Basosquamous Carcinoma Involving the Anterior Skull Base: A Neglected Tumor Treated Using Intraoperative Navigation as a Guide to Achieve Safe Resection Margins

ArticleinJournal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 69(1):230-6 · October 2010with6 Reads
DOI: 10.1016/j.joms.2010.06.206 · Source: PubMed
Abstract
Basosquamous carcinoma (BSC) or metatypical carcinoma is a rare and controversial form of basal cell carcinoma (BCC) that was first described by MacCormac in 1910. Numerous theories have been described in the literature regarding its origin but it is generally accepted as a variant of BCC that differentiates into squamous cell carcinoma (SCC). At present, it has an unsatisfactorily established phenotype but is considered to behave more like an SCC than a BCC. A reflection of this fact is its more aggressive nature with a significantly increased incidence of local and distant metastasis. It must be distinguished histologically from so-called "collision" tumors, which represent SCC and BCC arising as separate entities in the same area. We present a unique case of a neglected, large, and locally advanced case of BCC originating from the nose, but extending into the paranasal sinuses, orbit, and anterior skull base, that was treated with en bloc surgical resection using intraoperative navigation to assist in treatment planning and margin clearance.
    • "But Giacomel et al. [22] suggest that dermoscopy can be used to provide additional morphological information, as it was used in this study. This tumour has been poorly defined in the dermatological literature with confusing clinical and histological results, and in many studies not mentioning or recognizing the lesion [2,7,20]. Brantsch et al. [6] claim that immunohistochemistry distinguishes BSC from BCC and SCC. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Basosquamous carcinoma (BSC) is a rare non-melanoma skin cancer, considered to be a subtype of basal cell carcinoma (BCC). BSC often produces distant metastases with a higher risk of recurrence than that of BCC which is not commonly found in the lip. Case Report: A 57-year-old white female patient presented an ulcer on her lower lip that had an ongoing development for over six months. Physical examination, photo documentation, videoroscopy, scraped cytology, toluidine blue test, and biopsy of the ulcer were carried out. Results: Upon physical examination we observed an actinic cheilitis associated with the ulcer. Videoroscopy revealed the presence of fissures and erosion that had not been seen by oroscopy. Toluidine blue test was only positive for the region of the ulcer. Cytological analysis revealed rare nests compatible with carcinoma. Histopathology of the biopsy revealed a carcinoma with nests lined by basal cells associated with areas of squamous differentiation. The patient was then referred to surgery for the removal of the BCC. Analysis of the specimen showed free surgical margins and the immunohistochemical panel did not confirm the initial diagnosis of BCC, indicating a subtype of BSC. After surgery, the patient has been followed by periodic consultations. She is well and without further complications. Coments: BSC is considered to be an aggressive and rare tumor affecting mainly upper face and primarily affects men over 60 years of age. Since our patient is a woman presenting the lesion in the lower lip, this highlights the unusual and interesting presentation of this case report.
    Full-text · Article · Dec 2013
    • "It is very important to identify prognostic indicators of recurrence which should include: positive surgical margins, perineural or lymphatic invasion, bone involvement and size greater than of 3 cm in diameter. A close radiological and clinical follow-up should be mandatory in presence of one of these factors [17] but it appears necessary also in patients with a positive diagnosis of BSC even in absence of indicators. In addition we think that more attention should be paid for all tumours diagnosed as BCC but with aggressive histological features and involvement of deep structures (bone, nerves, blood and lymphatic vessels and others). "
    [Show abstract] [Hide abstract] ABSTRACT: Metatypical Basal Cell Carcinoma, also known as Basosquamous Carcinoma is a subtype of Basal Cell Carcinoma. It is similar to Basal Cell Carcinoma for the gross aspect and regional recurrences, but it has the capacity to spread and develop metastasis. This terrible characteristic endangers the life of the patient if it is not readily recognized by the physicians. Herein we present a report of two patients affected by BSC originating in the nasal region and external ear that after a series of devastating local recurrences metastasized to the lung and bones in one case. The true incidence of Basoquamous Carcinoma may be higher, with underreporting arising because of rarity of diagnosis and lack of awareness on the part of clinicians. Our experience suggests that a deep biopsy is often necessary to discover a BSC that appears as BCC but with local aggressive features.
    Full-text · Article · Nov 2012
  • Article · Jan 1997 · Otolaryngologia polska. The Polish otolaryngology
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