Basosquamous Carcinoma Involving the Anterior Skull Base: A Neglected Tumor Treated Using Intraoperative Navigation as a Guide to Achieve Safe Resection Margins
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.
Available from: Francesco Dispenza
- "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  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). "
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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.
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ABSTRACT: To review the past year's literature regarding current computer-assisted reconstruction techniques and their outcomes.
Current computer-assisted craniofacial reconstruction research is focused on data acquisition, planning, surgical and assessment phases. The major areas of interest among researchers include cosmetic surgery; cleft and craniofacial surgery; traumatic reconstruction, head and neck tumor reconstruction; and orthognathic surgery and distraction osteogenesis. Recent advances in the fields include facial analysis and planning in rhinoplasty, facial surface and bone graft volume analysis in cleft surgery, computer-guided tumor ablation and osteocutaneous reconstruction in tumor surgery, and preoperative planning and surgical assistance in orthognathic and distraction osteogenesis surgery.
Research in computer-aided craniofacial surgery is progressing at a rapid rate. Rather than just the latest innovation, sound research studies are proving computer assistance to be invaluable in producing superior outcomes, especially in the fields of head and neck surgery, orthognathic surgery, and craniomaxillofacial trauma surgery. Further outcome studies and cost-benefit analyses are still needed to show the superiority of these methods to contemporary techniques.
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