RESUMO
Introdução: O carcinoma basocelular (CBC) de vulva é uma condição rara que corresponde a menos de 0,4% dos casos de CBC e de 2% a 4% das neoplasias de vulva. O CBC de vulva é mais comum entre mulheres brancas, multíparas e na pósmenopausa, especialmente na sétima década de vida. O objetivo é relatar um caso de CBC de vulva no qual discutiram-se os aspectos do diagnóstico e tratamento. Relato de Caso: Mulher de 63 anos de idade, G1P1A0, chega ao consultório em janeiro de 2022 para tratamento de lesão persistente em vulva. Realizou-se biópsia incisional que mostrou tratar-se de provável carcinoma basocelular nodular com invasão da derme. A paciente submeteu-se a uma ressecção do tumor com margens macroscópicas livres e sutura primária. A cirurgia não teve complicações no pré-operatório e no pós-operatório. O histopatológico da peça cirúrgica mostrou tratar-se de carcinoma basocelular nodular com área irregular, plana, branco, medindo 0,7x0,4cm, com as margens laterais distando 7,0 e 5,0mm e profundas, 5,9mm; todas livres. Conclusão: O caso relatado é raro, tendo sido o tratamento de ressecção cirúrgica do CBC de vulva com margens bem-sucedido. Catorze meses após a cirurgia, a paciente encontra-se sem evidências de recidiva local ou regional.
Introduction: Basal cell carcinoma (BCC) of the vulva is a rare condition that accounts for less than 0.4% of BCC cases and 2% to 4% of vulvar neoplasms. BCC of the vulva is more common among white, multiparous and postmenopausal women, especially in the seventh decade of life. The aim is to report a case of BCC of the vulva in which aspects of diagnosis and treatment were discussed. Case report: A 63-year-old woman, G1P1A0, arrives at the office in January 2022 for treatment of a persistent lesion on her vulva. An incisional biopsy was performed and showed that it was likely nodular basal cell carcinoma with invasion of the dermis. The patient underwent tumor resection with free macroscopic margins and primary suture. The surgery had no complications preoperatively or postoperatively. The histopathology of the surgical specimen showed that it was a nodular basal cell carcinoma with an irregular, flat, white area, measuring 0.7x0.4cm, with the lateral margins 7.0 and 5.0mm apart and 5.9mm deep; all free. Conclusion: The reported case is rare, with surgical resection of BCC of the vulva with margins being successful. Fourteen months after surgery, the patient has no evidence of local or regional recurrence.
RESUMO
O tumor filoide é uma neoplasia fibroepitelial rara que representa 0,3 a 1% de todas as neoplasias mamárias. De acordo com a classificação histopatológica, 12 a 26% são do tipo borderline e aproximadamente 15% desses tumores recorrem após excisão cirúrgica. O tratamento recomendado para todos os tipos de tumor filoide é a excisão cirúrgica, e no caso de tumores gigantes o tratamento deve ser multidisciplinar. Apresentamos o caso de uma mulher de 46 anos com tumor filoide na mama esquerda que recorreu 4 anos após a excisão cirúrgica. O estudo anatomopatológico qualificou-o como tumor gigante e o estudo histopatológico relatou tumor filoide borderline. Foi submetida a excisão cirúrgica com mastectomia esquerda e reconstrução mamária com retalho de grande dorsal mais enxerto de gordura. A paciente apresentou evolução favorável sem recidiva. Concluindo, o tumor filoide gigante borderline recorrente é raro e seu manejo cirúrgico representa um desafio tanto na excisão quanto na reconstrução mamária.
Phyllodes tumor is a rare fibroepithelial neoplasm that represents 0.3 to 1% of all breast neoplasms. According to histopathologic classification, 12 to 26% are borderline type and approximately 15% of these tumors recur after surgical excision. The recommended treatment for all types of phyllodes tumor is surgical excision, and in the case of giant tumors the treatment should be multidisciplinary. We present the case of a 46-yearold woman with a phyllodes tumor in the left breast that recurred 4 years after surgical excision. The anatomopathological study qualified it as a giant tumor and the histopathological study reported a borderline phyllodes tumor. She underwent surgical excision with left mastectomy and breast reconstruction by means of a latissimus dorsi flap plus fat graft. The patient presented a favorable evolution without recurrence. In conclusion, the recurrent giant borderline phyllodes tumor is rare and its surgical management represents a challenge both in breast excision and reconstruction.
RESUMO
Introdução: Em 1977, a partir dos estudos anatômicos de McCraw et al., passou-se a utilizar o músculo peitoral maior como retalho miocutâneo em ilha. O presente artigo descreve um caso de reconstrução de um defeito da parede anterior do hemitórax direito através do retalho miocutâneo peitoral maior em ilha ipsilateral. Relato do Caso: A.E.S., de 66 anos, sexo masculino foi submetido a ressecção ampla de um carcinoma basocelular infiltrativo recidivante de 13,0 x 8,0cm da região paraesternal direita. O retalho miocutâneo foi transposto através de tunelização subcutânea e as cicatrizes posicionadas em forma de mamaplastia em T invertido. Conclusão: A presente tática cirúrgica é de fácil execução para cirurgiões habituados com reconstrução mamária, apresenta tempo cirúrgico curto e resultado estético-funcional satisfatório.
Introduction: In 1977, based on anatomical studies by McCraw et al., the pectoralis major muscle began to be used as an island myocutaneous flap. The present article describes a case of reconstruction of a defect in the anterior wall of the right hemithorax using the pectoralis major myocutaneous flap in an ipsilateral island. Case Report: AES, 66 years old, male, underwent wide resection of a recurrent infiltrative basal cell carcinoma measuring 13.0 x 8.0 cm in the right parasternal region. The myocutaneous flap was transposed through subcutaneous tunneling and the scars were positioned in the shape of an inverted T mammoplasty. Conclusion: This surgical tactic is easy to perform for surgeons accustomed to breast reconstruction, has a short surgical time, and has satisfactory aesthetic-functional results.
RESUMO
BACKGROUND: Surgery is the treatment of choice for patients with basal cell carcinoma (BCC). When surgery is not a choice, only radiotherapy is recommended for patients with high-risk facial BCC. Interferon could be an acceptable therapeutic option for these patients. OBJECTIVE: To evaluate the long-term clinical response to interferon therapy in patients with high-risk facial BCC. METHODS: Patients with high-risk facial BCC were treated with perilesional injections of alpha-2b+ gamma interferons. Those with incomplete clinical response were reevaluated, their residual tumors excised, and declared cured. Patients treated with interferon and those treated with interferon plus surgery were followed for five years. Time to recurrence and the emergence of a new facial BCC were estimated by Kaplan-Meier survival analysis. Adverse events were documented. RESULTS: This study included 195 participants; 143 (73.3%) showed a complete response (95% CI 67.2â80.1). Patients developed recurrence after a mean of 55 months (95% CI 53.8â57.4). The estimated rate of recurrence was 12.3% (95% CI 7.4â17.1). Patients developed a new BCC after a mean of 52.7 months (95% CI 50.4â54.9). The estimated rate for development of a new BCC was 20.0% (95% CI 14.4â25.9). Fifteen (7.7%) patients abandoned the study during follow-up. Adverse events were frequent but moderate or mild; fever and local pain were the most frequent. STUDY LIMITATIONS: Observational cohort design without a control group for comparison. CONCLUSIONS: Perilesional injections of alpha-2b+ gamma interferons in patients with facial high-risk BCC offer a satisfactory cure rate after five years of follow-up with an acceptable safety profile.
Assuntos
Carcinoma Basocelular , Neoplasias Faciais , Interferon alfa-2 , Interferon-alfa , Recidiva Local de Neoplasia , Neoplasias Cutâneas , Humanos , Carcinoma Basocelular/tratamento farmacológico , Carcinoma Basocelular/patologia , Masculino , Feminino , Pessoa de Meia-Idade , Seguimentos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Idoso , Resultado do Tratamento , Neoplasias Faciais/tratamento farmacológico , Interferon alfa-2/uso terapêutico , Interferon alfa-2/administração & dosagem , Interferon-alfa/uso terapêutico , Interferon-alfa/efeitos adversos , Interferon-alfa/administração & dosagem , Fatores de Tempo , Adulto , Antineoplásicos/uso terapêutico , Antineoplásicos/efeitos adversos , Estimativa de Kaplan-Meier , Idoso de 80 Anos ou mais , Interferon gama/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Proteínas Recombinantes/administração & dosagemRESUMO
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.
RESUMO
Abstract Background Surgery is the treatment of choice for patients with basal cell carcinoma (BCC). When surgery is not a choice, only radiotherapy is recommended for patients with high-risk facial BCC. Interferon could be an acceptable therapeutic option for these patients. Objective To evaluate the long-term clinical response to interferon therapy in patients with high-risk facial BCC. Methods Patients with high-risk facial BCC were treated with perilesional injections of alpha-2b+ gamma interferons. Those with incomplete clinical response were reevaluated, their residual tumors excised, and declared cured. Patients treated with interferon and those treated with interferon plus surgery were followed for five years. Time to recurrence and the emergence of a new facial BCC were estimated by Kaplan-Meier survival analysis. Adverse events were documented. Results This study included 195 participants; 143 (73.3%) showed a complete response (95% CI 67.2‒80.1). Patients developed recurrence after a mean of 55 months (95% CI 53.8‒57.4). The estimated rate of recurrence was 12.3% (95% CI 7.4‒17.1). Patients developed a new BCC after a mean of 52.7 months (95% CI 50.4‒54.9). The estimated rate for development of a new BCC was 20.0% (95% CI 14.4‒25.9). Fifteen (7.7%) patients abandoned the study during follow-up. Adverse events were frequent but moderate or mild; fever and local pain were the most frequent. Study limitations Observational cohort design without a control group for comparison. Conclusions Perilesional injections of alpha-2b+ gamma interferons in patients with facial high-risk BCC offer a satisfactory cure rate after five years of follow-up with an acceptable safety profile.
RESUMO
Surgical resection is the gold standard treatment for basal cell carcinomas, although there is literature supporting cryotherapy for low-risk cases. Our aim was to compare the histopathological aspects of recurrent postcryotherapy head and neck cutaneous BCC with de novo tumors, using a case-control study. 51 Recurrent postcryotherapy cases were selected between January 2017 and December 2021 and compared to 132 controls filtered from a consecutive series of de novo head and neck cutaneous BCC operated between January and December 2021. Aggressive variants, multifocality, invasion beyond adipose tissue and higher Clark levels were associated with recurrent cases on multivariate analysis. Previous cryotherapy treatment may have contributed to an increased risk of more aggressive recurrent disease and caution using this treatment modality is advised. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03919-7.
RESUMO
BACKGROUND: Basal cell carcinoma (BCC) dermoscopy is key to lower the biopsy threshold of suspicious lesions. There is a scarcity of published data on the dermoscopy of very small BCC (≤3mm) and its differences from larger BCCs. OBJECTIVE: To describe and compare dermoscopic features of BCCs measuring ≤3mm, with those from 3 to 10mm. METHODS: An analytical cross-sectional study, included biopsy-proven BCCs that had dermoscopic photographic images, between January 2017 and December 2022 in a Skin Cancer Center in Medellín, Colombia. Demographic, clinic-pathological and dermoscopic features were compared between very small BCCs (vsBCCs) and a reference group. RESULTS: A total of 326 BCCs in 196 patients were included, of whom 60% were male. The most common Fitzpatrick phototype was III. vsBCCs accounted for 25% of the lesions (81/326). Face and neck were the most frequent locations (53%), especially in very small tumors. The nodular type was more common in very small tumors than in larger lesions, the superficial type was less frequent, and aggressive types were equally prevalent in both groups. On dermoscopy, very small tumors were statistically more likely to present pigmented structures than reference lesions, especially blue-gray dots (67% vs. 54%), vessels were less frequent, particularly short-fine telangiectasias (SFT) (52% vs. 66%), as were other structures such as shiny white structures (SWS), ulceration, micro-erosions, and scales. STUDY LIMITATIONS: Latin-American sample, lacks information on dark phototypes CONCLUSIONS: Pigmented structures, especially blue-gray dots, were most common in vsBCCs when compared to larger lesions; SFT, SWS and other findings were less prevalent.
RESUMO
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.
RESUMO
BACKGROUND: Bleomycin is a chemotherapeutical drug used to treat several neoplasias, including non-melanoma skin cancer; it is effective in the treatment of basal cell carcinoma (BCC) via intralesional infiltration. Transdermal drug delivery, which includes technologies such as CO2 Laser, Dermapen, Dermaroller and MMP®, delivers the desired medication to treat skin neoplasias and also acts in skin rejuvenation. OBJECTIVE: To treat BCC lesions using bleomycin via MMP®. METHODS: Ninety-eight BCC lesions in different anatomical areas were treated using MMP® technology to administer and uniformly distribute bleomycin throughout the lesion and in the established safety margin. RESULTS: The cure rate after six months was 96.94%; and recurrences were not associated with lesion size and/or depth. Adverse effects were the expected ones. STUDY LIMITATIONS: The follow-up time was only six months. CONCLUSION: This therapeutic route showed to be promising and effective.
Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Humanos , Bleomicina/uso terapêutico , Preparações Farmacêuticas , Carcinoma Basocelular/tratamento farmacológico , Carcinoma Basocelular/patologia , Neoplasias Cutâneas/patologia , Administração CutâneaRESUMO
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.
RESUMO
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.
RESUMO
Abstract Background Bleomycin is a chemotherapeutical drug used to treat several neoplasias, including non-melanoma skin cancer; it is effective in the treatment of basal cell carcinoma (BCC) via intralesional infiltration. Transdermal drug delivery, which includes technologies such as CO2 Laser, Dermapen, Dermaroller and MMP®, delivers the desired medication to treat skin neoplasias and also acts in skin rejuvenation. Objective To treat BCC lesions using bleomycin via MMP®. Methods Ninety-eight BCC lesions in different anatomical areas were treated using MMP® technology to administer and uniformly distribute bleomycin throughout the lesion and in the established safety margin. Results The cure rate after six months was 96.94%; and recurrences were not associated with lesion size and/or depth. Adverse effects were the expected ones. Study limitations The follow-up time was only six months. Conclusion This therapeutic route showed to be promising and effective.
RESUMO
A preservação do desenho das margens cirúrgicas é essencial durante a realização da cirurgia micrográfica de Mohs. Contudo, a degermação cutânea no ato da antissepsia e o uso da gaze durante a anestesia local, com frequência, promovem a remoção dessas marcações. A utilização da película protetora Cavilon® 3M, ao fixar a tinta da caneta marcadora, mostrou-se eficaz na preservação do mapa cirúrgico, permitindo uma remoção precisa do espécime cirúrgico
The preservation of the surgical margins marking is essential during Mohs micrographic surgery. However, skin degermation during antisepsis and the use of gauze during local anesthesia often remove these markings. The use of the protective film Cavilon® 3M to fix the marking pen ink was effective in preserving the surgical map, allowing an accurate removal of the surgical specimen.
RESUMO
Introducción : La piel es un órgano complejo altamente vulnerable al envejecimiento, fenómeno que biológicamente provoca cambios a nivel tisular y celular. De manera usual los elementos histológicos que la caracterizan se describen con un enfoque cualitativo, sin tener en cuenta la edad, sin embargo, desde el punto de vista cuantitativo, aspecto este que lo posibilita la morfometría no ha sido abordado en todas sus potencialidades. Objetivo : Caracterizar el comportamiento de indicadores morfométricos como perímetro, área, volumen nuclear en las células de la capa espinosa de la epidermis sana, según edad y sexo. Métodos : Se realizó un estudio de serie de casos con 12 pacientes con diagnóstico histopatológico de carcinoma basocelular atendidos en Centro Oncológico del Hospital Provincial Universitario Vladimir Ilich Lenin de Holguín, en el año 2019 y a los cuales se les extirpó el tumor mediante una biopsia escisional que incluía la lesión y un borde amplio de piel sana. Se emplearon métodos teóricos y empíricos, estos últimos basados en técnicas morfométricas, luego se realizó análisis estadísticos de los datos obtenidos y se reflejaron en tablas. Resultados : A medida que avanza la edad el perímetro, el área y el volumen nuclear disminuyen en ambos sexos. Conclusiones : Tanto el perímetro, como el área y el volumen nuclear disminuyen en las células de la capa espinosa de la epidermis sana en ambos sexos a medida que avanza la edad, lo que traduce disminución del tamaño nuclear.
Introduction: The skin is a complex organ highly vulnerable to aging, a phenomenon that biologically causes changes at the tissue and cellular level. Usually the histological elements that characterize it are described with a qualitative approach, without taken age into account, however from the quantitative point of view, this aspect that morphometry makes possible has not been addressed in all its potentialities. Objective: To characterize the behavior of morphometric indicators such as perimeter, area, nuclear volume in the cells of the spinous layer of the healthy epidermis, according to age and sex. Methods: A case series study was carried out with 12 patients diagnosed with histopathology of basal cell carcinoma treated at the Oncology Center of the Provincial University Hospital Vladimir Ilich Lenin of Holguin, in the year 2019 and to which the tumor was removed by means of an excisional biopsy that included the lesion and a broad border of healthy skin. Theoretical and empirical methods were used, the latter based on techniques morphometric, then statistical analysis of the data obtained was performed and were reflected in tables. Results: As age advances the nuclear perimeter, area, and volume decreased in both sexes. Conclusions: Both the perimeter, the area and the nuclear volume decrease in the cell of the spinous layer of the healthy epidermis in both sexes as age advances, which translates into a decrease in nuclear size.
RESUMO
Introducción: El carcinoma basocelular sólido es el tumor más frecuente de piel con un grado de malignidad limitada que rara vez metastiza, a pesar de esto se detectan cada vez más personas que sufren este tipo de cáncer, lo que indica una falla en su diagnóstico y tratamiento oportuno. Los estudios morfométricos se hacen necesarios por el valor que aportan en el diagnóstico histológico y el pronóstico de la enfermedad. Objetivo: Describir el comportamiento de indicadores morfométricos como el área nuclear, volumen nuclear y factor de forma nuclear de las células tumorales del carcinoma basocelular sólido. Métodos: Se realizó un estudio de serie de casos de siete pacientes con el diagnóstico de carcinoma basocelular sólido de piel en el período septiembre 2018 a septiembre 2019 en la provincia Holguín. Se seleccionaron 300 campos y se midieron 1 777 núcleos celulares, lo que constituyó la muestra. Se caracterizaron indicadores morfométricos nucleares como el área, el volumen y el factor de forma. Se emplearon métodos teóricos y empíricos fundamentalmente, estos últimos basados en técnicas morfométricas. Resultados: La media aritmética del área nuclear es 130 µm2 y del volumen nuclear es 923 µm3, ambos están aumentados si se comparan con otros estudios realizados en piel sana envejecida. El factor de forma nuclear es 0,77, se acerca al valor 1 por lo que el pleomorfismo es bajo en el carcinoma basocelular. Conclusiones: Las células tumorales en el carcinoma basocelular sólido de piel se caracterizan por presentar núcleos que muestran un bajo pleomorfismo y un gran volumen, mayor que en el melanoma maligno, aunque menor que en la piel normal de personas mayores de 40 años.
Introduction: Solid basal cell carcinoma is the most frequent tumor of the skin with a limited degree of malignancy that rarely metastasizes, despite the fact that more and more people suffering from this type of cancer are being detected, which indicates a failure in its diagnosis and timely treatment. The morphometric studies are necessary due to the value they bring to the histological diagnosis and prognosis of the disease. Objective: To describe the behavior of morphometric indicators such as nuclear area, nuclear volume and nuclear shape factor of tumor cells from solid basal cell carcinoma. Methods: A study was carried out on a series of cases of 7 patients diagnosed with solid basal cell carcinoma of the skin from September 2018 to September 2019 in the province of Holguín. 300 fields were selected and 1 777 cell nuclei were averaged, which constituted the sample. Nuclear morphometric indicators such as area, volume and shape factor were characterized. Theoretical and empirical methods were used, the latter fundamentally based on morphometric techniques. Results: The arithmetic average of the nuclear area is 130 µm2 and of the nuclear volume is 923 µm3, both are increased if compared to other studies carried out on healthy, aged skin. The nuclear form factor is 0.77, it approaches the value 1 for that reason the pleomorphism is low in the basal cell carcinoma. Conclusions: The tumoral cells in solid basal cell carcinoma of the skin are characterized by presenting nuclei that show a low pleomorphism and a large volume, larger than in malignant melanoma, even smaller than in normal skin of people older than 40 years.
RESUMO
Abstract Background Basal cell carcinoma (BCC) dermoscopy is key to lower the biopsy threshold of suspicious lesions. There is a scarcity of published data on the dermoscopy of very small BCC (≤3 mm) and its differences from larger BCCs. Objective To describe and compare dermoscopic features of BCCs measuring ≤3 mm, with those from 3 to 10 mm. Methods An analytical cross-sectional study, included biopsy-proven BCCs that had dermoscopic photographic images, between January 2017 and December 2022 in a Skin Cancer Center in Medellín, Colombia. Demographic, clinic-pathological and dermoscopic features were compared between very small BCCs (vsBCCs) and a reference group. Results A total of 326 BCCs in 196 patients were included, of whom 60% were male. The most common Fitzpatrick phototype was III. vsBCCs accounted for 25% of the lesions (81/326). Face and neck were the most frequent locations (53%), especially in very small tumors. The nodular type was more common in very small tumors than in larger lesions, the superficial type was less frequent, and aggressive types were equally prevalent in both groups. On dermoscopy, very small tumors were statistically more likely to present pigmented structures than reference lesions, especially blue-gray dots (67% vs. 54%), vessels were less frequent, particularly short-fine telangiectasias (SFT) (52% vs. 66%), as were other structures such as shiny white structures (SWS), ulceration, micro-erosions, and scales. Study limitations Latin-American sample, lacks information on dark phototypes Conclusions Pigmented structures, especially blue-gray dots, were most common in vsBCCs when compared to larger lesions; SFT, SWS and other findings were less prevalent.
RESUMO
BACKGROUND: Mohs Micrographic Surgery (MMS) is commonly used to treat high-risk basal cell carcinoma (BCC). OBJECTIVES: Correlate clinicopathologic preoperative features with the number of MMS stages (primary endpoint) and margins (secondary endpoint) required for BCC complete excision. METHODS: We retrospectively analyzed BCCs treated by MMS in a 2-year period at the study's institution. Variables studied included the patient gender, age, immune status, lesion size, location, if it was a primary, recurrent, or persistent tumor, histopathologic characteristics, number of surgical stages, and amount of tissue excised. RESULTS: 116 BCCs were included. The majority (61.2%, n = 71) required a single-stage surgery for complete clearance, requiring a final margins of 3.11 ± 2.35 mm. Statistically significant differences between locations in different high-risk areas (periocular, perioral, nose, ear) and the number of MMS stages required for complete excision (p = 0.025) were found, with periocular tumours requiring the highest mean of stages (2.29 ± 0.95). An aggressive histopathology significantly influenced the number of MMS stages (p = 0.012). Any significant relation between clinicopathological features and variation in the final surgical margins was found, just certain tendencies (male patients, persistent tumor, periocular location, and high-risk histopathological tumors required larger margins). Neither patient age or tumor dimension correlated significantly with both number of MMS stages and final surgical margins. STUDY LIMITATIONS: Limitations of this study include its single-center nature with a small sample size, which limits the value of conclusions. CONCLUSION: Main factors related to a greater number of MMS stages were periocular location and high-risk histopathological subtype of the tumor.
Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Humanos , Masculino , Margens de Excisão , Cirurgia de Mohs , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
O hamartoma folicular basaloide (HFB) é um tumor anexial raro e benigno, que se assemelha ao carcinoma basocelular (CBC), e pode apresentar manifestações clínicas diversas. Uma mutação no gene PTCH, envolvido na síndrome de Gorlin-Goltz, poderia estar associada à patogênese dessa neoplasia. Descreve-se caso de menina, sete anos, apresentando múltiplas pápulas na face.
Basaloid follicular hamartoma (BFH) is a rare and benign adnexal tumor that resembles basal cell carcinoma (BCC) and may present with different clinical manifestations. A mutation in the PTCH gene, involved in Gorlin-Goltz syndrome, could be associated with the pathogenesis of this neoplasm. We describe the case of a 7-year-old girl with multiple papules on her face.
Assuntos
Humanos , Feminino , Criança , Dermatoses Faciais/diagnóstico , Hamartoma/diagnóstico , Imuno-Histoquímica , Dermatoses Faciais/patologia , Hamartoma/patologiaRESUMO
Carcinoma basocelular (CBC) é o câncer de pele mais comum. Quando localizado na região nasal, a reconstrução do defeito resultante de sua exérese pode se tornar muito desafiadora para o cirurgião dermatológico. A técnica do retalho em caracol (RC) pode ser utilizada para defeitos, principalmente na parede lateral do nariz, mas também a utilizamos de maneira modificada para fechamento de lesão da asa nasal. Nos dois casos, os resultados foram satisfatórios, tanto pela cosmética quanto pela funcionalidade.
Basal cell carcinoma (BCC) is the most common skin cancer. When located in the nasal region, reconstructing the defect resulting from its exeresis can become very challenging for the dermatological surgeon. The snail flap (SF) technique can be used to correct defects, mainly on the nose's lateral wall, but we use it in a modified way to close the nasal wing injury. In both cases, the results were satisfactory, cosmetically and functionally.