the scalp and to describe the clinical and histopathologic findings. METHODS: A tumor measuring 2 cm was surgically excised with a 0.5 cm conservative margin of normal tissue RESULTS: Based on the histopathologic findings of tumor, this case was diagnosed as proliferating trichilemmal tumor of the scalp. Eleven months after tumor resection, the patient is free of disease. CONCLUSION: Malignant proliferating trichilemmal tumor is a rare malignant lesion with an unpredictable biological behavior. After wide excision, long term clinical follow up of the patient for early diagnosis of metastases is judicious.

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)

Morphoeic basal cell carcinoma of the face.

The morphoeic (or sclerosing) basal cell carcinoma (mBCC) is the most aggressive subtype, as it spreads into the dermis beyond the clinically visible or palpable borders, making complete excision difficult. Our aim was to identify variables in the surgical management that might increase the rate of complete resection, so we made a retrospective study of 97 mBCCs. One-stage procedures (frozen section analysis) had a higher rate of complete resection (63 of 69, 91%) than two-stage procedures (permanent section analysis) (19 of 28, 68%, p<0.05). The false negative rate of frozen section analysis was 9%. Experienced surgeons had more complete excisions and a lower rate of operative re-excisions. The use of frozen section analysis is an effective way of judging invasion of margins by mBCC. The estimation of tumour margins and the treatment of mBCC requires substantial clinical experience.