Primary basal cell carcinoma of the caruncle: case report and review of the literature

ABSTRACT We present a rare case of primary caruncle basal cell carcinoma (BCC), a condition with limited occurrences. Our patient, an 80-year-old woman without prior ocular pathological history, presented a 2x2mm pedunculated blackish nodular lesion on the caruncle of her left eye, without local conjunctival or cutaneous involvement. Histological analysis following complete excision confirmed the presence of basal cell carcinoma within the caruncle. Over a span of 30 months, no recurrence has been observed. While scant cases are documented in the literature, we conducted a review of these instances. Despite its infrequent manifestation, this condition should be taken into account when evaluating caruncular tumors, given its tendency to invade the orbit. Complete excision with free surgical margins is the treatment of choice, and adjuvant radiotherapy or chemotherapy might be considered.

Respuesta terapéutica del HeberFERON® en pacientes con carcinoma basocelular y su asociación con la COVID-19

Introducción: El carcinoma basocelular constituye uno de los tipos de cáncer cutáneo de mayor incidencia. El uso del HeberFERON® ha demostrado una efectiva respuesta clínica. Objetivo: Evaluar la respuesta del HeberFERON® en pacientes con carcinoma basocelular asociado a la COVID-19, y su comportamiento en pacientes con igual diagnóstico dermatológico sin tratamiento previo con dicho fármaco, atendidos con cirugía. Materiales y métodos: Se realizó un estudio observacional descriptivo y retrospectivo en un universo de 184 pacientes adultos con carcinoma basocelular. Se analizaron las variables edad, sexo, fototipo de piel, comorbilidades asociadas, infección con SARS-CoV-2 asociada con tratamiento previo con HeberFERON® o cirugía; tiempo entre tratamiento recibido y padecimiento de COVID-19, y severidad de los síntomas. Los resultados se expresan en tablas. Resultados: Se estudiaron 94 pacientes tratados con HeberFERON® para el carcinoma basocelular, y 90 pacientes tratados con cirugía. Predominaron los masculinos, mayores de 60 años, fototipo de piel II-III, con comorbilidades cardiovasculares. De ellos, 24 (25,5 %) resultaron positivos a la COVID-19, y el 83,3 % desarrollaron síntomas leves. De los tratados con cirugía para el carcinoma basocelular, 61 resultaron positivos a la COVID-19 (67,7 %), y el 55,7 % tuvo sintomatología severa. Durante el ciclo de tratamiento con HeberFERON para el carcinoma basocelular, el 66,7 % enfermó con COVID-19 entre las 16 y 32 semanas. Posterior a las 32 semanas, se reportó un fallecido. Conclusiones: Los pacientes tratados con cirugía sin previo HeberFERON tuvieron más contagios con COVID-19, predominando los decesos asociados a ello, siendo menor en los que lo recibieron. De los tratados previamente con HeberFERON® para el carcinoma basocelular, el 74,5 % no enfermó de COVID-19, a pesar de haber sido el 52,8 % contactos de positivos al SARS-CoV-2.

Introduction: Basal cell carcinoma is one of the types of skin cancer with the highest incidence. The use of HeberFERON® has shown an effective clinical response. Objective: To evaluate the response of HeberFERON® in patients with BCC associated with COVID-19 and its behavior in patients with the same dermatological diagnosis without previous treatment with that drug, treated with surgery. Materials and methods: A descriptive and retrospective observational study was conducted in a universe of 184 adult patients with basal cell carcinoma. The variables analyzed were age, sex, skin phototype, associated comorbidities, SARS-CoV-2 infection, associated to previously treatment with HeberFERON® or surgery; time between treatment received and suffering from COVID-19; severity of symptoms. The results were expressed in tables. Results: 94 patients were treated with HeberFERON® for basal cell carcinoma, and 90 were treated with surgery. There was a predominance of male patients, aged over 60 years, skin phototype II-III, with cardiovascular morbidities. Of them, 24 (25.5%) were positive to COVID-19 (67.7%), and 83.3% developed mild symptoms. Of those treated with surgery for basal cell carcinoma, 61 were positive to COVID-19 (67,7%), and 55.7% had severe symptoms. During the HeberFERON® treatment cycle for basal cell carcinoma, 66.7% became ill with COVID-19 between 16 and 32 weeks. After 32 weeks one deceased was reported. Conclusions: Patients treated with surgery without prior HeberFERON® had more infections with Covid-19, the deaths associated with it predominating, being less in those who received it. Of those previously treated with HeberFERON® for basal cell carcinoma, 74.5% did not become ill with COVID-19, despite having been 52.8% contacts to SARS-CoV-2 positive people.

Frequency of skin diseases in renal transplant recipients and patients with chronic kidney disease in a tertiary center: a cross-sectional study

ABSTRACT BACKGROUND: The prevalence of chronic kidney disease (CKD) has increased in the recent decades, along with the number of patients in the terminal stages of this disease, requiring transplantation. Some skin disorders are more frequent in patients with CKD and in renal transplant recipients (RTR). OBJECTIVES: To evaluate the frequency of skin diseases in RTR and patients with CKD receiving conservative treatment. DESIGN AND SETTING: This observational cross-sectional study recruited consecutive patients with CKD and RTR from a nephrology clinic at a teaching hospital in Brazil between 2015 and 2020. METHODS: Quantitative, descriptive, and analytical approaches were used. The sample was selected based on convenience sampling. Data were collected from dermatological visits and participants' medical records. RESULTS: Overall, 308 participants were included: 206 RTR (66.9%, median age: 48 years, interquartile range [IQR] 38.0-56.0, 63.6% men) and 102 patients with CKD (33.1%, median age: 61.0 years, IQR 50.0-71.2, 48% men). The frequency of infectious skin diseases (39.3% vs. 21.6% P = 0.002) were higher in RTR than in patients with CKD. Neoplastic skin lesions were present in nine (4.4%) RTR and in only one (1.0%) patient with CKD. Among the RTR, the ratio of basal cell carcinoma to squamous cell carcinoma was 2:1. CONCLUSIONS: This study revealed that an increased frequency of infectious skin diseases may be expected in patients who have undergone kidney transplantation. Among skin cancers, BCC is more frequently observed in RTR, especially in those using azathioprine.

Carcinoma basocelular de la piel cabelluda tratado con HeberFERON. Seguimiento clínico, ecográfico e histopatológico

Fundamento: El carcinoma basocelular es infrecuente en la piel cabelluda. Es un tumor de invasión local y crecimiento lento, puede ser agresivo, destruir tejidos vecinos, causar ulceración e invadir en profundidad cartílago y hueso. Objetivo: Evaluar los resultados de la aplicación del HeberFERON y el seguimiento con ecografía cutánea en pacientes con carcinoma basocelular en la piel cabelluda. Metodología: Se realizó un estudio observacional, descriptivo y longitudinal en una serie de casos con diagnóstico de carcinoma basocelular de la piel cabelluda en el Policlínico Centro de la ciudad Sancti Spíritus, durante el período de 10 de julio del 2018 a 29 de julio del 2022. Se incluyeron 6 casos. Las variables estudiadas fueron la respuesta al tratamiento mediante la clínica, la ecografía cutánea e histopatología y presencia de eventos adversos. Resultados: Predominó el sexo masculino, subtipo histológico sólido, subtipo clínico nódulo ulcerativo, tamaño del tumor mayor de 30 mm y tiempo de evolución de más de 12 meses; la respuesta al tratamiento en la mayoría de los casos fue parcial. Los eventos adversos fueron dolor y ardor en el sitio de inyección, fiebre, edema y eritema perilesional. Conclusiones: El HeberFERON resultó de utilidad en los pacientes con carcinoma basocelular del cuero cabelludo ya que redujo el tumor en unos casos y en otros lo eliminó. La ecografía permitió la evaluación en tiempo real de la neoplasia; los eventos adversos más frecuentes fueron la fiebre y el dolor en el sitio de inyección, a pesar de ello ningún paciente abandonó el tratamiento.

Background: Basal cell carcinoma is uncommon in the scalp. It is a slow-growing locally invasive tumor, it can be aggressive in destroying neighboring tissues, cause ulceration and invade deep into the cartilage and bone. Objective: To evaluate the results of HeberFERON application and follow-up with cutaneous echographical in patients with scalp basal cell carcinoma. Methodology: An observational, descriptive and longitudinal study was conducted in a series of cases diagnosed with scalp basal cell carcinoma at the Center Polyclinic in Sancti Spíritus city during the period from July 10, 2018 to July 29, 2022. Six clinical cases were included. The studied variables were the answer to the treatment by clinical, cutaneous echographical and histopathology and the presence of adverse events. Results: Male sex predominated, solid histologic subtype, clinical subtype ulcerative nodule, tumor size greater than 30 mm and evolution time of over 12 months; the treatment response in most cases was partial; adverse events were pain and burning at the injection site, fever, edema and perilesional erythema. Conclusion: It was observed that in patients with scalp basal cell carcinoma, the HeberFERON treatment reduced in some cases and eliminated the tumor in others. Echography allowed real-time evaluation of the neoplasm, fever and pain at the injection site were the most frequent adverse events. In spite of this, none of the patients abandoned the therapy.

Resultados del uso de HeberFERON® en pacientes con carcinoma basocelular de alto riesgo en Matanzas

Introducción: El cáncer de piel es la más frecuente de todas las neoplasias. Su incidencia mundial ha aumentado en proporción epidémica, y existe un predominio en países tropicales debido a la constante exposición solar. El carcinoma basocelular es el que más afecta a la población y predomina en hombres de más de 60 años. Existen criterios para clasificar esta entidad en alto riesgo, basándose, sobre todo, en la localización y extensión de la lesión. Una opción novedosa y terapéutica de elección es el uso del HeberFERON®. Objetivo: Describir la respuesta clínica al tratamiento con HeberFERON® en pacientes con carcinoma basocelular de alto riego en Matanzas, en el período de febrero de 2019 a julio de 2021. Materiales y métodos: Se realizó un estudio descriptivo prospectivo en pacientes atendidos en la Consulta Provincial de Tumores Periféricos, de Matanzas, que presentaron carcinoma basocelular de alto riesgo en el período mencionado. Resultado: La población estuvo constituida por 55 pacientes, predominando los hombres y el grupo etario de 60 a 69 años. Las variantes ulceradas localizadas en la nariz constituyeron las formas clínicas agresivas de mayor incidencia. Conclusiones: Imperaron las respuestas completas en tumores mayores de 2 cm, evitando cirugías mutilantes, con lo que se evidencia la seguridad y eficacia del HeberFERON®.

Introduction: Skin cancer is the most frequent of all neoplasms. Its worldwide incidence has increased in epidemic proportions, and there is predominance in tropical countries due to constant sun exposition. Basal cell carcinoma is the one that most affects the population and predominates in men over 60 years of age. There are criteria to classify this entity as high risk, based, above all, in the location and extent of the lesion. A novel and therapeutic option of election is the use of HeberFERON™. Objective: To describe the clinical response to treatment with HeberFERON™ in patients with high-risk basal cell carcinoma in Matanzas, from February 2019 to July 2021. Materials and methods: Prospective, descriptive study was carried out in patients treated at the Provincial Clinic of Peripheral Tumors, of Matanzas, who presented high-risk basal cell carcinoma in the aforementioned period. Results: The population consisted of 55 patients, predominating men and the age group from 60 to 69 years. The ulcerative forms located in the nose constituted the aggressive clinical forms of highest incidence. Conclusions: Complete responses prevailed in tumors larger than 2 cm, avoiding mutilating surgeries, thus demonstrating the safety and efficacy of HeberFERON™.

HeberFERON en el tratamiento de pacientes con carcinoma basocelular en zona de alto riesgo / HeberFERON in the Treatment of Patients with Basal Cell Carcinoma on a High-Risk Zone

Introducción: El carcinoma basocelular es un tumor de invasión local de crecimiento; se origina en las células epidérmicas de los folículos pilosos o las células basales de la epidermis, cuando se localizan en zona de alto riesgo en la cara tienen un mayor índice de recurrencia tumoral y de invasión a estructuras adyacentes y subyacentes. Objetivo: Evaluar los resultados de la aplicación del HeberFERON en pacientes con carcinoma basocelular en zona de alto riesgo. Métodos: Se realizó un estudio observacional, descriptivo y prospectivo en pacientes con diagnóstico clínico, dermatoscópico e histopatológico de carcinoma basocelular en zona de alto riesgo, tratados con HeberFERON en la consulta del Policlínico Centro de Sancti Spíritus desde el 12 de enero de 2016 hasta el 25 de marzo de 2022. La muestra quedó conformada por 62 pacientes Las principales variables estudiadas fueron la respuesta al tratamiento y los eventos adversos. Resultados: Predominó el sexo masculino, el área urbana, fototipocutáneo III y la edad mayor de 40 años. La localización más frecuente fue la nasal; el subtipo clínico el nódulo ulcerativo; el histológico, el sólido; el tumor primitivo y menor de 2 cm; la respuesta al tratamiento fue completa en la mayoría de los pacientes. Los eventos adversos más comunes fueron dolor y ardor en el sitio de inyección, edema y eritema perilesional, fiebre y cefalea. Conclusiones: La mayoría de los pacientes tratados con HeberFERON tuvieron una respuesta completa, los eventos adversos fueron los descritos en la literatura por el uso de interferones, sin cambio en la actitud farmacológica(AU)

Introduction: Basal cell carcinoma is a growing and locally invasive tumor; it originates in the epidermal cells of hair follicles or the basal cells of the epidermis. When located in a high-risk facial zone, they present a higher rate of tumor recurrence and invasion to adjacent and underlying structures. Objective: To evaluate the results of HeberFERON application in patients with basal cell carcinoma on a high-risk zone. Methods: An observational, descriptive and prospective study was conducted in patients with a clinical, dermatoscopic and histopathological diagnosis of basal cell carcinoma on a high-risk zone, treated with HeberFERON in the consultation of Policlínico Centro of Sancti Spíritus, from January 12, 2016 to March 25, 2022. The sample was made up of 62 patients. The main variables studied were response to treatment and adverse events. Results: There was a predominance of the male sex, the urban area, skin phototype III and age over 40 years. The most frequent localization was nasal; the clinical subtype, ulcerative nodule; the histological subtype, solid. The response to treatment was complete in most patients. The most common adverse events were pain and burning at the injection site, perilesional erythema and edema, fever and headache. Conclusions: Most patients treated with HeberFERON had a complete response; the adverse events were those described in the literature due to the use of interferons, with no change in pharmacological behavior(AU)

HeberFERON en el tratamiento de pacientes con carcinoma basocelular de la oreja / HeberFERON in the treatment of patients with basal cell carcinoma of the ear

Fundamento: El carcinoma basocelular de la región auricular es considerado uno de los más agresivos y con peor pronóstico, suele ser destructivo y mutilante por lo que el tratamiento conservador, como es el uso de los interferones, es importante en la práctica médica habitual. Objetivo: Evaluar los resultados de la aplicación del HeberFERON en una serie de pacientes con carcinoma basocelular en la región auricular. Metodología: Se realizó un estudio observacional, descriptivo y longitudinal en una serie de casos con diagnóstico clínico, dermatoscópico e histopatológico de carcinoma basocelular de la oreja que recibieron tratamiento con HeberFERON en el Policlínico Centro de la ciudad Sancti Spíritus, durante el período del 20 de febrero de 2017 a 20 de diciembre de 2022. En total se incluyeron 29 pacientes. Se realizó una evaluación inicial, durante y 16 semanas después del tratamiento; se les inyectó 10.5 UI de HeberFERON 3 veces por semana perilesional e intradérmico hasta completar 9 dosis. Las variables fueron la respuesta al tratamiento y presencia o no de eventos adversos. Resultados: Predominó el sexo masculino, la localización en la concha de la oreja, subtipo clínico nódulo ulcerativo y el histológico sólido, con respuesta completa en la mayoría de los pacientes. Como eventos adversos más comunes se presentaron dolor en el sitio de inyección, fiebre, edema y eritema perilesional. Conclusiones: La respuesta al tratamiento fue favorable en la mayoría de los pacientes y los eventos adversos que se observaron fueron los descritos en la literatura sin cambio en la actitud farmacológica.

Background: Basal cell carcinoma of the auricular region is one of the most aggressive cancers and with the worst prognosis, is usually destructive and mutilating, therefore conservative treatment, such as the use of interferons, is important in routine medical practice. Objective: To evaluate the results of HeberFERON application in a series of patients with basal cell carcinoma in the auricular region. Methodology: An observational, descriptive and longitudinal study was conducted on a series of cases with clinical, dermoscopic and histopathologic diagnosis of basal cell carcinoma of the ear treated with HeberFERON at the Center Polyclinic in Sancti Spíritus city, during the period from February 20, 2017 through December 20, 2022. A total of 29 patients were included in the study. An evaluation was conducted at the start of treatment, during treatment, and 16 weeks after treatment; the patients were treated with 10.5 IU of HeberFERON by perilesional and intradermal injections three times a week until completing nine doses. The variables were the response to the treatment and the presence or absence of any adverse events. Results: The male sex predominated, location in the ear turbinate, clinical subtype ulcerative nodule and solid histologic subtype, with a complete response in the majority of patients. The most common adverse events were injection site pain, fever, edema, and perilesional erythema. Conclusions: The response to treatment was favorable in most patients, and the adverse events observed were those described in the literature, with no change in pharmacologic attitude.

Adequacy of surgical margins, re-excision, and evaluation of factors associated with recurrence: a retrospective study of 769 basal cell carcinomas

Abstract Background: Achieving adequate surgical margins and preventing recurrence are important in the treatment of basal cell carcinoma (BCC). Objectives: The objectives of this study were to evaluate the adequacy of surgical margins and the re-excision rates in patients with primary BCC who underwent standard surgical treatment using our proposed algorithm and to define the risk factors in patients with recurrent BCC. Methods: The medical records of patients who were histopathologically diagnosed with BCC were reviewed. An algorithm created based on previous literature was used to determine the distribution of optimal surgical margins adequacy and re-excision rates. Results: Statistically significant differences were observed between the cases with and without recurrence in age at diagnosis (p = 0.004), tumor size (p = 0.023), tumor location in the H zone of the face (p = 0.005), and aggressive histopathological subtype (p = 0.000). When the tumors were evaluated for adequacy of deep and lateral surgical margins and re-excision rates, higher rates of adequate excision (457 cases, 68.0%) and re-excision (43 cases, 33.9%) were noted for tumors in the H or M zone. Study limitations: Inadequate follow-up of newly diagnosed patients in terms of recurrence and metastasis and the retrospective application of our proposed algorithm are the limitations of the present study. Conclusions: Our results showed that if BCC was detected at an early age and at an early stage, recurrence was lower. The H and M zones were the regions with the highest rates of optimal surgical outcomes.

Basal Cell Adenocarcinoma - 2 Case Series of a Rare Entity

Introduction: Basal cell adenocarcinoma is a rare well recognized low grade malignant salivary gland tumor often resembles basal cell adenoma. the infiltrating growth pattern and likelihood of vascular and perineural involvement distinguishes basal cell adenocarcinoma with basal cell adenoma. Case presentation: Here we present histopathological and immune histochemical analysis of two such rare cases of basal cell adenocarcinoma and review of literature is discussed. Conclusion: Basal cell adeno carcinoma is a low grade malignancy and doesn’t metastasize. With only few hundreds of cases that has been reported in literature, basal cell adeno carcinoma should be included as differential diagnosis in salivary gland tumors in order not to miss the diagnosis

Tratamiento con HeberFERON( en el carcinoma basal palpebral

El carcinoma basal palpebral representa un 90 % de los tumores malignos oculares con una alta morbilidad. Su incidencia tiene un comportamiento diferente en las distintas partes del mundo y, por lo general, aumenta con la edad. El diagnóstico positivo se realiza por la evaluación histológica de la muestra mediante biopsia escisional. El tratamiento ideal es el quirúrgico, aunque existen otras opciones de tratamiento. El no quirúrgico tiene como objetivo la eliminación del tumor, así como evitar las complicaciones o las secuelas funcionales y estéticas por la cirugía. Se reconocen numerosas opciones dentro de la modalidad terapéutica no quirúrgica; imiquimod, 5-fluorouracilo, inhibidores de la vía de Hedgehog y los interferones. Diversos estudios han demostrado la utilidad de los interferones en monoterapia o como terapia combinada, en pacientes no susceptibles de actuaciones quirúrgicas. Por esta razón, se decidió revisar la literatura científica actual sobre la eficacia y seguridad del HeberFERON® en el tratamiento del carcinoma basal palpebral. Se realizó una búsqueda actualizada teniendo en cuenta los descriptores correspondientes a las palabras clave relacionadas con la temática a investigar, en las bases de datos bibliográficas Medline (buscador PubMed), SciELO, Ebsco, Clinical Key y en Google Académico. Se recuperaron 35 artículos que su contenido respondía al tema de estudio.

Palpebral basal carcinoma represents 90% of ocular malignant tumors with high morbidity. Its incidence has a different behavior in different parts of the world and generally increases with age. Positive diagnosis is made by histological evaluation of the specimen by excisional biopsy. The ideal treatment is surgical, although other treatment options are available. Non-surgical treatment is aimed at eliminating the tumor, as well as avoiding the complications or functional and esthetic sequelae of surgery. Numerous options are recognized within the non-surgical therapeutic modality; imiquimod, 5-fluorouracil, Hedgehog pathway inhibitors and interferons. Several studies have demonstrated the usefulness of interferons in monotherapy or as combination therapy in patients not amenable to surgery. For this reason, it was decided to review the current scientific literature on the efficacy and safety of HeberFERON® in the treatment of palpebral basal cell carcinoma. An updated search was carried out taking into account the descriptors corresponding to the key words related to the subject under investigation, in the bibliographic databases Medline (PubMed search engine), SciELO, Ebsco, Clinical Key and Google Scholar. Thirty-five articles were retrieved whose content corresponded to the subject of the study.

Reconstruction of the nasal columella using bilateral nasolabial flaps: case report / Reconstrução da columela nasal com utilização de retalhos nasolabiais bilaterais: relato de caso

Introduction: The columella is an important subunit of the nose, essential for nasal architecture and facial aesthetics. The total reconstruction of the nasal columella becomes a great challenge after repairing trauma, carcinomas, and necrosis in this region. There are descriptions in the literature of numerous reconstruction techniques using different flaps, such as a frontal region flap, an infraclavicular region flap, and a unilateral and bilateral nasolabial flap. Case Report: A total reconstruction of the nasal columella after resection of basal cell carcinoma (BCC) using a bilateral nasolabial flap is reported. Conclusion: The technique proved effective for correcting the complex defect after BCC resection, with technical ease for resolution and good aesthetic and functional results.

Introdução: A columela é uma importante subunidade do nariz, sendo essencial para a arquitetura nasal e estética facial. A reconstrução total da columela nasal torna-se, portanto, um grande desafio após reparação de traumas, carcinomas e necroses nesta região. Há na literatura a descrição de inúmeras técnicas de reconstrução com uso de diferentes retalhos, como retalho da região frontal, retalho da região infraclavicular, retalho nasolabial unilateral e bilateral. Relato de Caso: Reporta-se uma reconstrução total da columela nasal pós-ressecção de carcinoma basocelular (CBC) utilizando retalho nasolabial bilateral. Conclusão: A técnica utilizada mostrou-se eficaz para correção do defeito complexo pós-ressecção de CBC, apresentando facilidade técnica para resolução e bom resultado estético-funcional.

Dermoscopic features of basal cell carcinoma in skin of color: A retrospective cross-sectional study from Puducherry, South India

Background: Dermoscopy is useful in the diagnosis of basal cell carcinoma (BCC). However, most descriptions of the dermoscopic features of BCCs are in Caucasians (skin types I-III) and there is a paucity of data in dark-skinned Indian patients. Aims: The aim of this study was to describe the various dermoscopic features of BCC in dark-skinned patients from South India and correlate these with the histopathologic subtypes. Methods: A retrospective observational study of biopsy-proven cases of BCC was conducted at a tertiary care center in South India using nonpolarized contact dermoscopy. Results: Sixty BCCs in 35 patients predominantly of skin phototypes IV or V were studied. These included 32 nodular, 27 superficial and 1 infiltrative type of BCC. The most common dermoscopic features noted were maple leaf-like areas (61.7%), blue-white veils (53.4%), ulceration (48.4%) and short fine telangiectases (46.7%). Ulceration, blue-white veils and arborizing vessels were significantly associated with nodular BCCs, while maple leaf-like areas, red-white structureless areas, multiple small erosions and spoke wheel areas were noted with superficial BCCs. Limitations: The limitations of this study include its retrospective nature, the use of only nonpolarized light for examination, the lack of other histopathological variants of BCC as well as the lack of a comparison group. Conclusion: We report a dermoscopic study of BCC in dark-skinned patients from Puducherry, South India. The blue-white veil was observed in half of the patients and was significantly associated with nodular BCCs. The addition of the blue-white veil to the diagnostic criteria for pigmented BCC could improve the diagnostic accuracy of dermoscopy in Indian patients.

Non-melanoma skin cancer: an analysis of compromised margins in excisions / Câncer de pele não melanoma: uma análise do comprometimento de margens em excisões

Introduction: Non-melanoma skin cancer is the most frequent neoplasm in Brazil, with an estimated 176,930 new cases during the 2020-2022 period, with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) as the most common subtypes. Surgical treatment of the lesions is effective, with a recurrence rate varying between 3 and 23%, with compromised margins being an important prognostic factor for this recurrence, increasing the importance of complete excision of the tumor. Method: To prepare this work, 1127 lesions treated at the Hospital de Amor Amazônia were analyzed, seeking to quantify cases and analyze surgically compromised margins through a retrospective analytical descriptive study. For this, histopathological reports of the operated patients were reviewed, dividing them according to sex, age, lesion topography, date of excision, lesion diameter, lesion depth, presence of ulceration, compromised margins, and histological type. Results: Among the lesions treated, 65% were BCC and 35% SCC, both histological types presenting a low incidence of compromised margins. In cases of CPB impairment, treatment via exeresis was chosen in 100% of cases. Concerning BCC impairment, the majority opted for clinical follow-up, with reapproach in only 9% of cases. Conclusion: This study demonstrates that the cases treated at the Hospital de Amor Amazônia align with the epidemiological data in the main literature, except for finding a higher incidence of non-melanoma skin cancer in men. In addition, this work demonstrates good results in the clinical approach of compromised margins in BCC lesions.

Introdução: O câncer de pele não melanoma é a neoplasia mais frequente no Brasil, com uma estimativa de 176.930 novos casos durante o triênio 2020-2022, tendo o carcinoma basocelular (CBC) e o carcinoma espinocelular (CEC) como subtipos mais presentes. O tratamento cirúrgico das lesões é efetivo, apresentando taxa de recorrência variando entre 3 e 23%, sendo o comprometimento de margens importante fator prognóstico para essa recorrência, aumentando a importância da excisão completa do tumor. Método: Para a elaboração deste trabalho, foram analisadas 1127 lesões abordadas no Hospital de Amor Amazônia, buscando quantificar casos e analisar margens cirurgicamente comprometidas por meio de um estudo descritivo analítico retrospectivo. Para isso, foram revisados laudos histopatológicos dos pacientes operados, dividindo-os de acordo com sexo, idade, topografia da lesão, data de excisão, diâmetro da lesão, profundidade da lesão, presença de ulceração, comprometimento de margens e tipo histológico. Resultados: Dentre as lesões abordadas, 65% eram CBC e 35% CEC, ambos os tipos histológicos apresentando baixa incidência de margens comprometidas. Nos casos de comprometimento em CEC, optou-se pelo tratamento via exérese em 100% dos casos. Já em relação ao comprometimento em CBC, optou-se majoritariamente pelo acompanhamento clínico, com reabordagem em apenas 9% dos casos. Conclusão: Este estudo demonstra que os casos abordados no Hospital de Amor Amazônia vão ao encontro dos dados epidemiológicos presentes nas principais literaturas, com ressalva, apenas, ao encontrar uma maior incidência de câncer de pele não melanoma em homens. Além disso, esse trabalho demonstra bons resultados na abordagem clínica de margens comprometidas em lesões de CBC.

Double transposition flap for lower eyelid reconstruction: case report of a new surgical approach / Retalho de dupla transposição para reconstrução de pálpebra inferior: relato de caso de uma nova abordagem cirúrgica

Introduction: Non-melanoma tumors frequently affect the lower palpebral region and constitute a challenge for reconstructing the surgical wound without causing functional or aesthetic changes. Primary closure is generally impossible, and flaps are preferred over grafts as they generate less eyelid retraction. This article aims to describe a new surgical reconstruction technique. Method: A modified McGregor flap technique is described for correcting a surgical defect greater than 50% of the anterior lamella of a recurrent basal cell carcinoma lesion in the lower eyelid. Results: The patient was evaluated on the 7th, 14th, 21st, and 45th postoperative days. She presented a good functional and aesthetic response to the technique used. Conclusion: Using the double transposition flap, we demonstrate a new technique for closing defects larger than two-thirds in the lower eyelid.

Introdução: Os tumores não melanomas acometem frequentemente a região palpebral inferior e consistem em um desafio para a reconstrução da ferida operatória sem ocasionar alteração funcional ou estética. O fechamento primário geralmente não é possível e os retalhos são preferenciais aos enxertos por gerarem menor retração palpebral. Este artigo tem como objetivo descrever uma nova técnica de reconstrução cirúrgica. Método: Descreve-se técnica modificada do retalho de McGregor para correção de defeito cirúrgico maior que 50% da lamela anterior, de lesão recidivada de carcinoma basocelular localizada em pálpebra inferior. Resultados: Paciente foi avaliada no 7º, 14º, 21º e 45º dia de pós-operatório. Apresentou boa resposta funcional e estética com a técnica utilizada. Conclusão: Demonstramos uma nova técnica de fechamento de defeitos maiores do que dois terços na pálpebra inferior através do retalho de dupla transposição.

Interpretation of Expert Consensus on Diagnosis and Treatment of Cutaneous Basal Cell Carcinoma (2021) by A Multidisciplinary Team / 肿瘤防治研究

Basal cell carcinoma (BCC) is the most common malignant tumor in dermatology with incidence rising rapidly. Expert consensus on diagnosis and treatment of cutaneous basal cell carcinoma (2021) was published in September 2021 by Skin Tumor Research Center, Chinese Society of Dermatology and Subcommittee on Skin Tumor, China Dermatologist Association. This consensus comprehensively describes the epidemiology, pathogenesis, clinical manifestations, auxiliary examination, pathology, pretreatment assessment, treatment, prognosis, and follow-up education. It offers an important guideline for promoting the standardized diagnosis and treatment of skin BCC in China. In this work, multidisciplinary experts interpreted the main contents of the consensus, including clinicopathological findings, pretreatment assessment, and treatment advance.

Mutations of PTCH1 gene in two pedigrees with bifid rib-basal cell nevus-jaw cyst syndrome / 浙江大学学报·医学版

Two male patients with bifid rib-basal cell nevus-jaw cyst syndrome (BCNS) were admitted to Department of Stomatology, the First Affiliated Hospital of Bengbu Medical College due to radiological findings of multiple low density shadows in the jaw. Clinical and imaging findings showed thoracic malformation, calcification of the tentorium cerebellum and falx cerebrum as well as widening of the orbital distance. Whole exon high-throughput sequencing was performed in two patients and their family members. The heterozygous mutations of c.C2541C>A(p.Y847X) and c.C1501C>T(p.Q501X) in PTCH1 gene were detected in both patients. Diagnosis of BCNS was confirmed. The heterozygous mutations of PTCH1 gene locus were also found in the mothers of the two probands. Proband 1 showed clinical manifestations of low intelligence, and heterozygous mutations of c.C2141T(p.P714L) and c.G3343A(p.V1115I) were detected in FANCD2 gene. Proband 2 had normal intelligence and no FANCD2 mutation. The fenestration decompression and curettage of jaw cyst were performed in both patients. Regular follow-up showed good bone growth at the original lesion, and no recurrence has been observed so far.

Cirugía micrográfica de Mohs en carcinomas cutáneos: siete años de experiencia en Uruguay / Mohs micrographic surgery in skin cancer: 7 years' experience in uruguay / Cirurgia micrográfica de Mohs em carcinomas cutáneos: 7 anos de experiência no Uruguai

Introducción: la cirugía micrográfica de Mohs es una técnica para la exéresis de cánceres de piel con la ventaja del examen histológico del 100% de los márgenes quirúrgicos, logrando así la tasa de curación más alta con la máxima preservación de tejido sano circundante. Objetivo: realizar una descripción clínico-epidemiológica de 7 años de experiencia en Uruguay. Método: análisis descriptivo de pacientes operados por un mismo cirujano de Mohs registrando datos clínicos, tumorales y quirúrgicos. Resultados: se estudiaron 641 cirugías. 54,9% fueron realizadas en hombres y 45,1% en mujeres. La edad media fue de 69 años. El 68,2% correspondió a carcinoma basocelular y 31,8% a carcinoma espinocelular. El 79,4% se encontraba en cabeza y cuello. El 87,8% de los tumores fueron primarios y un 11,1% recidivas. El tipo más frecuente de cierre fue el cierre simple con 48,7% seguido de los colgajos con un 31,7%. Conclusiones: la cirugía de Mohs es un procedimiento seguro y eficaz, y nuestros resultados coinciden con lo descrito en centros de referencia internacional. Este trabajo describe 7 años de experiencia en Uruguay de la técnica de CMM, siendo el mayor a nivel nacional.

Introduction: Mohs micrographic surgery is a technique for skin cancer exeresis involving the advantage of 100% of surgical margins histological exam, which leads to highest healing rates with the maximum preservation of the surrounding healthy tissue. Objective: to conduct a clinical and epidemiological description of a 7 years' experience in Uruguay. Method: descriptive analysis of patients operated by the same Mohs surgeon who recorded clinical, tumor and surgical data. Results: 641 surgeries were included in the study. 54.9% of surgeries were performed in men and 45.1% in women. Average age was 69 years old. 68.2% of cases corresponded to basal cell carcinoma and 31.8% to squamous cell carcinoma. 79.4% were located in the head and neck, 87.8% of tumors were primary and 11.1% were cases of relapse. The most frequent type of closure was simple in 48.7% of cases, followed by flaps in 31.7%. Conclusions: Mohs surgery is a safe an effective procedure, and the results of the study agree with what is described in international reference centers. The study describes a 7 years' experience in Uruguay of Mohs micrographic surgery, being it the largest research conducted in Uruguay.

Introdução: a cirurgia micrográfica de Mohs é uma técnica de excisão de cânceres de pele com a vantagem do exame histológico de 100% das margens cirúrgicas, alcançando assim a maior taxa de cura com a máxima preservação do tecido saudável circundante. Objetivo: realizar uma descrição clínico-epidemiológica de 7 anos de experiência no Uruguai. Método: análise descritiva de pacientes operados pelo mesmo cirurgião com experiência na técnica de Mohs registrando dados clínicos, tumorais e cirúrgicos. Resultados: foram estudadas 641 cirurgias. 54,9% foram realizados em homens e 45,1% em mulheres. A média de idade foi de 69 anos. 68,2% corresponderam a carcinoma basocelular e 31,8% a carcinoma espinocelular. 79,4% estavam na cabeça e pescoço. 87,8% dos tumores eram primários e 11,1% recidivas. O tipo de fechamento mais frequente foi o fechamento simples (48,7%) seguido do fechamento com retalhos com (31,7%). Conclusões: a cirurgia de Mohs é um procedimento seguro e eficaz, e nossos resultados coincidem com os descritos em centros de referência internacionais. Este trabalho descreve 7 anos de experiência no Uruguai da técnica CMM, sendo a maior a nível nacional.

Prurito ótico por carcinoma basocelular en conducto auditivo externo / Otic pruritus due to basal cell carcinoma of the external auditory canal

El carcinoma basocelular es el tumor cutáneo más frecuente en el área de cabeza y cuello; la exposición crónica al sol es el factor de riesgo más importante para este tumor. Suele manifestarse clínicamente con síntomas anodinos en estadios iniciales, lo que contribuye a que su diagnóstico sea difícil y tardío. Tiene un comportamiento localmente invasivo, especialmente a nivel del pabellón auricular. Este es el único caso descrito en el conducto auditivo externo no relacionado con la exposición al sol, con características clínicas y terapéuticas que lo hacen peculiar.

Basal cell carcinoma is the most frequent skin tumor in the head and neck area, and chronic sun exposure is the most important risk factor. It usually manifests clinically with anodyne symptoms in the early stages, which contributes to its difficult late diagnosis. It is locally invasive, especially at the level of the pinna. It is the only case described in the external auditory canal not related to sun exposure; it presents clinical and therapeutic characteristics that make it peculiar.

Efectividad del Heberferon en el tratamiento del carcinoma basocelular

El Carcinoma basocelular es el cáncer de piel más frecuente en el ser humano, representa aproximadamente entre un 70 y un 80 % de los cánceres cutáneos no melanoma en la población de color de piel blanca, este es un tumor maligno de estirpe epitelial y es el más frecuente en la consulta dermatológica, soliendo afectar a individuos mayores de 50 años con máxima incidencia entre la sexta y octava década de la vida. Se realizó un estudio postcomercialización, observacional, de serie de casos, de vigilancia temprana del medicamento en condiciones de práctica médica habitual. La investigación se ejecutó con los pacientes con diagnóstico de carcinoma basocelular, atendidos en la consulta en la consulta de oncodermatología, que tiene su sede Hospital ‟Carlos Manuel de Céspedes" de Bayamo, durante el período comprendido entre enero 2018 a diciembre 2019.El universo estuvo constituido por 120 pacientes y la muestra por 92 pacientes mayores de 18 años, a los que se les administró HeberFERON, resultando ser efectivo en el tratamiento de carcinoma basocelular de cualquier localización, tipo y tamaño. Se confirmó la efectividad en condiciones de práctica médica habitual, en las variables: respuesta clínica al tratamiento, utilizando para ello, los criterios RECIST, además mostró un perfil de seguridad adecuado. Los eventos adversos reportados fueron en su mayoría grado 1 y grado 2, según la clasificación del CTCAE, versión 5 y por su gravedad, se clasificaron no grave.

Basal cell carcinoma is the most frequent skin cancer in humans, representing approximately between 70 and 80% of non-melanoma skin cancers in the white-skinned population, this is a malignant tumor of epithelial lineage and is the most frequent in dermatological consultation, usually affecting individuals over 50 years of age with maximum incidence between the sixth and eighth decade of life. A post-marketing study was conducted, observational, case series, of early surveillance of the drug under conditions of routine medical practice. The research was carried out with patients diagnosed with basal cell carcinoma, attended in the consultation in the oncodermatology consultation, which has its headquarters Hospital ‟Carlos Manuel de Céspedes" of Bayamo, during the period from January 2018 to December 2019. The universe consisted of 120 patients and the sample was 92 patients over 18 years of age, who were administered HeberFERON, proving to be effective in the treatment of basal cell carcinoma of any location, type and size. The effectiveness in conditions of usual medical practice was confirmed, in the variables: clinical response to treatment, using the RECIST criteria, in addition to showing an adequate safety profile. The adverse events reported were mostly grade 1 and grade 2, according to the classification of the CTCAE, version 5 and due to their severity, they were classified as non-serious.

O carcinoma basocelular é o câncer de pele mais frequente em humanos, representando aproximadamente entre 70 e 80% dos cânceres de pele não melanoma na população de pele branca, sendo este um tumor maligno de linhagem epitelial e o mais frequente na consulta dermatológica, acometendo geralmente indivíduos com mais de 50 anos de idade com incidência máxima entre a sexta e a oitava década de vida. Foi realizado um estudo pós-comercialização, observacional, série de casos, de vigilância precoce da droga sobcondições de prática médica de rotina.A pesquisa foi realizada com pacientes diagnosticados com carcinoma basocelular, atendidos na consulta na consulta de oncodermatologia, que temsua sede no Hospital Carlos Manuel de Céspedes, de Bayamo, no período de janeiro de 2018 a dezembro de 2019. O universo foi composto por 120 pacientes e a amostra foi de 92 pacientes com mais de 18 anos de idade, aos quais foi administrado HeberFERON, mostrando-se eficaz no tratamento do carcinoma basocelular de qualquer localização, tipo e tamanho. A efetividade nas condições de prática médica habitual foi confirmada, nas variáveis: resposta clínica ao tratamento, utilizando-se os critérios RECIST, além de apresentarum perfil de segurança adequado. Os eventos adversos relatados foram, em sua maioria, grau 1 e grau 2, de acordo com a classificação do CTCAE, versão 5 e, devido à sua gravidade, foram classificados como não graves.

Efectividad del Heberferon en pacientes con queratosis actínica asociada a carcinoma basocelular

Las queratosis actínicas son neoformaciones dermatológicas planas oexofísticas, presentes mayormente en zonas fotoexpuestas, de evolución crónica y generalmente asintomáticas, siendo la expresión más temprana del carcinoma espinocelular, producidas por la exposición solar crónica en personas fundamentalmente de piel clara. Se realizó un estudio longitudinal prospectivo de intervención terapéutica. El universo estuvo constituido por 130 pacientes y la muestra por 116 pacientes diagnosticados con queratosis actínica que concomitaron con carcinoma basocelular que asistieron a la consulta de oncodermatología del Hospital Provincial Docente "Carlos Manuel de Céspedes" de Bayamo, en el período comprendido de enero 2019 a diciembre 2020; con el objetivo de evaluar la efectividad del tratamiento con HeberFERON® en la queratosis actínica asociada a carcinoma basocelular. Para valorar la asociación entre las variables se empleó el test de Chi Cuadrado de Mantel. Fue frecuente en el estudio el sexo masculino, las edades comprendidas entre 61 y 80 años, el fototipo cutáneo II de la clasificación de Fitzpatrick, que presentaron más de 20 lesiones de queratosis actínica, de localización frecuente en los antebrazos. El HeberFERON fue efectivo y se logró respuesta favorable al tratamiento desde el punto de vista clínico y por dermatoscopia. Los efectos adversos frecuentes tras la administración del HeberFERON® fueron la fiebre, seguido de malestar general y el dolor en el sitio de la inyección.

Actinic keratoses are flat dermatological neoformations or oexofistic, present mostly in photoexposed areas, of chronic evolution and generally asymptomatic, being the earliest expression of squamous cell carcinoma, produced by chronic sun exposure in people mainly fair-skinned. A prospective longitudinal study of therapeutic intervention was conducted. The universe consisted of 130 patients and the sample consisted of 116 patients diagnosed with actinic con queratosis who concomitated with basal cell carcinoma who attended the oncodermatology consultation of the "Carlos Manuel de Céspedes" Provincial Teaching Hospital of Bayamo, in the period from January 2019 to December 2020; with the objective of evaluating the effectiveness of treatment with HeberFERON® in actinic keratosis associated with basal cell carcinoma. To assess the association between the variables, the Mantel Chi-Square test was used. The male sex, ages between 61 and 80 years, cutaneous phototype II of the Fitzpatrick classification, which presented more than 20 lesions of actinic keratosis, of frequent location in the forearms, were frequent in the study. HeberFERON was effective and a favorable response to treatment was achieved from the clinical point of view and by dermoscopy. Common side effects following administration of HeberFERON® were fever, followed by malaise and pain at the injection site.

As ceratoses actínicas são neoformações dermatológicas planas ou oexofísticas, presentes principalmente em áreas fotoexpostas, de evolução crônica e geralmente assintomáticas, sendo a expressão mais precoce do carcinoma espinocelular, produzido pela exposição solar crônica em pessoas principalmente de pele clara. Foi realizado um estudo longitudinal prospectivo de intervenção terapêutica. O universo foi composto por 130 pacientes e a amostra por 116 pacientes diagnosticados com conqueratose actínica que se concomitaram com carcinoma basocelular e que compareceram à consulta de oncodermatologia do Hospital Universitário Provincial "Carlos Manuel de Céspedes" de Bayamo, no período de janeiro de 2019 a dezembro de 2020; com o objetivo de avaliar a eficácia do tratamento com HeberFERON® na queratose actínica associada ao carcinoma basocelular. Para avaliar a associação entre as variáveis, foi utilizado o teste Qui-Quadrado de Mantel. O sexo masculino, com idades entre 61 e 80 anos, o fototipo cutâneo II da classificação de Fitzpatrick, que apresentou mais de 20 lesões de queratose actínica, de localização frequente nos antebraços, foram frequentes no estudo. O HeberFERON foi eficaz e uma resposta favorável ao tratamento foi alcançada do ponto de vista clínico e por dermatoscopia. Os efeitos secundários frequentes após a administração de HeberFERON® foram febre, seguida de mal-estar e dor no local da injeção.