Fig.2
Tumor islands, variable in shape and in size
Fig.3
Basal cell carcinoma: basaloid neoplastic cells with a palisade arrangement and abundant melanin pigment
References
1. Hyde JN, Montgomery FH. Diseases of the skin. Lea Brothers, Philadelphia, 1897: 669.
2. Krompecher E. Der Basalzellkrebs. Fischer, Jena, 1903.
3. Lever WF, Schaumburg-Lever G. Histopathology of the skin, Lippincott, Philadelphia, 1983: 562-575.
4. Maize JC, Burgdorf WHC, Hurt MA, et al. Cutaneous Pathology. Churchill Livingstone, Philadelphia, 1998, pp.451-461.
5. Dormarus HV, Steven PJ. Metastatic basal cell carcinoma: report of five cases and review of 170 cases of the literature. J Am Acad Dermatol 10: 1043, 1984.
Fig.1
Basal cell carcinoma: masses of blue cells in the dermis
BASAL CELL CARCINOMA
(Synonym: basal cell epithelioma)
Basal cell carcinoma is a skin tumor, already known at the end of XIX century, under the name of "superficial epithelioma" and of "ulcus rodens" (rodent ulcer) [1]. In 1903, the distintive term "basal cell", which refers to the histological resemblance of the cells to the cells of the basal layer of the epideris, was conied by Krompecher [2]. Basal cell carcinoma occurs, almost always (except for nevoid basal cell epithelioma syndrome) on hair-bearing skin and virtually never on mucosae; it is now considered as a tumor of the hair follicle. The tumor is generally single, but multiple lesions, simultaneous or subsequent, are quite frequent [3].
It occurs in adult subjects, even if occasionally can occur in adolescents and children. Predisposing factors include prolonged exposure to strong sun light, roentgen rays and, less commonly, burn scars [3].
Grossly, the tumor appears as a papule or a nodule, sometimes pigmented or with teleagiectases on its surface. The neoplasm is often ulcerated and characterized by a infiltrative and destroying growth. Sometimes, it appears as an ulcer with rolled borders. Less frequently, it is an indurated plaque, flat or slightly depressed with ill defined borders (morphealike variant) or a pedunculated nodule, covered by reddened skin (fibroepithelioma); sometimes the lesion appears as an erythematous, scaling pacth (superficial variant)[3]. Microscopically, all variants of basal cell carcinoma are composed of basaloid cells with a large, oval or elongated nucleus and scant cytoplasm. Such cells resemble to the cells of the epidermal basal layer, but lack of intercellular bridges. Using routine stains, the neoplastic tissue stains deeply with hematoxylin and only slightly with eosin, assuming a characteristic blue color. The nodular variant is characterized by solid and cystic cellular masses, which can ulcerate the epidermis, infiltrating the dermis and sometimes the subcutaneous fat. The superficial variant shows basaloid cellular buds attached to the underface of the epidermis, the adenoid variant shows glandular-like structures; the keratotic variant is characterized by keratinic material formation anf horny cysts, which however lack of the granular layer below parakeratotic cells. The morphea-like variant shows numerous cords and solid islands embedded in a fibrous stroma [4].
Basal cell carcinoma is a tumor which basically shows local aggressiveness, infiltrating and destrying the surrounding tissues, but generally with no propensity to distant metastases. Therefore, a radical excision with a histologic examination of the surgical margins may lead to a complete recovery. In fact, if located in easily accessible anatomical sites, the tumor is usually excised with adequate margins and the risk of recurrence is low; in particular sites, such as face, lip, auditory meatus, eyelids, nasal region, a complete excision may appear more problematic and if residual tumor cells are left, recurrences are possible. In sites such these, an intraoperative histological examination of the margins can reduce the risk of recurrences.
In the literature lymph node and distant metastases from basal cell carcinoma are reported, but such an event is extremely rare. In all the medical literature of all time, there are less than 200 reported cases [5], in which, however, initial diagnoses should be reviewed. In our experience (20 years), no case of metastatic basal cell carcinoma has been found. in conclusion, metastases in basal cell carcinoma may exist, but it can be said that metastatic basal cell carcinoma is extremely rare or exceptional.
page 14
The other pages
- Home Page: Dermatopathology - C. Urso, MD
- page 1: Melanoma of the skin
- page 2: Histologic diagnosis of cutaneous melanoma
- page 3: Melanoma arising in a melanocytic nevus
- page 4: Infiltration and pseudoinfiltration
- page 5: Sweat gland carcinomas
- page 6: The sentinel lymph node in cutaneous melanoma
- page 7: Bullous cutaneous diseases
- page 8: Spitz nevus
- page 9: Prognostic factors in cutaneous melanoma
- page 10: The dysplastic nevus
- page 11: Dermatofibrosarcoma protuberans
- page 12: Melanoma in situ
- last page: Questions, comments and opinions
page 13: Merkel cell carcinoma
page 14: Basal cell carcinoma
page 15: Melanoma in paediatric age