Background We observed that basal cell carcinoma (BCC) on the ear demonstrates a more aggressive phenotype compared with other body sites. Objective We sought to determine if it is statistically significant that BCC on the ear is more aggressive. Methods We queried our 2009 database for all BCCs biopsied from the ear. Multiple data points, including tumor subtype and risk level, were analyzed for 100 BCCs on the ear and 100 BCCs on the cheek. Results BCC on the ear was diagnosed 471 times. Of the first 100 occurrences of BCC on the ear, 57% were high risk compared with 38% on the cheek (odds ratio 2.16, 95% confidence interval 1.23-3.81, P  = .01). Men were more likely to have BCC on the ear: 79% male on the ear and 53% male on the cheek ( P Limitations The data were retrieved from a single year at our institution, and there could potentially be regional bias given that the population of data is from a single institution. Many of the specimens we evaluate are reviewed in consultation and may thus represent a selection bias. Conclusion BCC on the ear presents as an aggressive phenotype in the majority of cases for both men and women, and it occurs much more frequently in men. Knowledge of this information can help guide physicians and ensure that these tumors are adequately biopsied and treated.

Basal cell carcinoma on the ear is more likely to be of an aggressive phenotype in both men and women.

Cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) represent 45.5% and 37.02%, respectively, of total malignant skin cancer according to the latest registry of Egyptian National Cancer Institute. Minichromosome maintenance (MCM) proteins are essential replication initiation factors. The current study examined the immunohistochemical expression of MCM2 in normal skin (10 cases), some proliferative skin lesions (6 psoriasis, 2 keratoacanthoma, and 2 seborrheic keratosis), and nonmelanoma epithelial skin cancers (20 BCC and 21 SCC). MCM2 was expressed in basal layer of normal epidermis and upregulated in proliferative skin lesions and nonmelanoma epithelial skin cancers without significant differences between the latter groups (P > 0.05). Mean and median values of MCM2 percentage of expression in BCC were higher than that of SCC (P = 0.004). MCM2 promotes proliferative capacity of the cells manifested by its expression in basal layer of epidermis, hyperproliferative skin lesions, and malignant cutaneous tumors. Proliferative capacity of BCC may be higher than SCC and this does not necessarily reflect aggressive behavior.

Immunohistochemical expression of MCM2 in nonmelanoma epithelial skin cancers.

Background. An interesting clinical feature of basal cell carcinoma (BCC) of the skin is marked interpatient variation in tumor number, lesion accrual and anatomic distribution. We analyzed a proportion of patients with multiple BCCs in the cohort of pathology report-confirmed cases of BCC and investigated clinicopathological differences between individuals suffered from multiple tumor lesions and patients with a single tumor only. Material and Methods . All consecutive patients with primary cutaneous BCCs, that were histologically diagnosed at our Department of Pathology during 10-year period were enrolled into the study. Results . A cohort of 899 participants with a total of 1.239 histologically proven primary BCCs were assessed. Of them, 728 (81%) had single BCC and 171 (19%) had multiple BCCs. Multiple lesions occurred more frequently in men than women. Mean number of tumors per patient was 1.5 in males and 1.2 in females. Among participants with multiple BCC manifestation, there was steady increase of the male-to-female ratio with rising tumor number per individual. In the multiple BCC subgroup, the tumors were found more commonly in the trunk and upper limbs, and less frequently in the face. Histologically, these BCCs much more commonly included superficial subtype. There was positive correlation between the non-aggressive histologic phenotype of BCC and multiple tumor presentation on the one hand, and the aggressive histologic phenotype of BCC and a single tumor occurrence on the other. Conclusion : Our analysis shows that clinicopathological features associated with multiple BCC manifestation include male gender, tumor location in the trunk and upper extremities, and superficial histologic subtype. Focus on this risk profile may be beneficial for clinical screening and may help clinicians in the selection of individuals, who should be followed up more closely.

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Basal Cell Carcinoma Multiplicity - a Retrospective Analysis of 899 Biopsy-proven Patients from a Single Institute

Evaluation of tumor cell proliferation status belongs to the basic prognostic indicators in a routine biopsy report. In cutaneous basal cell carcinoma (BCC), however, there are discrepancies about a true prognostic significance of this histopathological parameter. The aim of this study was to assess a proliferative activity (Ki-67 index) in BCCs of the skin. Biopsy specimens from 80 cutaneous BCCs (63 primary, 17 recurrent) of different histological types from 75 subjects (34 men, 41 women) were enrolled into this study. All samples were immunohistochemically stained by antibody against Ki-67 antigen (DAKO, clone MIB-1, dilution 1:100). For the statistical analysis, χ
 2 test was employed. We found a striking percentage variability of nuclear Ki-67 expression in individual tumors (range 2–70%). Mean value of Ki-67 index was 27.4% (in primary tumors 28.1 %, in recurrent lesions 25.6%). The highest Ki-67 expression occurred in infiltrative BCCs (average 38.1%), morpheaform BCCs (average 37.0%), and superficial BCCs (average 35.7%), the lowest expression was recorded in nodular BCCs (average 21.7%) and BCCs with adnexal (trichoepithelial) differentiation (18.6%). There were not persuasive and statistically significant quantitative differences in proliferation activity of tumor cells between the individual histological BCC types, as well as between primary and recurrent lesions. A distribution of Ki-67 positive cells in tumor nests was mostly irregular and areas with a high number of Ki-67 labeled cells often occurred adjacent to areas with a lower number of cells expressing this marker. Because of a marked Ki-67 staining variability, we can conclude that the simple quantification of BCC proliferation activity alone may not be sufficient for the prediction of further biological behavior, evolution and clinical outcome of this malignancy.

https://www.degruyter.com/downloadpdf/j/biolog.2012.67.issue-3/s11756-012-0035-8/s11756-012-0035-8.xml

Immunohistochemical evaluation of proliferative activity (Ki-67 index) in different histological types of cutaneous basal cell carcinoma

Basal cell carcinoma (BCC) is the most common malignancy in humans. We present a man with a recurrent BCC of the scalp that presented as an intracranial tumor 18 years after original excision.

/pdf/recurrent-basal-cell-carcinoma-with-intracranial-invasion-a-4hz180bizp.pdf

Recurrent basal cell carcinoma with intracranial invasion: a case report and literature review.

Basal cell carcinoma of the skin is currently the most frequent malignancy in human population. Basal cell carcinoma represents a heterogeneous group of tumors with a variable clinical and morphological picture. Based on its biological behaviour, we generally differentiate between indolent (superficial and nodular) and aggressive type (infiltrative, micronodular, and metatypical) of basal cell carcinoma. Because of the different biological characteristics of these tumors, it is questionable whether they are a part of a continuous spectrum of carcinogenesis, starting with indolent and ending with aggressive forms, or they represent separate developmental lines. In the current clinical practice, there is an increasing demand for identification of tumors that are prognostically more adverse and their impact on the overall health status of patients is more serious. Recent advances in pathology and molecular medicine allow identification of various biomarkers from tumor tissue that are significantly involved in the mechanisms of malignant cell transformation. Detection of these biomarkers is of great importance in predicting further clinical behaviour of the cancer. The authors of the paper present basic information about biological behaviour of cutaneous basal cell carcinoma and provide an overview of the most important biomarkers that influence the clinical outcome and disease progression and are detectable through a routine biopsy tissue examination. It is now necessary to search for novel histological and molecular parameters that, in the future, could have a prognostic value in diagnostic and therapeutic process of this disorder.

[Basal cell carcinoma of the skin--biological behaviour of the tumor and a review of the most important molecular predictors of disease progression in pathological practice].

Basal cell carcinoma (BCC) of the skin is generally characterised by a favourable clinical outcome. The slow and mostly local character of growth helps in its early recognition, thus the vast majority of cases are diagnosed in the early phase of disease. However, in cases of long-term neglect of clinical symptoms, certain cancers may reach huge proportions and may significantly destroy surrounding tissue. BCCs larger than 5 cm are called giant BCCs. The authors of the article present a case report of woman suffering from a giant BCC of the head with a history of 15 years of lasting growth, during which she had refused a medical examination. Finally, she was forced to go into hospital due to episodes of unconsciousness and convulsions. Clinical investigations revealed a huge ulcerating tumour in the fronto-parietal region infiltrating the skull and penetrating into the cranial cavity with compression of the brain. A surgical extirpation of the tumor-affected soft tissue and the calva was performed with plastic reconstruction of dura mater and skin. Microscopic examination of biopsy specimens confirmed a diagnosis of mixed BCC with nodular, infiltrative and metatypical features, which had completely infiltrated calva and dura mater. It was not possible to surgically remove a part of the tumour-affected bones of the left orbita, thus the patient is going to undergo local radiotherapy. This case report emphasizes the fact that BCC, in spite of its usually "benign" biological behaviour, should never be underestimated because it may progress to the advanced stage of the disease, for which treatment is much more difficult with a larger negative impact and a significantly worse prognosis for the patient.

Péc M

Papers

[Basal cell carcinoma of the skin--biological behaviour of the tumor and a review of the most important molecular predictors of disease progression in pathological practice].

[Giant cutaneous basal cell carcinoma of the head with intracranial propagation--a case report].