REFERENCIAS BIBLIOGRÁFICAS / BIBLIOGRAPHICAL REFERENCES

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1.) Basal Cell Carcinoma in Children  Report of 3 Cases 

2.) Papillomaviruses in non-melanoma skin cancer: epidemiological  aspects. 

3.) Reconstruction of the scalp and cranium using multiple free-tissue  transfers following recurrent basal cell carcinoma. 

4.) Prognostic value of apoptotic index in cutaneous basal cell  carcinomas of head and neck. 

5.) Low levels of urokinase plasminogen activator components in basal  cell carcinoma of the skin. 

6.) Folliculotropic T cells in regressive basal cell carcinoma of skin. 

7.) Repeated 5-aminolevulinic acid-based photodynamic therapy following  electro-curettage for pigmented basal cell carcinoma. 

8.) Sporadic Bazex-Dupre-Christol-like Syndrome: Early Onset Basal Cell  Carcinoma, Hypohidrosis, Hypotrichosis, and Prominent Milia. 

9.) Reporting basal cell carcinoma: a survey of the attitudes of  histopathologists. 

10.) Host-related and environmental risk factors for cutaneous basal  cell carcinoma: evidence from an italian case-control study. 

11.) Collagenolytic and gelatinolytic matrix metalloproteinases and  their inhibitors in basal cell carcinoma of skin: comparison with normal  skin. 

12.) A Cancer-Registry-Assisted Evaluation of the Accuracy of Digital  Epiluminescence Microscopy Associated with Clinical Examination  of Pigmented Skin Lesions. 

13.) Expression of p53 in arsenic-related and sporadic basal cell  carcinoma. 

14.) Decision support software to help primary care physicians triage  skin cancer: a pilot study. 

15.) A randomized, 12-year primary-prevention trial of beta carotene  supplementation for nonmelanoma skin cancer in the physician's health  study. 

16.) Photofrin photodynamic therapy can significantly deplete or  preserve oxygenation in human basal cell carcinomas during treatment,  depending on fluence rate. 

17.) Gamma-irradiation deregulates cell cycle control and apoptosis in  nevoid basal cell carcinoma syndrome-derived cells. 

18.) Expression of desmoglein I and plakoglobin in skin carcinomas. 

19.) Expression of basement membrane antigens and matrix  metalloproteinases 2 and 9 in cutaneous basal and squamous cell  carcinomas. 

20.) Detoxifying enzyme genotypes and susceptibility to cutaneous  malignancy. 

21.) Tumors arising in nevus sebaceus: A study of 596 cases. 

22.) Liposome-mediated gene transfer into human basal cell carcinoma. 

23.) Proliferative Actinic Keratosis: Three Representative Cases. 

24.) Diet and basal cell carcinoma of the skin in a prospective cohort  of men. 

25.) Preliminary observations on the use of topical tazarotene to treat  basal-cell carcinoma. 

26.)HLA phenotypes and multiple basal cell carcinomas. 

27.) Multiple non-melanoma skin cancer: evidence that different MHC  genes are associated with different cancers. 

28.) HLA DR4 is associated with the development of multiple basal cell  carcinomas and malignant melanoma. 

29.) Multiple basal cell carcinoma in tropical Australia. 

30.) HLA-DR1 is not a sign of poor prognosis for the development of  multiple basal cell carcinomas. 

31.) Multiple basal cell carcinomas and HLA frequencies in southern  Australia. 

32.) Expression of human lymphocyte antigen (HLA)-DR on tumor cells in  basal cell carcinoma. 

33.) Human leukocyte antigen associations in basal cell carcinoma. 

34.) Translocation (4; 14) and concomitant inv(14) in a basal cell  carcinoma. 

35.) Long-term therapy with low-dose isotretinoin for prevention of  basal cell carcinoma: a multicenter clinical trial. Isotretinoin-Basal  Cell Carcinoma Study Group [see comments] 

36.) Treatment and prevention of basal cell carcinoma with oral  isotretinoin. 

37.) Chemoprevention of basal cell carcinoma with isotretinoin. 

38.) Chemoprevention of skin cancer in xeroderma pigmentosum. 

39.) Relative importance of prior basal cell carcinomas, continuing sun 

exposure, and circulating T lymphocytes on the development of basal cell  carcinoma. 

40.) Topical tretinoin in actinic keratosis and basal cell carcinoma. 

41.) Margin assessment of selected basal cell carcinomas utilizing laser  Doppler velocimetry. 

42.) Carbon dioxide laser vaporization and curettage in the treatment of  large or multiple superficial basal cell carcinomas. 

43.) The effect of intralesional 5-fluorouracil therapeutic implant (MPI  5003) for treatment of basal cell carcinoma. 

44.) Cryosurgery and topical fluorouracil: a treatment method for  widespread basal cell epithelioma in basal cell nevus syndrome. 

45.) Selective cytotoxic effect of topical 5-fluorouracil. 

46.) Nodular superficial pigmented basal cell epitheliomas. 

47.) Metastatic basal cell carcinoma: response to chemotherapy. 

48.) Basal cell carcinoma of the vulva with lymph node and skin  metastasis--report of a case and review of 20 Japanese cases. 

49.) Basal cell carcinoma of the scalp resulting in spine metastasis in  a black patient. 

50.) Long-term survival following bony metastases from basal cell  carcinoma. Report of a case. 

51.)Giant basal cell carcinoma with metastasis and secondary  amyloidosis: report of case. 

52.) Pulmonary metastases from a basal cell carcinoma. 

53.) Nonrecurrent primary basal cell carcinoma of the lower extremity  with late metastasis. 

54.) [Metastatic basal cell carcinoma] 

55.) Metastatic basal cell carcinoma: report of twelve cases with a  review of the literature [see comments] 

56.) Rapid development of metastases from basal cell carcinoma  presenting as cranial nerve palsies. 

57.) Photodynamic therapy by topical aminolevulinic acid,  dimethylsulphoxide and curettage in nodular basal cell carcinoma: a  one-year follow-up study. 

58.) Epidemiologic characteristics and clinical course of patients with  malignant eyelid tumors in an incidence cohort in Olmstead County,  Minnesota. 

59.) Does wound healing contribute to the eradication of basal cell  carcinoma following curettage and electrodessication? 

60.)Does inflammation contribute to the eradication of basal cell  carcinoma following curettage and electrodesiccation? 

61.) Cryosurgery in dermatology. 

62.) [The treatment of basal cell carcinoma patients by dermatologists  in Netherland]. 

63.) [Therapy of non-melanocytic skin tumors]. 

64.) [High resolution ultrasound imaging: value in treatment of  basocellular carcinoma by cryosurgery]. 

65.) Recurrent basal cell carcinoma treated with cryosurgery. 

66.) Fractional cryosurgery. A new technique for basal cell carcinoma of  the eyelids and periorbital area. 

67.) Long-term follow-up of cryosurgery of basal cell carcinoma of the  eyelid. 

68.) Five-year results of curettage-cryosurgery of selected large  primary basal cell carcinomas on the nose: an alternative treatment in a  geographical area underserved by Mohs' surgery. 

69.) Laser microsurgery for superficial T1-T2 basal cell carcinoma of  the eyelid margins. 

70.)[Use of Nd:YAG laser for treatment of basal-cell carcinomas and some 

premalignant conditions]. 

71.) Laser therapy of skin tumors. 

72.) Treatment of superficial basal cell carcinoma and squamous cell  carcinoma in situ with a high-energy pulsed carbon dioxide laser. 

73.) Prediction of subclinical tumor infiltration in basal cell  carcinoma. 

74.) Recurrence rates of treated basal cell carcinomas. Part 3: Surgical  excision. 

75.) Human papillomavirus type 2-associated basal cell carcinoma in two  immunosuppressed patients. 

76.) Occurrence of human papillomavirus type 16 DNA in cutaneous  squamous and basal cell neoplasms. 

77.) Basal cell carcinoma of the genitalia. 

78.) Detection of human papillomavirus DNA in PUVA-associated  non-melanoma skin cancers. 

79.)Premalignant lesions and cancers of the skin in the general  population: 

evaluation of the role of human papillomaviruses. 

80.) Human papillomavirus type 2-associated basal cell carcinoma in two  immunosuppressed patients. 

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1.) Basal Cell Carcinoma in Children  Report of 3 Cases 

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Arch Dermatol. 2000;136:370-372 

Benjamin W. LeSueur, BS; Nancy G. Silvis, MD; Ronald C. Hansen, MD 

Background  The peak incidence of basal cell carcinoma occurs in the  seventh decade of life and is rare in children. When found in the  pediatric  age group, basal cell carcinoma is usually associated with a genetic  defect, such as basal cell nevus syndrome, xeroderma pigmentosum, or  nevus  sebaceus. In areas of intense UV radiation exposure, such as the 

southwestern United States, children may be at increased risk of  developing  this malignancy de novo. 

Observations  Three children (2 boys, aged 8 and 16 years, and an  11-year-old girl) from Tucson, Ariz, with isolated basal cell carcinoma  unassociated with any other disease or syndrome are described. 

Conclusions  Basal cell carcinoma in children is probably the result of  a  combination of UV radiation exposure and genetic background. Early  recognition in children can prevent extensive tissue destruction and  excess  scarring after excision. A higher index of suspicion for basal cell  carcinoma may also aid in prompt diagnosis of a possible genetic  disorder,  such as basal cell nevus syndrome. 

BASAL CELL carcinoma (BCC) in children is rare. Cases of BCC in the  pediatric population have been reported in association with basal cell  nevus syndrome,1 xeroderma pigmentosum,2 and nevus sebaceus3 and after  high-dose radiotherapy.4 Isolated cases of BCC unrelated to one of these 

causes are seldom reported in pediatric patients. Consequently,  clinicians  often have a low index of suspicion, leading to delay in diagnosis. We  report 3 cases of de novo BCC in children who presented to the  dermatology  clinic at the University of Arizona Medical Center, Tucson. These  children 

had no known genetic syndromes and had not undergone radiotherapy. 

COMMENT

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Non melanoma skin cancers are the most common malignant neoplasms in the  United States, representing one third of all cancers diagnosed every  year.5, 6 Basal cell carcinoma represents 75% of nonmelanoma skin  cancers  and has an estimated annual incidence of more than 700,000 cases  nationally.7, 8 The US average annual incidence of BCC in whites is  currently 191 per 100,000 and is increasing at a rate of 3% to 7% per  year.7, 9 

Ultraviolet radiation exposure is partly responsible for both BCC and  squamous cell carcinoma, as evidenced by their increased prevalence  after  chronic exposure to sunlight and the preponderance of these lesions on  sun-damaged skin. Although squamous cell carcinoma is associated with  cumulative sun exposure, BCC in younger patients does not show this  association.10, 11 D'Errico et al10 report that BCC arising before the  age  of 40 years corresponds with childhood or recreational sun exposure but  does not correlate directly with cumulative sun damage. Thus, in areas  of  the world where the UV radiation is most intense, such as the Sunbelt in 

the United States, childhood sun exposure is at a maximum and younger  patients are at a higher risk of developing BCC. 

Other factors besides sunlight are reported to influence the development  of  BCC. Gailani et al11 note a strong association between BCC and the  inactivation of a gene at chromosome 9q22, which is thought to be a  tumor  suppressor. Inactivation of this gene was found in tumor tissue in 68%  of  BCCs examined and did not correlate directly with sun exposure or age.  The  cause of this mutation is unknown, but possible factors may include  ionizing radiation, arsenicals, and polyaromatic hydrocarbons. Basal  cell  nevus syndrome and xeroderma pigmentosum represent inherited genetic  mutations that predispose those affected to BCC. Patients with basal  cell  nevus syndrome are found to have a germline mutation on chromosome 9.12 

The peak incidence of BCC occurs in the seventh decade of life.13 In the  pediatric age group, BCC usually occurs in the setting of a known  genetic  defect (Table 1). Although uncommon, isolated BCC in children without  these  conditions has been reported.14-29 Price et al14 described a 17-year-old 

boy with a solitary BCC of the nose. The patient had a history of  sunburns  1 or 2 times per year since the age of 9 years. His mother had a BCC  removed at the age of 44 years. Histologically, the tumor was described  as  superficial BCC. Scobie and Preston17 described a 4-year-old boy with a  BCC  of the scalp. The patient presented with a small "cyst" on the occipital 

region of the scalp and a family history of skin cancer. The lesion,  described histologically as well defined, recurred 8 months after  excision.  Excision was repeated without recurrence of tumor, based on follow-up 1  year later.17 A 12-year-old boy living in Arizona was described by  Comstock  et al18 with a BCC on the nose. The lesion had been present since his 

nose  was scratched by a cat 1 year earlier. The youngest patient with BCC, a  27-month-old infant, was described by Keramidas and Anagnostou.21 In  this  case, the lesion grew rapidly and ulcerated after a 4-month delay in  diagnosis. 

It is debatable whether BCC is more aggressive in children. Leffell et  al30  defined aggressive-growth BCC as sclerosing, morpheaform, infiltrative,  or  invasive into nerves. Their retrospective review showed an increased  occurrence of aggressive-growth BCC in patients younger than 35 years  old  compared with older patients. In contrast, Betti et al13 and Dinehart et  al16 found no increase in the frequency of the morpheaform pattern in  younger patients. All 3 of our patients had histologically less  aggressive  forms of BCC. 

As total incidence rates of BCC continue to rise, childhood cases may  become more common. This increase in pediatric BCC may be especially  true  in areas of high-level UV radiation exposure. The percentage of sunny  days  during the year, higher altitude, and location closer to the equator may 

place children in these areas at increased risk. Early recognition can  prevent extensive tissue destruction and scarring after excision and aid  in  prompt diagnosis of a possible genetic syndrome. We recommend that  clinicians have a higher index of suspicion for BCC when evaluating  questionable lesions in children. 

REFERENCES

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1.  Gorlin RJ, Goltz RW.  Multiple nevoid basal-cell epithelioma, jaw cysts and bifid rib. 

N Engl J Med. 1960;262:908-912.  2. 

Leibowitz E, Janniger CK, Schwartz RA, Lambert WC. 

Xeroderma pigmentosum.  Cutis. 1997;60:75-77, 81-84. 

3.  Goldstein GD, Whitaker DC, Argenyi ZB, Bardach J.  Basal cell carcinoma arising in a sebaceous nevus during childhood. 

J Am Acad Dermatol.1988;18:429-430. 

4.  Garcia-Silva J, Velasco-Benito JA, Pena-Penabad C, Armijo M.  Basal cell carcinoma in a girl after cobalt irradiation to the cranium  for acute lymphoblastic leukemia: case report and literature review.  Pediatr Dermatol.1996;13:54-57. 

5.  Silverberg E, Lubera JA. 

Cancer statistics, 1989.  CA Cancer J Clin.1989;39:3-20. 

6.  Boring CC, Squires TS, Tong T  Cancer statistics, 1991.  CA Cancer J Clin.1991;41:19-36. 

7.  Silverberg E, Boring CC, Squires TS.  Cancer statistics, 1990.  CA Cancer J Clin.1990;40:9-26. 

8.  Parker SL, Tang T, Bolden S, Wingo PA.  Cancer statistics, 1997. 

CA Cancer J Clin.1997;47:5-27. 

9.  Green A.  Changing patterns in incidence of nonmelanoma skin cancer.  Epithelial Cell Biol.1992;1:47-51. 

10.  D'Errico M, Calcagnile AS, Corona R, et al.  p53 mutations and chromosome instability in basal cell carcinomas 

developed at an early or late age.  Cancer Res.1997;57:747-752. 

11.  Gailani MR, Leffell DJ, Zeigler A, Gross EG, Brash DE, Bale AE.  Relationship between sunlight exposure and a key genetic alteration in  basal cell carcinoma.  J Natl Cancer Inst. 1996;88:349-354. 

12.  Gailani MR, Bale SJ, Leffel DJ, DiGiovanna JJ, Peck GL, Poliak S.  Developmental defects in Gorlin syndrome related to a putative tumor  suppressor gene on chromosome 9.  Cell.  1992;69:111-117.  MEDLINE   

13.  Betti R, Inselvini E, Carducci M, Crosti C.  Age and site prevalence of histologic subtypes of basal cell carcinomas. 

Int J Dermatol. 1995;34:174-176. 

14.  Price MA, Goldberg LH, Levy ML.  Juvenile basal cell carcinoma. 

Pediatr Dermatol.1994;11:176-177. 

15.  Cox NH.  Basal cell carcinoma in young adults.  Br J Dermatol.1992;127:26-29. 

16.  Dinehart SM, Dodge R, Stanley WE, Franks HH, Pollack SV.  Basal cell carcinoma treated with Mohs surgery: a comparison of 54 

younger patients with 1050 older patients.  J Dermatol Surg Oncol.1992;18:560-566. 

17.  Scobie WG, Preston J. 

Basal cell carcinoma in children.  J R Coll Surg Edinb.1992;37:46-47. 

18.  Comstock J, Hansen RC, Korc A.  Basal cell carcinoma in a 12-year-old boy.  Pediatrics.1990;86:460-462. 

19.  Cullen KW, Bleach NR, Green DM.  Juvenile basal cell carcinoma. 

Br J Clin Pract.1989;43:419-420. 

20.  Fliss DM, Hauben DJ, Ben-Meir P, Sion-Vardy N.  Solitary basal cell carcinoma in a child.  Ann Plast Surg.1989;22:43-46. 

21.  Keramidas DC, Anagnostou D.  Basal cell carcinoma of the lower lid in a 27-month-old child.  Z Kinderchir.1987;42:250-251. 

22.  Rahbari H, Mehregan AH. 

Basal cell epithelioma (carcinoma) in children and teenagers.  Cancer. 1982;49:350-353. 

23.  Henriksson C, Eldh J, Hersle K, Suurkula M.  Basal cell carcinoma in children: case report.  Scand J Plast Reconstr Surg.1981;15:157-158. 

24.  Hernandez-Perez E. 

Basal cell carcinoma in children.  Dermatologica.1975;150:311-315. 

25.  Milstone EB, Helwig EB. 

Basal cell carcinoma in children.  Arch Dermatol.1973;108:523-527. 

26.  Coskey RJ, Chow C. 

Basal cell epitheliomas in children and young adolescents.  Cutis.1973;12:224-226. 

27.  Botvinick I, Mehregan AH, Weissman F.  Morphea-like basal cell epithelioma in a child.  Arch Dermatol.1967;95:67-68. 

28.  Murray JE, Cannon B. 

Basal-cell cancer in children and young adults. 

N Engl J Med.1960;262:440-443. 

29.  Sewell RL.  Basal cell carcinoma in youth.  Arch Surg. 1941;42:909-912. 

30.  Leffel DJ, Headington JT, Wong DS, Swanson NA.  Aggressive-growth basal cell carcinoma in young adults.  Arch Dermatol.1991;127:1663-1667. 

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2.) Papillomaviruses in non-melanoma skin cancer: epidemiological  aspects. 

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Semin Cancer Biol 1999 Dec;9(6):397-403 

Kiviat NB 

Department of Pathology, University of Washington, Seattle, WA, 98103, 

USA 

[Record supplied by publisher] 

 

Worldwide, non-melanoma skin cancers (NMSCs), which include squamous  cell  carcinoma (SCC) and basal cell carcinoma (BCC), are the most commonly  diagnosed cancers among Caucasians. It is well established that  ultraviolet  radiation (UVR) plays a central role in the development of these  cancers,  and more recently, a role for specific genetic mutations in the  pathogenesis of BCC has been identified. The possibility that certain  types  of HPV, either alone or in conjunction with UVR, may play a role in the  pathogenesis of these cancers is suggested by several lines of evidence  reviewed below.*9 @2depidemiology / non-melanoma skin cancer /  papillomavirus Copyright 2000 Academic Press. 

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3.) Reconstruction of the scalp and cranium using multiple free-tissue  transfers following recurrent basal cell carcinoma. 

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J Reconstr Microsurg 2000 Feb;16(2):89-93 

Anderson PJ, Ragbir M, Berry RB, McLean NR 

Department of Plastic and Reconstructive Surgery, Shotley Bridge General 

Hospital, Durham, UK. 

It is well-recognised that recurrent disease can occur following surgery 

for malignancy in the head and neck region. This is particularly true of 

basal cell carcinoma in which recurrences may occur over many years and  despite the use of different treatment modalities. Reconstruction of  large  defects may become increasingly difficult and can be optimally managed  by  free tissue transfer. The authors report a case of basal cell carcinoma  that has required treatment for over 20 years, unique in that on five  different occasions, free flaps have been used for reconstruction. 

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4.) Prognostic value of apoptotic index in cutaneous basal cell  carcinomas  of head and neck. 

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Oral Oncol 1999 Nov 1;35(6):541-547 

Staibano S, Lo Muzio L, Mezza E, Argenziano G, Tornillo L, Pannone G, De 

Rosa G 

Department of Biomorphological and Functional Sciences, Pathology 

Section, 

Faculty of Medicine and Surgery, University "Federico II", Naples, Italy 

 

 

Basal cell carcinoma (BCC) is the most common type of human cancer,  often  locally invasive, and following a benign clinical course. However, a  proportion of BCCs do recur after treatment, causing extensive local  tissue  destruction, seldom metastasizing. Morphological methods to  unequivocally  distinguish the aggressive forms of these tumors (BCC2) from the  ordinary  ones (BCC1) have so far been lacking. Apoptosis, or programmed cell  death,  is thought to be important for the death of tumor cells in various  stages  of carcinogenesis. We analyzed the extent of apoptosis in BCCs of head  and  neck in a morphological, morphometric, and electron-microscopic study,  to  estabilish on a retrospective basis, the relative frequency of  recurrence  of tumors showing different apoptotic rates. We found that BCC1 showed  lower apoptotic index (AI) than BCC2 [BCC1: AI from 2.03 to 10.45% (mean 

value: 5.98%) BCC2: AI from 21.91 up to 43.82% (mean value: 39.82%)].  The  morphometric analysis of both BCC1 and BCC2 revealed significant  differences between the values concerning nuclear area, length,  perimeter,  and roundness of the apoptotic cells with respect to the 'viable'  neoplastic cells. Electron-microscopy confirmed that the features of  morphological apoptotic cells were characteristic of programmed cell  death.  We hypothesized that low apoptotic rates in BCC1 could be indicative of  a  good prognosis. In fact, this corresponded to an 'expansive' but not  still  invasive neoplastic state. In this phase, however, the tumor cells may  constitute the target for genetic changes triggered by enviromental  physical or chemical mutagenic agents, such as UV rays. BCC2, then,  could  be the result of newly selected mutated neoplastic cellular clones, with 

more aggressive biological behavior. The high apoptotic level found in  BCC2  could thus be used as an indirect alarm signal from pathologists. This  hypothesis seems to be supported by most of the current data in the  literature and by the clinical outcome of BCC2 of our series. In our  opinion, routine evaluation of apoptosis in BCCs could be proposed to  facilitate their sub-classification, contributing toward the evaluation  of  the prospective outcome of the individual patients.   

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5.) Low levels of urokinase plasminogen activator components in basal  cell  carcinoma of the skin. 

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Int J Cancer 2000 Feb;85(4):457-459 

Maguire T, Chin D, Soutar D, Duffy MJ 

Department of Surgery, St. Vincent's Hospital, Dublin, Ireland. 

Basal cell carcinoma of the skin (BCC) is the most common cancer  worldwide.  Unlike most other human malignancies, BCCs rarely metastasise. In this  investigation, we show that the serine protease urokinase plasminogen  activator (u-PA), which is causally involved in metastasis, is expressed  at  lower levels in BCCs compared to other skin cancers, such as  squamous-cell  carcinomas (SCCs) or malignant melanomas. Similarly, the u-PA receptor  as  well as the inhibitor PAI-1 were present at lower levels in BCCs  relative  to both SCCs and melanomas. In contrast to u-PA, tissue-plasminogen  activator, which is not thought to be involved in metastasis, was  present  at similar levels in the different types of skin lesion investigated. We 

conclude that the failure of BCCs to metastasise may at least be  partially  related to low expression of components of the u-PA system. Copyright  2000  Wiley-Liss, Inc. 

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6.) Folliculotropic T cells in regressive basal cell carcinoma of skin. 

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Am J Dermatopathol 2000 Feb;22(1):30-3 

Lespi PJ, Gregorini SD 

Department of Pathology, HIGA Dr Jose Penna, Bahia Blanca, Buenos Aires, 

Argentina. 

 

The histologic features of regression may be found in some basal cell  carcinomas (BCCs), and it is known that T-cell infiltrates have a  significant role in host defense against this tumor. We examined 945  hair  follicles (HFs) adjacent to 150 regressing BCCs of skin for the presence  of  inflammatory infiltrates and compared the results against 315 HFs in 50  samples of normal skin. Focal T-cell infiltrates localized mainly to the 

upper portion of the HFs were found in 14.5% of the follicles adjacent  to  regressing BCCs. A statistically significant increase of inflammation in 

HFs was observed in BCCs with active regression compared with BCCs with  inactive and mixed regression (P < 0.05). An increase in the number of  HFs  involved by T lymphocytes was also found in regressing BCCs compared to  normal skin ( P < 0.00005). These data suggest that the damage to the  follicles is concordant with active regression of BCCs. We speculate  that  the immune-mediated regression of BCCs is not only specifically directed  to  the cells of the tumor but may also induce activated lymphocytes with  cytotoxic capability to cross react with the follicular epithelium. 

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7.) Repeated 5-aminolevulinic acid-based photodynamic therapy following  electro-curettage for pigmented basal cell carcinoma. 

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J Dermatol 2000 Jan;27(1):10-5 

Itoh Y, Henta T, Ninomiya Y, Tajima S, Ishibashi A 

Department of Dermatology, National Defense Medical College, Tokorozawa, 

Japan. 

5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) in the 

standard 

manner is ineffective for pigmented basal cell carcinoma (pBCC), because 

melanin absorbs the photoactivating light interred for protoporphyrin 

IX.  The objective of this study was to assess the therapeutic outcome of  pBCCs  with repeated ALA-PDT following removal of pigmentation with  electro-curettage. After electro-curettage, 16 pBCCs were treated with a 

combination of topical application of 20% ALA in O/W emulsion and  topical  instillation of 10% ALA solution, followed by photoactivating light.  ALA-PDT was performed more than three times. Fourteen of 16 pBCCs showed 

CR. Two pBCCs showing PR or NR were excised. Repeated ALA-PDT following  electro-curettage was effective for pBCC. 

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8.) Sporadic Bazex-Dupre-Christol-like Syndrome: Early Onset Basal Cell  Carcinoma, Hypohidrosis, Hypotrichosis, and Prominent Milia. 

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Dermatol Surg 2000 Feb;26(2):152-154 

Glaessl A, Hohenlautner U, Landthaler M, Vogt T 

Department of Dermatology, University of Regensburg, Regensburg, 

Germany. 

BACKGROUND: We present the case of a 32-year-old woman with a large  recurrent multifocal basal cell carcinoma on the scalp. Conspicuous  accompanying symptoms were multiple periorbital milia, hypotrichosis of  the  body and the scalp, and hypohidrosis. The sparse hair of the scalp  showed  further abnormalities such as pili torti, as well as flattened,  irregularly  curly hairs. OBJECTIVE: In 1964, Bazex et al. described a syndrome  characterized by congenital hypotrichosis, follicular atrophoderma, and  basocellular neoplasms that included basal cell nevi and early onset  basal  cell carcinomas. The Bazex-Dupre-Christol syndrome is a rare X-linked  dominant disease. A sporadic occurrence with the typical constellation  of  these symptoms has not yet been reported. The lack of a positive family  history and no signs of follicular atrophoderma argues for a sporadic  occurrence of a Bazex-Dupre-Christol-like syndrome. The case reported  shares several features with the classic Bazex-Dupre-Christol syndrome.  CONCLUSION: Our report documents the necessity to look for early  development of basal cell carcinomas in patients who show signs of the  epidermal malformations described. 

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9.) Reporting basal cell carcinoma: a survey of the attitudes of  histopathologists. 

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J Clin Pathol 1999 Nov;52(11):867-9 

Milroy CJ, Richman PI, Wilson GD, Sanders R 

Restoration of Function and Appearance Trust, Mount Vernon Hospital, 

Northwood, Middlesex, UK. milroy@graylab.ac.uk 

AIMS: To investigate the histopathological reporting of basal cell  carcinoma. METHODS: Methods of classification and attitudes to excision  margins were ascertained from histopathologists in 130 centres; 82  replies  were obtained (63% response rate). RESULTS: 24% of those replying did  not  use any classification system for basal cell carcinoma. The remainder  (76%)  used a wide variety of different classification systems. A small number  (9%) of those questioned felt reporting on completeness of excision was  not  important. The majority of histopathologists considered the excision  margin  was worth reporting but there were differences in methods of processing  and  reporting biopsies. CONCLUSIONS: There is considerable variation in  histopathological reporting of basal cell carcinoma. There is a need for 

uniformity of histopathological reporting to allow both improved  management  decisions and comparative audit of this extremely common skin cancer.   

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10.) Host-related and environmental risk factors for cutaneous basal  cell  carcinoma: evidence from an italian case-control study. 

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J Am Acad Dermatol 2000 Mar;42(3):446-52 

Naldi L, DiLandro A, D'Avanzo B, Parazzini F 

[Medline record in process] 

 

BACKGROUND: Despite its frequency, there is a paucity of data on risk  factors for basal cell carcinoma. OBJECTIVE: We assessed potential risk  factors for basal cell carcinoma in a population from southern Europe.  METHODS: This multicenter case-control study involved 528 newly  diagnosed  cases and 512 controls. RESULTS: In the multivariate analysis, red hair, 

lighter colored eyes, high nevus counts on the upper limbs, and the  presence of solar lentigines and actinic keratoses were all associated  with  basal cell carcinoma. The risk of the tumor increased in subjects who  reported burning easily and experiencing sunburn episodes before 15  years  of age. An association was documented with indices of recreational sun  exposure but no clear evidence of exposure-effect relationship was  found.  No relation was found with occupational sun exposure. Finally, basal  cell  carcinoma appeared to be significantly associated with a family history  of  skin tumors, a personal history of tumors other than those on skin, and  radiotherapy. CONCLUSION: Genetic and environmental factors appear to be 

involved in the onset of basal cell carcinoma. 

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11.) Collagenolytic and gelatinolytic matrix metalloproteinases and  their  inhibitors in basal cell carcinoma of skin: comparison with normal skin. 

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Br J Cancer 2000 Feb;82(3):657-65 

Varani J, Hattori Y, Chi Y, Schmidt T, Perone P, Zeigler ME, Fader DJ, 

Johnson TM 

Department of Pathology, The University of Michigan Medical School, Ann 

Arbor 48109, USA. 

Tissue from 54 histologically-identified basal cell carcinomas of the  skin  was obtained at surgery and assayed using a combination of functional  and  immunochemical procedures for matrix metalloproteinases (MMPs) with  collagenolytic activity and for MMPs with gelatinolytic activity.  Collagenolytic enzymes included MMP-1 (interstitial collagenase), MMP-8  (neutrophil collagenase) and MMP-13 (collagenase-3). Gelatinolytic  enzymes  included MMP-2 (72-kDa gelatinase A/type IV collagenase) and MMP-9  (92-kDa  gelatinase B/type IV collagenase). Inhibitors of MMP activity including  tissue inhibitor of metalloproteinases-1 and -2 (TIMP-1 and TIMP-2) were 

also assessed. All three collagenases and both gelatinases were detected 

immunochemically. MMP-1 appeared to be responsible for most of the  functional collagenolytic activity while gelatinolytic activity  reflected  both MMP-2 and MMP-9. MMP inhibitor activity was also present, and  appeared, based on immunochemical procedures, to reflect the presence of 

TIMP-1 but not TIMP-2. As a group, tumours identified as having  aggressive-growth histologic patterns were not distinguishable from  basal  cell carcinomas with less aggressive-growth histologic patterns. In  normal  skin, the same MMPs were detected by immunochemical means. However, only 

low to undetectable levels of collagenolytic and gelatinolytic  activities  were present. In contrast, MMP inhibitor activity was comparable to that 

seen in tumour tissue. In previous studies we have shown that exposure  of  normal skin to epidermal growth factor in organ culture induces MMP  up-regulation and activation. This treatment concomitantly induces  stromal  invasion by the epithelium (Varani et al (1995) Am J Pathol 146:  210-217;  Zeigler et al (1996b) Invasion Metastasis 16: 11-18). Taken together  with  these previous data, the present findings allow us to conclude that the  same profile of MMP/MMP inhibitors that is associated with stromal  invasion  in the organ culture model is expressed endogenously in basal cell  carcinomas of skin. 

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12.) A Cancer-Registry-Assisted Evaluation of the Accuracy of Digital  Epiluminescence Microscopy Associated with Clinical Examination of  Pigmented Skin Lesions. 

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Dermatology 2000;200(1):11-16 

Stanganelli I, Serafini M, Bucch L 

Skin Cancer Clinic, Center for Cancer Prevention, Department of 

Prevention, 

Ravenna Health Care District, Ravenna, Italy. 

BACKGROUND: The accuracy of digital epiluminescence microscopy (D-ELM)  as  an adjunct to clinical examination for the diagnosis of pigmented skin  lesions (PSLs) has seldom been evaluated. OBJECTIVE: To compare the  accuracy of the combined clinical/D-ELM (C/D-ELM) examination with that  of  the clinical examination alone. METHODS: A total of 3,372 PSLs from  1,556  consecutive patients referred to a skin cancer clinic underwent clinical 

examination and a combined C/D-ELM examination. The reference diagnosis  was  established using the histology report of known surgical excisions plus  a  cancer-registry-based follow-up (duration 18 months) of benign C/D-ELM  diagnoses. The two diagnostic approaches were compared for sensitivity,  predictive value and false-positive rate. RESULTS: The series included  55  melanomas and 43 basal cell carcinomas. About 50% of malignant  misdiagnosed  cases were identified solely through the cancer registry. The C/D-ELM  diagnosis showed a greater sensitivity for melanoma <0.76 mm thick (83  vs.  46% for clinical examination alone; ratio, 1.82) and basal cell  carcinoma  (79 vs. 49%; ratio, 1.62), a greater predictive value for melanoma (81  vs.  53%; ratio, 1.53) and a reduced total false-positive rate (0.3 vs. 0.9%; 

ratio, 0.31). CONCLUSION: D-ELM showed a potential to improve the  clinical  diagnosis of PSL. Copyright (R) 2000 S.Karger AG, Basel 

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13.) Expression of p53 in arsenic-related and sporadic basal cell  carcinoma. 

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Arch Dermatol 2000 Feb;136(2):195-8 

Boonchai W, Walsh M, Cummings M, Chenevix-Trench G 

The Queensland Institute of Medical Research, University of Queensland, 

Brisbane, Australia. 

BACKGROUND: The TP53 gene has been shown to have an important role in  the  genesis of sporadic, presumably mainly sunlight-related, basal cell  carcinoma (BCC). However, its role in arsenic-related BCCs is not clear, 

although the trivalent form of arsenic has been long recognized as a  cause  of BCC. Arsenic treatment has been shown to cause hypermethylation of  the  TP53 gene in lung carcinoma cell lines, but it is not known if this  occurs  in vivo in arsenic-related BCCs. OBJECTIVE: To compare the  immunohistochemical expression of the p53 protein in arsenic-related and 

sporadic BCCs to determine if the expression pattern is consistent with  gene silencing. SETTING: A research institute and hospital in Australia. 

CASES: One hundred seventeen white patients with 121 sporadic BCCs and  21  white patients with 92 arsenic-related BCCs. MAIN OUTCOME MEASURES: The  expression and the intensity of p53 were scored semiquantitatively.  Statistical analysis was performed using the chi2 test. RESULTS:  Arsenic-related BCCs express p53 less often and at a lower intensity  than  sporadic BCCs (P = .001; 2-tailed test). The BCCs from sun-exposed  sites,  whether arsenic related or sporadic, more frequently showed  overexpression  of p53 than those from less-exposed areas (P = .004; 2-tailed test). T

he  more aggressive subtypes of BCC show a higher level of expression of p53  than the less aggressive forms (P = .04; 2-tailed chi2 test).  CONCLUSIONS:  These results are consistent with the hypothesis that the TP53 gene is  down-regulated by methylation in arsenic-related BCC, particularly those  from less-exposed sites. However, an alternative possibility is that  mutations in TP53 that stabilize the protein are less common in  arsenic-related BCCs. Further analysis will be necessary to distinguish  between these hypotheses. 

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14.) Decision support software to help primary care physicians triage  skin  cancer: a pilot study. 

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Arch Dermatol 2000 Feb;136(2):187-92 

Gerbert B, Bronstone A, Maurer T, Hofmann R, Berger T 

Division of Behavioral Sciences, School of Dentistry, University of  California, San Francisco 94111, USA. gerbert@itsa.ucsf.edu 

OBJECTIVE: To determine whether decision support software can help  primary  care physicians proficiently triage lesions suggestive of basal cell and  squamous cell carcinoma. DESIGN/MEASURES: Physicians selected triage  options for 15 digitized images of skin lesions, with and without use of  the decision support software.

PARTICIPANTS/SETTINGS:

Twenty primary  care  physicians practicing in a health maintenance organization or a city  health  clinic.

INTERVENTION:

Decision support software designed to help  physicians  arrive at a triage recommendation consisted of a clinical information  form,  a decision tree, and support features (teaching points, example images,  and  diagrams).

RESULTS: Without using the decision support software,  physicians  chose the wrong triage decision 36.7% of the time; using the decision  support software, they chose the wrong response only 13.3% of the time.  Not  using the decision support software, they failed to correctly perform a  biopsy on or refer patients with cancerous lesions 22.1% of the time;  using  the software, they failed to correctly perform a biopsy on or refer  patients with cancerous lesions only 3.6% of the time. Physicians scored  an  average of 3 points (of a possible 15 points) higher when they used the  software (signed rank, 101.0; P<.001). They scored an average of 1 point 

higher on the 7 cancerous lesions when they used the software (signed  rank,  65.5; P<.001).

CONCLUSIONS:

Use of decision support software could  improve  primary care physicians' triage decisions for lesions suggestive of  nonmelanoma skin cancer, and potentially reduce morbidity and health  care  costs. We are designing a larger study to evaluate the accuracy and  utility  of the software with patients seen in clinical practice. 

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15.) A randomized, 12-year primary-prevention trial of beta carotene  supplementation for nonmelanoma skin cancer in the physician's health  study. 

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Arch Dermatol 2000 Feb;136(2):179-84 

Frieling UM, Schaumberg DA, Kupper TS, Muntwyler J, Hennekens CH 

Division of Preventive Medicine, Brigham and Women's Hospital, Harvard 

Medical School, Boston, Mass, USA. 

CONTEXT: Although basic research provides plausible mechanisms for  benefits  of beta carotene supplementation on nonmelanoma skin cancer (NMSC)  primarily consisting of basal cell carcinoma (BCC) and squamous cell  carcinoma (SCC), observational studies are inconsistent. Randomized  trial  data are limited to 1 trial of secondary prevention that showed no  effect  of beta carotene on the incidence of NMSC after 5 years.

OBJECTIVE: To  test  whether supplementation with beta carotene reduces the risk for  development  of a first NMSC, including BCC and SCC.

DESIGN: Randomized,  double-blind,  placebo-controlled trial with 12 years of beta carotene supplementation  and  follow-up. SETTING: Physicians' Health Study in the United States. 

 PARTICIPANTS: Apparently healthy male physicians aged 40 to 84 years in  1982 (N = 22 071). INTERVENTION: Beta carotene, 50 mg, on alternate  days.  MAIN OUTCOME MEASURE: Relative risk (RR) and 95% confidence interval  (CI)  for a first NMSC, BCC, and SCC. RESULTS: After adjusting for age and  randomized aspirin assignment, there was no effect of beta carotene on  the  incidence of a first NMSC (RR, 0.98; 95% CI, 0.92-1.05), BCC (RR, 0.99;  95%  CI, 0.92-1.06), or SCC (RR, 0.97; 95% CI, 0.84-1.13). There was also no  significant evidence of beneficial or harmful effects of beta carotene  on  NMSC by smoking status (current, past, or never).

CONCLUSION: This  large-scale, randomized, primary prevention trial among apparently  healthy  well-nourished men indicates that an average of 12 years of  supplementation  with beta carotene does not affect the development of a first NMSC,  including BCC and SCC. 

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16.) Photofrin photodynamic therapy can significantly deplete or  preserve  oxygenation in human basal cell carcinomas during treatment, depending  on  fluence rate. 

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Cancer Res 2000 Feb 1;60(3):525-9 

Henderson BW, Busch TM, Vaughan LA, Frawley NP, Babich D, Sosa TA, Zollo 

JD, Dee AS, Cooper MT, Bellnier DA, Greco WR, Oseroff AR 

Photodynamic Therapy Center, Roswell Park Cancer Institute, Buffalo, New 

York 14263, USA. 

At high fluence rates in animal models, photodynamic therapy (PDT) can  photochemically deplete ambient tumor oxygen through the generation of  singlet oxygen, causing acute hypoxia and limiting treatment  effectiveness.  We report that standard clinical treatment conditions (1 mg/kg  Photofrin,  light at 630 nm and 150 mW/cm2), which are highly effective for treating 

human basal cell carcinomas, significantly diminished tumor oxygen  levels  during initial light delivery in a majority of carcinomas. Oxygen  depletion  could be found during at least 40% of the total light dose, but tumors  appeared well oxygenated toward the end of treatment. In contrast,  initial  light delivery at a lower fluence rate of 30 mW/cm2 increased tumor  oxygenation in a majority of carcinomas. Laser treatment caused an  intensity- and treatment time-dependent increase in tumor temperature.  The  data suggest that high fluence rate treatment, although effective, may  be  inefficient. 

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17.) Gamma-irradiation deregulates cell cycle control and apoptosis in  nevoid basal cell carcinoma syndrome-derived cells. 

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Jpn J Cancer Res 1999 Dec;90(12):1351-7 

Fujii K, Miyashita T, Takanashi J, Sugita K, Kohno Y, Nishie H, Yasumoto 

S, 

Furue M, Yamada M 

Department of Genetics, National Children's Medical Research Center, 

Tokyo. 

The nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal  dominant  disorder characterized by nevi, palmar and plantar pits, falx  calcification, vertebrate anomalies and basal cell carcinomas. It is  well  known in NBCCS that gamma-irradiation to the skin induces basal cell  carcinomas or causes an enlargement of the tumor size, although the  details  of the mechanism remain unknown. We have established lymphoblastoid cell 

lines from three NBCCS patients, and we present here the first evidence  of  abnormal cell cycle and apoptosis regulations. A novel mutation (single  nucleotide deletion) in the coding region of the human patched gene,  PTCH,  was identified in two sibling patients, but no apparent abnormalities  were  detected in the gene of the remaining patient. Nevertheless, the three  established cell lines showed similar features in the following  analyses.  Flow cytometric analyses revealed that the NBCCS-derived cells were  accumulated in the G2M phase after gamma-irradiation, whereas normal  cells  showed cell cycle arrest both in the G0G1 and G2M phases. The fraction  of  apoptotic cells after gamma-irradiation was smaller in the NBCCS cells.  The  level of p27 expression markedly decreased after gamma-irradiation in  the  NBCCS cells, although the effects of the irradiation on the expression  profiles for p53, p21 and Rb did not differ in normal and NBCCS cells.  These findings may provide a clue to the molecular mechanisms of  tumorigenesis in NBCCS. 

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18.) Expression of desmoglein I and plakoglobin in skin carcinomas. 

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J Cutan Pathol 2000 Jan;27(1):24-9 

Tada H, Hatoko M, Tanaka A, Kuwahara M, Muramatsu T 

Division of Plastic Surgery, Nara Medical University, Japan. 

Reduction or absence of cell-cell adhesion molecules has been reported  in  various carinomas and the abnormal expression of these molecules  contributes to the invasive and metastatic behavior of malignant tumor  cells. In epidermal keratinocytes, the main cell-cell adhesion systems  are  adherens junctions and desmosomes. Previous studies have shown that, in  skin carcinomas, the decreased expression of E-cadherin, major  constitutional glycoprotein of adherens junctions, is associated with  the  invasive and metastatic ability of the tumor cells. In the present  study,  we examined the expression of desmoglein I and plakoglobin, the  constitutional components of desmosomes, in various skin carcinomas such  as  basal cell carcinoma (BCC), squamous cell carcinoma (SCC), extramammary  Paget's disease and Bowen's disease by an immunofluorescence method. In  normal human skin, desmoglein I and plakoglobin were strongly expressed  in  the intercellular space of the epidermis except for the basal cell  layer.  In BCC and SCC, the expression of desmoglein I and plakoglobin was  markedly  reduced or absent in tumor cells.

 In carcinoma in situ of Paget's  disease,  compared with the normal epidermal cells surrounding tumor cell nests,  the  expression of these molecules was reduced in tumor cells. In Paget's  disease with dermal infiltration of tumor cells, the expression of these  molecules was almost absent throughout the epidermis. In Bowen's  disease,  the expression of desmoglein I was reduced in the dumping cells and  dyskeratotic cells. These results suggest that the expression of  desmosomal  cadherin is reduced or absent in human skin carcinomas, and that  reduction  of these molecules may also contribute to the invasiveness and  metastasis  of skin carcinomas. 

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19.) Expression of basement membrane antigens and matrix  metalloproteinases  2 and 9 in cutaneous basal and squamous cell carcinomas. 

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Anticancer Res 1999 Jul-Aug;19(4B):2929-38 

Dumas V, Kanitakis J, Charvat S, Euvrard S, Faure M, Claudy A 

INSERM U346, Lyon, France. 

BACKGROUND: Basement membrane (BM) antigens and matrix  metalloproteinases  (MMP) are involved in tumor invasion and metastasis. Basal (BCC) and  squamous cell carcinomas (SCC) differ with respect to their biological  behavior since the former are only locally aggressive whereas the latter 

have a metastatic potential. MATERIALS AND METHODS:

We studied the  immunohistochemical expression of several BM antigens and of MMP2 and  MMP9,  in 13 BCC, 13 SCC, and 8 in situ skin carcinomas. RESULTS: The  expression  of most BM antigens was reduced in the tumors in comparison with normal  skin. Hemidesmosome- and lamina lucida-associated antigens (plectin,  NUT2,  alpha 6/CD49f and laminin-5) were more decreased in BCC, whereas  collagens  type VII and IV were more decreased in SCC as compared with BCC; in BCC  and  SCC both collagens tended to be decreased on the leading edge of  invasive  tumor masses. In situ carcinomas showed a slightly diminished expression  of  alpha 6/CD49f integrin, plectin and NUT2. The expression of both MMP2  and  MMP9 was increased in SCC as compared with BCC.

CONCLUSION: Our findings  further upheld the role of BM antigens and MMPs in the process of tumor  aggressiveness. The reduced expression of collagen IV, combined with an  increased expression of both MMP2 and MMP9 could account for the  increased  metastatic potential of SCC vs BCC through an increased invasion of the  extracellular matrix and the vascular space. 

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20.) Detoxifying enzyme genotypes and susceptibility to cutaneous  malignancy. 

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Br J Dermatol 2000 Jan;142(1):8-15 

Lear JT, Smith AG, Strange RC, Fryer AA 

Department of Dermatology, Clinic 6, Bristol Royal Infirmary, Bristol 

BS2 

8HW, U.K.; *Department of Dermatology, North Staffordshire NHS Trust,  Stoke  on Trent ST4 7PA, U.K.; Department of Dermatology, Centre for Cell and  Molecular Medicine, School of Postgraduate Medicine, Keele University,  North Staffordshire Hospital, Stoke on Trent ST4 7PA, U.K. 

While ultraviolet (UV) exposure is thought to be a major risk factor for  basal cell carcinoma (BCC) and squamous cell carcinoma, more recent  research has focused on genetic factors predisposing to these cancers.  UV  constitutes an oxidative stress with generation of free radicals,  leading  to lipid and DNA damage and gene mutation. It could therefore be  hypothesized that individual ability to deal with these products may be  important in cutaneous carcinogenesis. It is clear from recent studies  that  polymorphisms in detoxifying enzyme genes are important in determining  susceptibility to skin cancer.

 The magnitude of effect in BCC is similar  to  that seen with many other previously described risk factors. However,  uncertainties exist regarding the phenotypic consequences of some of  these  polymorphisms and relevant substrates. This review describes the  influence  of polymorphisms in detoxifying enzymes in determining susceptibility to  skin cancer (in particular to BCC) and give a brief overview of the  biochemistry of the detoxification process. 

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21.) Tumors arising in nevus sebaceus: A study of 596 cases. 

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J Am Acad Dermatol 2000 Feb;42(2 Pt 1):263-8 

Cribier B, Scrivener Y, Grosshans E 

Laboratoire d'Histopathologie Cutanee, Clinique Dermatologique des 

Hopitaux 

Universitaires de Strasbourg, France. 

BACKGROUND: Prophylactic surgical excision of nevus sebaceus (NS) during  childhood is often recommended because various neoplasms can occur on  NS.  The proportion of malignant tumors occurring on NS is highly variable  among  the published series, and there are controversies on the nature of these  neoplasms because many of the previously described basal cell carcinomas  could actually be trichoblastomas, which are benign follicular tumors. 

OBJECTIVE: We retrospectively analyzed all cases of NS of our  collection,  excised during the period from 1932 through 1998, and recorded all  associated epithelial and nonepithelial changes. We especially  differentiated basal cell carcinomas from trichoblastomas by silhouette  analysis and examination of the stroma. These findings were analyzed  according to gender, age, and localization.

METHODS:

Microscopic  analysis  of NS by two examiners was performed independently of clinical data. 

RESULTS:

A total of 596 cases were included from 290 females and 306  males,  mean age 25.4 years (range, 1 month to 87 years); 232 were excised in  children younger than 16 years. NSs were located on the scalp in 49.8%  of  cases. Basal cell carcinomas were found in 5 cases (0.8%, mean age 39.3  years) and benign tumors in 81 cases (13.6%, mean age 46.3 years).  Syringocystadenoma papilliferum (n = 30, 15 males, 15 females) and  trichoblastoma (n = 28, 7 males, 21 females) were the most frequent  benign  tumors. NS with associated tumors were located on the scalp in 79% of  cases. Only 4 benign tumors (1.7%) and 2 warts were observed in patients  younger than 16 years. Various types of epithelial hyperplasia were  noted  that could not be considered neoplasms, as well as epidermal and  apocrine  cysts.

CONCLUSION:

The rate of malignant tumors arising on NS was very  low  and we did not observe such cases in children, who had associated benign  tumors in only 1.7% of cases. Benign neoplasms were common and most of  them  occurred on the scalp; this was not a bias resulting from a longer  duration  before surgery. Trichoblastoma and not basal cell carcinoma was the most  frequent follicular tumor associated with NS and showed a striking  female  predominance. Most trichoblastomas had previously been misdiagnosed but  could actually be easily recognized by typical histologic features.  Because  most tumors occurred in adults older than 40 years, our study suggests  that  prophylactic surgery in young children is of uncertain benefit. Clinical  follow-up is probably sufficient, and even those cases with clinical  changes often proved to be benign tumors or warts. 

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22.) Liposome-mediated gene transfer into human basal cell carcinoma. 

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Gene Ther 1999 Dec;6(12):1929-35 

Hottiger MO, Dam TN, Nickoloff BJ, Johnson TM, Nabel GJ  Howard Hughes Medical Institute, University of Michigan Medical Center,  Departments of Internal Medicine and Biological Chemistry, Ann Arbor,  MI,  USA. 

Direct intralesional injection of DNA encoding interferon-alpha2  (IFN-alpha2) was used in an effort to sustain local protein delivery for  the treatment of human basal cell carcinoma (BCC). A novel model to  study  this malignancy was established by transplantation of human BCC tissue  on  to immunodeficient mice with a relatively high rate of engraftment and  stable phenotype for superficial BCC (20 of 25; 80%). Gene transfer was  significantly increased by using DNA liposome complexes (lipoplexes).  Recombinant gene expression was detected predominantly in the epidermis  and, to a lesser extent, in the dermis. Gene transfer of IFN-alpha2  using  this method resulted in sustained production of IFN-alpha2 protein and  increased expression of a known IFN-inducible gene, the class II major  histocompatibility (MHC) antigen, and induced BCC regression, presumably  through a non-immune mechanism. Intralesional injection of DNA  lipoplexes  encoding IFN-alpha protein may therefore be applicable to the treatment  of  cutaneous BCC. 

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23.) Proliferative Actinic Keratosis: Three Representative Cases. 

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Dermatol Surg 2000 Jan;26(1):65-69 

Goldberg LH, Chang JR, Baer SC, Schmidt JD 

OBJECTIVE:

 This article describes a new subtype of actinic keratosis  that  exhibits proliferative characteristics both histologically and  clinically.  We describe three representative cases occuring in the presence of  infiltrative squamous cell carcinoma (SCC) and/or basal cell carcinoma  (BCC).

METHODS: Histories of each lesion in the three cases discussed  were  obtained. The lesions were removed by Mohs micrographic surgery.  Permanent  sections, stained with hematoxylin and eosin, were examined and studied  under light microscopy.

RESULTS: All three lesions had failed  conventional  treatment with liquid nitrogen and/or 5-fluorouracil (5-FU). Histologic  examination of the lesions revealed sheets of dysplastic cells growing  along the basal layer of the epidermis and migrating down hair follicles  and sweat ducts. An associated infiltrative SCC and/or BCC was found in  each case.

 CONCLUSIONS: Proliferative actinic keratosis is resistant to  standard therapies because of deep migration of abnormal cells along  hair  follicles and sweat ducts. It has a strong propensity to develop  infiltrative SCC and may occur concomitantly with BCC. 

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24.) Diet and basal cell carcinoma of the skin in a prospective cohort  of men. 

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Am J Clin Nutr 2000 Jan;71(1):135-41 

van Dam RM, Huang Z, Giovannucci E, Rimm EB, Hunter DJ, Colditz GA,  Stampfer MJ, Willett WC  Departments of Nutrition and Epidemiology, Harvard School of Public  Health, 

Boston, MA 02115, USA. 

BACKGROUND: Low intake of fat and high intake of specific vitamins have  been hypothesized to reduce risk of basal cell carcinoma of the skin  (BCC). 

OBJECTIVE:

Our objective was to examine intakes of fat, antioxidant  nutrients, retinol, folate, and vitamin D in relation to risk of BCC.  DESIGN: In 1986, diet was assessed by a validated food-frequency  questionnaire in 43217 male participants of the Health Professionals  Follow-up Study who were 40-75 y of age and free of cancer. During 8 y  of  follow-up, we ascertained 3190 newly diagnosed cases of BCC.

RESULTS: 

Total  fat consumption was associated with a lower risk of BCC [relative risk  (RR): 0.81; 95% CI: 0.72, 0.90 for the highest compared with the lowest  quintile of intake; P for trend < 0.001). Simultaneous modeling of  specific  fatty acids suggested that this inverse association was limited to  monounsaturated fat (RR: 0.79; 95% CI: 0.65, 0.96; P for trend = 0. 02);  saturated and polyunsaturated fat were not associated with BCC risk.  Folate  intake was associated with a slightly higher risk of BCC (RR: 1.19; 95%  CI:  1.01, 1.40; P for trend = 0.11), whereas alpha-carotene was associated  with  a slightly lower risk (RR: 0.88; 95% CI: 0.79, 0.99; P for trend =  0.01).  Intakes of long-chain n-3 fatty acids, retinol, vitamin C, vitamin D, or  vitamin E were not materially related to BCC risk.

CONCLUSIONS:

 These  findings do not support the hypothesis that diets low in fat or high in  specific vitamins lower risk of BCC. 

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25.) Preliminary observations on the use of topical tazarotene to treat  basal-cell carcinoma. 

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N Engl J Med 1999 Dec 2;341(23):1767-8 

Peris K, Fargnoli MC, Chimenti S 

Publication Types: 

Letter 

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26.)HLA phenotypes and multiple basal cell carcinomas. 

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SO  - Dermatology  1994;189(3):222-4 

AU  - Rompel R; Petres J; Kaupert K; Mueller-Eckhardt G 

PT  - JOURNAL ARTICLE 

AB  - BACKGROUND: Previous investigators noted an association of  multiple 

basal cell carcinomas (BCC) with certain HLA antigens; however, these  findings were contradictory, and the associations were only weak. 

OBJECTIVE: The aim of the study was to objectify the previously found  associations.

METHODS: Serologic HLA typing for class I and class II  antigens was performed in 49 unrelated patients with 5 or more BCCs.  RESULTS: HLA-DR4 showed decreased frequencies in the patient group as  compared with healthy controls (n = 716). Cw7 was found to be increased  in  the total group of patients as well as in a subgroup with multiple BCCs  of  the face (n = 24), while a subgroup with BCCs mainly on the trunk (n =  25)  revealed increased frequencies of HLA-A11, -B17, -B22 and -Cw3. However,  none of these deviations appeared significant after correction of p  values. 

 CONCLUSION: We conclude that, if at all, the HLA system plays only a  minor  role in the development of multiple BCCs. 

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27.) Multiple non-melanoma skin cancer: evidence that different MHC  genes  are associated with different cancers. 

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SO  - Dermatology  1994;188(2):88-90 

AU  - Czarnecki D; Tait B; Nicholson I; Lewis A 

PT  - JOURNAL ARTICLE 

AB  - HLA DR frequencies of patients with multiple non-melanoma skin  cancers were analysed. There were significant differences in the  frequencies of HLA DR1, DR4 and DR7 between patients who only had basal  cell carcinomas and patients who had both basal and squamous cell  carcinomas. There were significant differences in the frequency of HLA  DR53  between the two groups. This antigen is in linkage disequilibrium with  HLA  DR4 and DR7, and it is not possible to distinguish the primary  susceptibility locus. 

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28.) HLA DR4 is associated with the development of multiple basal cell  carcinomas and malignant melanoma. 

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SO  - Dermatology  1993;187(1):16-8 

AU  - Czarnecki D; Nicholson I; Tait B; Nash C 

PT  - JOURNAL ARTICLE 

AB  -

An association between HLA DR4 and the development of multiple  basal  cell carcinomas (BCC) and malignant melanoma (MM) was detected in  southern  Australia. There were highly significant differences in HLA DR  frequencies  between patients with multiple BCCs and MM and matched patients with  multiple BCCs only. These findings suggest that hereditary factors  associated with the HLA system influence what types of multiple skin  cancers people develop. 

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29.) Multiple basal cell carcinoma in tropical Australia. 

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SO  - Int J Dermatol  1992 Sep;31(9):635-6 

AU  - Czarnecki D; Collins N; Chow P; Nicholson I; Tait B 

PT  - JOURNAL ARTICLE 

AB  - No association between HLA DR1 and the development of multiple  basal  cell carcinomas (BCC) was found among patients who had lived at least  two-thirds of their lives in the tropics. The percentage of patients  with  multiple BCCs increased with age; this was different from what has been  found in people living in the temperate zone of Australia. 

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30.) HLA-DR1 is not a sign of poor prognosis for the development of  multiple basal cell carcinomas. 

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SO  - J Am Acad Dermatol  1992 May;26(5 Pt 1):717-9 

AU  - Czarnecki D; Lewis A; Nicholson I; Tait B; Nash C 

PT  - JOURNAL ARTICLE 

AB  - BACKGROUND: HLA-DR1 is associated with the development of multiple  basal cell carcinomas (BCC). However, the association is weak. 

OBJECTIVE:  The purpose of our study was to determine whether HLA-DR1 is a marker  for  susceptibility to the development of many BCCs during a lifetime. 

METHODS:  Persons with multiple BCCs were placed into two groups: those with less  than 10 and those with 20 or more. In addition, the HLA-DR1 frequencies  were analyzed. RESULTS: HLA-DR1 was associated with multiple BCCs in the 

group with less than 10 BCCs but not with the other group. These  patients  were significantly younger on average than those with 20 or more BCCs. 

 CONCLUSION: HLA-DR1 is associated with the development of multiple BCCs  at  an early age but it is not associated with development of large numbers  of  BCCs. The amount of UV light a person receives appears to be more  important. 

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31.) Multiple basal cell carcinomas and HLA frequencies in southern  Australia. 

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SO  - J Am Acad Dermatol  1991 Apr;24(4):559-61 

AU  - Czarnecki D; Lewis A; Nicholson I; Tait B 

PT  - JOURNAL ARTICLE 

AB 

 - An association between HLA-DR1 and the development of multiple  basal  cell carcinomas was detected in southern Australia. A reduction in  HLA-DR4  was found in patients with basal cell carcinoma compared with a local  control group. The relative risk for HLA-DR1 was 2.1, which was lower  than  that for persons in farther countries from the equator. 

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32.) Expression of human lymphocyte antigen (HLA)-DR on tumor cells in  basal cell carcinoma. 

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SO  - J Am Acad Dermatol  1987 Apr;16(4):833-8 

AU  - Kohchiyama A; Oka D; Ueki H 

PT  - JOURNAL ARTICLE 

AB  - Immunohistologic studies of eight patients with basal cell  carcinoma  were undertaken using a series of monoclonal antibodies. In all of the  patients, the majority of dermal infiltrates reacted with OKT3 and OKIa1 

(HLA-DR), with a slight predominance of OKT4+ helper/inducer T cells  (the  mean OKT4/OKT8 ratio was 1.8). Both OKT4+ and OKT8+ cells were seen  infiltrating the tumor masses. In addition, in five cases, human  lymphocyte  antigen (HLA)-DR was demonstrated on some tumor cells close to a vast  number of HLA-DR+ infiltrates surrounding the carcinoma, but not on  epidermal keratinocytes and tumor cells devoid of the HLA-DR+  infiltrates.  A considerable number of OKT6+ dendritic cells were also observed  surrounding the carcinoma. Staining with OKB7 and OKM1 revealed  negligible  reactive cells, and virtually none of the dermal infiltrates reacted  with  Leu-7 (HNK-1). These findings suggest that in addition to varied  immunologically competent cells, expression of HLA-DR antigen on tumor  cells may participate in a cellular immune reaction, a defense mechanism  against tumor cell proliferation in basal cell carcinoma. 

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33.) Human leukocyte antigen associations in basal cell carcinoma. 

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SO  - J Am Acad Dermatol  1985 Jun;12(6):997-1000 

AU  - Myskowski PL; Pollack MS; Schorr E; Dupont B; Safai B 

PT  - JOURNAL ARTICLE 

AB  - Basal cell carcinoma is the most common form of skin cancer and is 

one in which both host and environmental factors are thought to play a 

role  in its pathogenesis. For an investigation of the role of human leukocyte  antigen (HLA)-associated variations in genetic susceptibility,  thirty-one  patients with multiple basal cell carcinomas were typed for HLA-A, B, C,  and DR antigens. Patients were compared with both local and appropriate  ethnic group controls. No statistically significant association with  HLA-A,  B, or C antigens was noted in any group. However, a significant increase  in  HLA-DR1 was noted in non-Irish, non-Ashkenazi patients. A tendency  toward a  decrease in HLA-DR3 was also noted among patients of Irish or Ashkenazi  Jewish descent. The role of HLA-associated genetic factors in this form  of  skin cancer needs further investigation. 

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34.) Translocation (4; 14) and concomitant inv(14) in a basal cell  carcinoma. 

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SO  - Cancer Genet Cytogenet  1991 Oct 15;56(2):177-80 

AU  - Kawasaki RS; Caldeira LF; Andre FS; Gasques JA; Castilho WH; 

Bozola 

AR; Thome JA; Tajara EH 

PT  - JOURNAL ARTICLE 

AB  - Chromosome analysis of short-term cultures from a basal cell  carcinoma was performed. The analyzed karyotypes showed a pseudodiploid  clone characterized by a der(4)t(4; 14) (p14; p11) and a concomitant  inversion of the same chromosome 4 involved in the t(4; 14) with the  breakpoints at p14 and q25. 

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35.) Long-term therapy with low-dose isotretinoin for prevention of  basal  cell carcinoma: a multicenter clinical trial. Isotretinoin-Basal Cell  Carcinoma Study Group [see comments] 

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SO  - J Natl Cancer Inst  1992 Mar 4;84(5):328-32 

AU  - Tangrea JA; Edwards BK; Taylor PR; Hartman AM; Peck GL; Salasche  SJ; 

Menon PA; Benson PM; Mellette JR; Guill MA; et al 

PT  - CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED  CONTROLLED TRIAL 

AB  - BACKGROUND:

High-dose isotretinoin has been reported to have a  prophylactic effect on nonmelanoma skin cancer, although it is  associated  with significant toxicity. PURPOSE: To test the effectiveness of the  long-term administration of low-dose isotretinoin in reducing the  occurrence of basal cell carcinoma at a new site in patients with  previously treated basal cell carcinomas and to measure the toxicity  associated with this regimen, we conducted a clinical trial at eight  cancer  centers.

METHODS: Nine hundred and eighty-one patients with two or more  previously confirmed basal cell carcinomas were randomly assigned to  receive either 10 mg of isotretinoin or a placebo daily. Patients were  followed for 36 months and monitored at 6-month intervals for skin  cancer  and toxic effects.

RESULTS: After 36 months of treatment, no  statistically  significant difference in either the cumulative percent of patients with  an  occurrence of basal cell carcinoma at a new site or the annual rate of  basal cell carcinoma formation existed between patients receiving  isotretinoin and those receiving the placebo. Elevated serum  triglycerides,  hyperostotic axial skeletal changes, and mucocutaneous reactions were  more  frequent in the group receiving isotretinoin than in the control group,  and  these differences were all statistically significant (P less than .001). 

CONCLUSION: This low-dose regimen of isotretinoin not only is  ineffective  in reducing the occurrence of basal cell carcinoma at new sites in  patients  with two or more previously treated basal cell carcinomas but also is  associated with significant adverse systemic effects.

IMPLICATION: The  toxicity associated with the long-term administration of isotretinoin,  even  at the low dose used in this trial, must be weighted in planning future  prevention trials. 

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36.) Treatment and prevention of basal cell carcinoma with oral  isotretinoin. 

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SO  - J Am Acad Dermatol  1988 Jul;19(1 Pt 2):176-85 

AU  - Peck GL; Di Giovanna JJ; Sarnoff DS; Gross EG; Butkus D; Olsen TG; 

Yoder FW 

PT  - JOURNAL ARTICLE 

AB  - Twelve patients with multiple basal cell carcinomas resulting from  varying causes were treated with high-dose oral isotretinoin (mean daily  dosage: 3.1 mg/kg/day) for a mean of 8 months. Of the 270 tumors  monitored  in these patients, only 8% underwent complete clinical and histologic  regression. All patients developed moderate to severe acute toxicities,  leading five patients to withdraw from the study. Retinoid skeletal  toxicity was identified in two patients who were examined after  long-term  therapy. Lower doses of isotretinoin (0.25 to 1.5 mg/kg/day) were  ineffective for chemotherapy but demonstrated a chemopreventive effect  in a  subset of three patients who received these lower doses for 3 to 8  years.  Two of these three patients have been observed after discontinuation of  therapy. In one patient with a history of arsenic exposure, only one new  tumor has appeared in a 27-month posttreatment observation period; in  the  other patient with the nevoid basal cell carcinoma syndrome, 29 new  tumors  have appeared within a 13-month period. This suggests that the need for  long-term maintenance therapy with isotretinoin for chemoprevention of  basal cell carcinoma may depend on the underlying cause of the skin  cancers. 

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37.) Chemoprevention of basal cell carcinoma with isotretinoin. 

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SO  - J Am Acad Dermatol  1982 Apr;6(4 Pt 2 Suppl):815-23 

AU  - Peck GL; Gross EG; Butkus D; Di Giovanna JJ 

PT  - JOURNAL ARTICLE  AB  -

 Three patients with multiple basal cell carcinomas, due either to  excessive sunlight exposure, the nevoid basal cell carcinoma syndrome,  or  arsenical insecticide exposure, were treated with oral isotretinoin for  2  1/2 to 4 years. Although higher doses were used initially, approximately  1.5 mg/kg/day was used for long-term therapy in all three patients.  Therapeutic effects on existing tumors varied between each patient, and  only nine of sixty-five lesions underwent complete clinical regression.  No  tumors enlarged in two patients; a few tumors enlarged slightly in the  third patient, particularly during the later courses of therapy when  isotretinoin was given at lower dosage. No new lesions have been  observed  in any of these three patients. With these encouraging preliminary data,  it  now may be appropriate to perform larger trials for longer periods of  time  to determine the usefulness of isotretinoin in the chemoprevention of  basal  cell carcinoma in patients with multiple tumors. 

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38.) Chemoprevention of skin cancer in xeroderma pigmentosum. 

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SO  - J Dermatol  1992 Nov;19(11):715-8 

AU  - Kraemer KH; Di Giovanna JJ; Peck GL 

PT  - JOURNAL ARTICLE 

AB  - Xeroderma pigmentosum is a rare recessive disease with sun  sensitivity, increased freckling and defective DNA repair. Xeroderma  pigmentosum patients have more than a 1000-fold increased risk of  developing skin cancer including basal cell carcinoma, squamous cell  carcinoma and melanoma. We studied chemoprevention of new skin cancers  with  oral retinoids in xeroderma pigmentosum patients who had multiple skin  cancers. Xeroderma pigmentosum patients were cleared of all pre-existing  tumors surgically and then treated with high dose (2 mg/kg/day) oral  isotretinoin (13-cis retinoic acid, Accutane) for two years and then for  one year off treatment. Patients were examined at regular intervals for  new  tumor formation and for side effects. Five xeroderma pigmentosum  patients  had a total of 121 basal or squamous cell carcinomas in 2 years before  treatment and only 25 tumors during 2 years of treatment. The tumor  frequency increased 8.5-fold after the drug was discontinued (New Engl J  Med 318: 1633-1637, 1988). Toxicity (cutaneous, triglyceride,  liver-function or skeletal abnormalities) prompted subsequent use of a  low  dose protocol. Patients were treated initially with 0.5 mg/kg/day oral  isotretinoin and the dose was increased sequentially to 1.0 or 1.5  mg/kg/day. We found that toxicity was less with the lower doses. The  lowest  effective, least toxic dose varied among the xeroderma pigmentosum  patients. 

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39.) Relative importance of prior basal cell carcinomas, continuing sun  exposure, and circulating T lymphocytes on the development of basal cell  carcinoma. 

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SO  - J Invest Dermatol  1992 Aug;99(2):227-31 

AU  - Robinson JK; Rademaker AW 

PT  - JOURNAL ARTICLE 

AB  - This 36-month prospective study of a group of 61 people at high  risk  to develop multiple basal cell carcinomas (BCC) examined the circulating  lymphocyte subsets of the population, patterns of sun exposure, and the  longitudinal development of basal cell carcinoma. Sun exposure status  was  highly correlated with immune status defined by the CD4/CD8 T-lymphocyte  ratio. There were significantly more BCC at 18 and 36 months in the 35  patients with high sun exposure and low CD4/CD8 ratio than in the 20  patients with low sun exposure and high CD4/CD8 ratio. A multivariate  analysis assessed the relative importance of prior basal cell carcinoma,  sun exposure, and immune status on the development of the skin cancer.  Basal cell carcinoma developing in the previous 18 months and sun  exposure  during those 18 months were the first and second most important  variables  in determining development of basal cell carcinoma during the next 18  months. CD4/CD8 ratio had no additional predictive ability once prior  skin  cancers and sun exposure were accounted for. A low ratio of CD4/CD8  cells  correlated with high sun exposure during the preceding 18 months. 

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40.) Topical tretinoin in actinic keratosis and basal cell carcinoma. 

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SO  - J Am Acad Dermatol  1986 Oct;15(4 Pt 2):829-35 

AU  - Peck GL 

PT  - CLINICAL TRIAL; JOURNAL ARTICLE 

AB  - In several studies between 1962 and 1978, topical tretinoin was  proved capable of producing complete regression of actinic keratosis and  basal cell carcinoma. But because its efficacy is not comparable to that  of  other modalities, topical tretinoin is currently used only as an adjunct  to  topical 5-fluorouracil in the treatment of actinic keratosis. One recent  report found topical tretinoin ineffective in the chemoprevention of  actinic keratosis. Although the oral synthetic retinoids isotretinoin  and  etretinate have been used in the prevention and treatment of cutaneous  malignancy, the potential exists for chronic toxicity from the prolonged  systemic therapy that appears necessary for maintaining the  chemopreventive  effect. For this reason, it may be appropriate to study further the  preventive as well as therapeutic effects of topical tretinoin and other  retinoids for actinic keratosis and skin cancer. If they prove safe and  effective, the use of topical retinoids in the prevention and treatment  of  cutaneous tumors may be the most significant clinical application of  these  drugs. 

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41.) Margin assessment of selected basal cell carcinomas utilizing laser 

Doppler velocimetry. 

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SO  - Int J Dermatol  1993 Apr;32(4):290-2 

AU  - Kirsner RS; Haiken M; Garland LD 

PT  - JOURNAL ARTICLE 

AB  - BACKGROUND. Basal cell carcinomas (BCC) have increased  vasculature,  therefore, blood flow within the tumor may be greater than normal  surrounding skin. We attempted to detect the difference in blood flow  between the tumor and uninvolved surrounding skin utilizing laser  doppler  velocimetry (LDV).

METHODS. Ten patients with 14 BCC were studied. Using  LDV, we calculated the size of the tumor based on margin assessment as  predicted by the measured difference in blood flow and compared this  size  with the clinically predicted size and the size of the defect after Mohs  micrographic surgery (MMS).

RESULTS. Clinical evaluation of tumor size  prior to MMS did not correlate with the size of the surgical defect  after  MMS; however, correlation was found between the predicted size of the  tumor  as determined by LDV and the defect after MMS.

 CONCLUSIONS. Tumor size  of  BCC as predicted by measured differences in blood flow using LDV  correlated  with the size of the surgical defect after MMS. This suggests that LDV  was  able to detect the difference in blood flow between the tumor and  uninvolved surrounding skin. 

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42.) Carbon dioxide laser vaporization and curettage in the treatment of  large or multiple superficial basal cell carcinomas. 

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SO  - J Dermatol Surg Oncol  1987 Feb;13(2):119-25 

AU  - Wheeland RG; Bailin PL; Ratz JL; Roenigk RK 

PT  - JOURNAL ARTICLE

  AB  - Many of the standard forms of therapy for large or multiple  superficial basal cell carcinomas are limited by significant  postoperative  pain, excessive scarring, and prolonged wound healing time. Combining  traditional curettage with carbon dioxide laser vaporization creates a  procedure that allows excellent visualization, due to the bloodless  surgical field produced by the laser, minimal nonspecific thermal  damage,  rapid healing, and diminished postoperative pain. In addition, the speed  and ease with which this procedure can be performed allow successful  treatment of many lesions in a single outpatient session. We wish to  report  our results using this technique for the treatment of 52 patients with  370  superficial basal cell carcinomas. 

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43.) The effect of intralesional 5-fluorouracil therapeutic implant (MPI  5003) for treatment of basal cell carcinoma. 

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SO  - J Am Acad Dermatol  1992 Nov;27(5 Pt 1):723-8 

AU  - Orenberg EK; Miller BH; Greenway HT; Koperski JA; Lowe N; Rosen T;  Brown DM; Inui M; Korey AG; Luck EE 

PT  - CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL 

 AB  - BACKGROUND:

Basal cell carcinomas (BCCs) are usually treated with  ablative procedures. A nonsurgical treatment alternative would be of  value  in selected patients. OBJECTIVE: We evaluated the safety and efficacy of  a  new preparation for intralesional sustained-release chemotherapy with  MPI  5003, 5-Fluorouracil Therapeutic Implant, for treatment of BCCs. 

 METHODS: 

 Two doses of intralesional MPI 5003 (0.25 and 0.5 ml) were compared in a  double-blind study of 20 patients with biopsy-proven BCC. One BCC per  patient was treated weekly for up to 6 weeks and followed up monthly for  3  months until excisional biopsy for histologic examination. Before  excision  the cosmetic appearance of the test site was graded.

RESULTS:

Eighty  percent of 10 BCCs treated with 0.5 ml of MPI 5003 had histologically  confirmed cures as compared with 60% of 10 tumors treated with the lower  dose (0.25 ml). Cosmetic assessments before excision were typically good  to  excellent. No systemic side effects occurred.

CONCLUSION:

 Results  indicate  the potential of MPI 5003 for targeted local chemotherapy for BCC.  

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44.) Cryosurgery and topical fluorouracil: a treatment method for  widespread basal cell epithelioma in basal cell nevus syndrome. 

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SO  - J Dermatol  1993 Aug;20(8):507-13 

AU  - Tsuji T; Otake N; Nishimura M 

PT  - JOURNAL ARTICLE 

AB  - A 58-year-old man with basal cell nevus syndrome had variously  sized  basal cell epitheliomas (BCEs), mostly of the superficial type, on his  chest, back, and lumbar areas. BCEs on the lumbar area were treated with  5-fluorouracil (5-FU) cream which was applied daily under occlusive  dressings (ODT). Complete erosion occurred in the center, but not at the  periphery of the lesions. In the latter regions, BCE remained. Then  cryosurgery (cryo) followed by topical 5-FU (cryo + 5-FU) was tried to  treat the peripheral, non-eroded lesions; this caused complete erosions.  Biopsy specimens obtained 6 months after epithelization did not show any  evidence of recurrence. We also tried either cryo alone or cryo + 5-FU  on  the chest lesions, and either 5-FU alone or cryo + 5-FU on the abdominal  lesions. Cryo alone or 5-FU alone could not clear BCE, but cryo + 5-FU  could. These results suggest that the cryo + 5-FU was the most effective  of  these therapies. 

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45.) Selective cytotoxic effect of topical 5-fluorouracil. 

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SO  - Arch Dermatol  1983 Sep;119(9):774-83 

AU  - Dillaha CJ; Jansen GT; Honeycutt WM; Bradford AC 

PT  - JOURNAL ARTICLE 

AB  - As an investigative procedure, a hydrophilic ointment containing  20%  5-fluorouracil (5-FU) was applied to the skin of patients with extensive  actinic keratoses of the face and neck, for a period of four weeks. This  resulted in a selective inflammation, erosion, and disappearance of the  keratoses without significant alteration of the normal skin. Transitory  adverse reactions included corneal and conjunctival irritations,  phototoxic  reactions, and erosion of the lower lip border. No evidence of systemic  absorption was detected. Only preliminary follow-up observations are  available, and no conclusion can be drawn as to the long-term results. 

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46.) Nodular superficial pigmented basal cell epitheliomas. 

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SO  - Arch Dermatol  1982 Nov;118(11):928-30 

AU  - Shelley WB; Wood MG 

PT  - JOURNAL ARTICLE 

AB  - Eradication of multiple nodules, papules, and plaques of pigmented  basal cell epitheliomas of the back of one patient was achieved by nine  months of daily treatment with 5% fluorouracil cream. Such topical  chemotherapy offers the physician an alternative to surgery and  radiation  in treating patients who have widespread nodular superficial  epitheliomas.  The need for a prolonged period of treatment and follow-up is  emphasized. 

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47.) Metastatic basal cell carcinoma: response to chemotherapy. 

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SO  - J Am Acad Dermatol  1990 May;22(5 Pt 2):905-8 

AU  - Bason MM; Grant-Kels JM; Govil M 

PT  - JOURNAL ARTICLE 

AB  - Basal cell carcinoma is a common cutaneous neoplasm that rarely  metastasizes. Unfortunately, there is little effective treatment  available  when metastasis does occur. Therefore potentially promising therapies  for  metastatic basal cell carcinoma should be reported. We report a case of  basal cell carcinoma metastatic to bone, bone marrow, and the pleural  cavity in a 51-year-old woman who showed a striking, albeit brief,  response  to treatment with a combination of cisplatin, bleomycin, methotrexate,  and  5-fluorouracil. 

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48.) Basal cell carcinoma of the vulva with lymph node and skin  metastasis--report of a case and review of 20 Japanese cases. 

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SO  - J Dermatol  1995 Jan;22(1):36-42 

AU  - Mizushima J; Ohara K 

PT  - JOURNAL ARTICLE; REVIEW (37 references); REVIEW OF REPORTED CASES 

AB  - A 79-year-old Japanese woman who had basal cell carcinoma  presenting  as a large ulcer on her vulva with lymph node and skin metastasis is  described. Histological examination revealed that tumor nests with  peripheral palisading invaded deeply into the subcutaneous tissue and  were  accompanied by marked mucinous changes and fibrous reaction. Vascular  invasion was also observed. There were inguinal lymph node metastases  and  two papular skin metastases on her right thigh. The primary tumor and  the  metastases were excised. The defect was repaired by bilateral gracilis  musculo cutaneous flaps and a skin graft. We surveyed the literature and  found 20 cases of metastasizing basal cell carcinoma in Japan. 

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49.) Basal cell carcinoma of the scalp resulting in spine metastasis in  a  black patient. 

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SO  - J Am Acad Dermatol  1994 Nov;31(5 Pt 2):916-20 

AU  - Oram Y; Orengo I; Alford E; Green LK; Rosen T; Netscher DT 

PT  - JOURNAL ARTICLE 

AB  - Basal cell carcinoma (BCC), the most common skin cancer in the  United  States, is locally invasive but has a low risk of metastasis. BCC is  rare  in black patients but, regardless of racial origin, most BCC occurs on  sun-exposed areas. We describe a 67-year-old black man with a large BCC  on  the hairy scalp, a relatively sun-protected area, that metastasized to  the  spine. To our knowledge, this is the first description of a black  patient  with development of metastatic BCC on an otherwise normal scalp. 

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50.) Long-term survival following bony metastases from basal cell  carcinoma. Report of a case. 

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SO  - Arch Dermatol  1986 Aug;122(8):912-4 

AU  - Hartman R; Hartman S; Green N 

PT  - JOURNAL ARTICLE 

AB  - A patient with recurrent basal cell carcinoma developed  cervical-vertebral and epidural metastases. He received palliative  irradiation and had a durable remission for three years. With relapse,  he  underwent a laminectomy and chemotherapy and remained asymptomatic at 54  months following the diagnosis of bony metastases. To our knowledge, he  is  the longest reported survivor with bony metastases and is illustrative  of  the potential survival advantage from palliative therapy. 

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51.)Giant basal cell carcinoma with metastasis and secondary  amyloidosis:  report of case. 

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SO  - Acta Derm Venereol  1983;63(6):564-7 

AU  - Beck HI; Andersen JA; Birkler NE; Ottosen PD 

PT  - JOURNAL ARTICLE 

AB  - Basal cell carcinoma of the skin is a slow growing relatively  benign  tumor usually located on the head and neck. Although rare, metastasis to  lymph nodes or parenchymatous organs has been reported previously (1-9).  We  wish to add another case of metastasizing basal cell carcinoma of the  skin,  which presented certain unique features only rarely reported (1), namely  complicating amyloidosis in the kidneys, the lymph nodes, the spleen and  probably in the intestinal canal. 

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52.) Pulmonary metastases from a basal cell carcinoma. 

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SO  - J Cutan Pathol  1981 Jun;8(3):235-40 

AU  - Keenan R; Hopkinson JM 

PT  - JOURNAL ARTICLE 

 AB  - Although basal cell carcinomas are the commonest malignant  condition  of the skin (Borel 1973) pulmonary metastases are rare; it appears that  only 30 authenticated cases have been reported (Sakula 1977). A further  case is described of a man aged 64 who presented severe dyspnoea and who  for 12 years had harbored an untreated ulcerating lesion of the  abdominal  wall shown histologically to be a basal cell carcinoma. Chest  radiography  showed metastatic disease confirmed histologically to be identical to  the  ulcerating skin lesion. Unfortunately, because of the severe respiratory  condition, no definitive treatment was indicated and the patient died of  respiratory failure 2 weeks following discharge. 

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53.) Nonrecurrent primary basal cell carcinoma of the lower extremity  with  late metastasis. 

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SO  - J Dermatol Surg Oncol  1994 Jul;20(7):490-3 

AU  - Siegle RJ; Wood T 

PT  - JOURNAL ARTICLE 

AB  - BACKGROUND.

Metastatic basal cell carcinoma (MBCC) is rare, with  most  cases of head and neck origin and from large multi-recurrent tumors.  MBCC  is very rare from lower extremities and even more rare from primary  tumors  that were small and treated without local recurrence.

OBJECTIVE.

This  paper  presents a case of MBCC in a 78-year-old woman who had previously  undergone  resection without local recurrence of a small lower extremity basal cell  carcinoma.

CONCLUSION.

MBCC can present atypically with site of origin  on  lower extremities, initial tumor size small, and nonrecurrence of the  primary tumor site. The clinician should be aware of this as well as  understand that prompt and aggressive surgical therapy to localized  metastases may extend survival. 

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54.) [Metastatic basal cell carcinoma] 

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SO  - Ann Dermatol Venereol  1993;120(2):135-8 

AU  - Beaulieu-Lacoste I; Joly P; Ruto F; Thomine E; Fusade T;  Chevallier  B; Ortoli JC; Lauret P 

MC  - English Abstract 

PT  - JOURNAL ARTICLE; REVIEW (16 references); REVIEW OF REPORTED CASES 

AB  - A case of basal cell carcinoma in a 17-year old male patient  complicated, 5 years later, by inguinal and pulmonary metastases is  reported. This clinical case raises two problems: the reality of the  entity  and the long-term follow-up of this type of tumours. 

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55.) Metastatic basal cell carcinoma: report of twelve cases with a  review  of the literature [see comments] 

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SO  - J Am Acad Dermatol  1991 May;24(5 Pt 1):715-9 

AU  - Lo JS; Snow SN; Reizner GT; Mohs FE; Larson PO; Hruza GJ 

PT  - JOURNAL ARTICLE; REVIEW (67 references); REVIEW, TUTORIAL 

AB  - Metastatic basal cell carcinoma was found in 12 patients at the  University of Wisconsin Mohs Surgery Clinic during the period 1936 to  1989.  All patients were white men. The time of onset of the primary tumor  ranged  from childhood to 71 years. Eleven patients had previous treatment for  basal cell carcinoma; two patients had received x-ray radiation to the  face  for teenage acne. The locations of the primary basal cell carcinomas  were  the face (n = 10), back (n = 1), and arm (n = 1). The primary tumors  ranged  from 3.6 x 3.0 to 20.0 x 7.0 cm. The interval from onset to the first  sign  of metastases ranged from 7 to 34 years. In all cases, the primary tumor  was histologically identical to the metastatic lesion. Perineural  extension  of the basal cell carcinoma in the primary lesion was found in five  cases.  Regional lymph nodes were the most frequent site of metastasis.  Treatment  consisted of a combination of surgery, radiation, and chemotherapy. Only  two patients survived more than 5 years after surgical treatment. One  patient has survived 25 years and is still alive. 

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56.) Rapid development of metastases from basal cell carcinoma  presenting  as cranial nerve palsies. 

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SO  - J Dermatol Surg Oncol  1988 Dec;14(12):1410-2 

AU  - Ambros RA; Standiford SB; Sobel HJ; Haim A; Mohit-Tabatabai MA 

PT  - JOURNAL ARTICLE 

 AB  - A case is reported of metastatic basal cell carcinoma presenting  with  multiple neurologic deficits 20 months after excision of the primary  lesion  with good local control. Many features associated with the development  of  metastasis from basal cell carcinoma were not present in this case. 

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57.) Photodynamic therapy by topical aminolevulinic acid,  dimethylsulphoxide and curettage in nodular basal cell carcinoma: a  one-year follow-up study. 

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Acta Derm Venereol 1999 May;79(3):204-6 

Soler AM, Warloe T, Tausjo J, Berner A 

Photodynamic Out-patient Clinic, Department of Surgical Oncology, The  Norwegian Radium Hospital, Oslo. 

Fifty-eight patients with 119 nodular (2 mm or more in thickness) basal  cell carcinomas successfully treated with photodynamic therapy were  included in this 1-year follow-up study. The initial cure rate at 3-6  months was 92% after photodynamic therapy, which included an initial  debulking procedure and topical application of dimethylsulphoxide in  order  to enhance penetration of 5-aminolevulinic acid (20% in cream) to which  the  lesions were exposed for 3 h prior to exposure to light. At examination  12-26 months (mean 17 months) after treatment 113 lesions (95%) were  still  in complete response. Six lesions (5%) had recurred, located on the  face,  scalp and ear. The cosmetic outcome was evaluated as excellent to good  in  91%. Microscopic examination of biopsies taken from healed areas in 7  patients did not reveal any sign of damage in 5 and only minor  alterations  in 2. 

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58.) Epidemiologic characteristics and clinical course of patients with  malignant eyelid tumors in an incidence cohort in Olmstead County,  Minnesota. 

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Ophthalmology 1999 Apr;106(4):746-50 

Cook BE Jr, Bartley GB 

Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester,  Minnesota 55905, USA. 

OBJECTIVE: To determine the epidemiologic and clinical characteristics  of  patients with malignant eyelid tumors in an incidence cohort. DESIGN:  Cohort series.

 PARTICIPANTS: A computerized retrieval system was used to  identify all patients residing in Olmsted County, Minnesota, who had a  newly diagnosed malignant eyelid tumor during the 15-year interval from  1976 through 1990. The patients' medical records were reviewed for  demographic and clinical data.

INTERVENTION: Surgical excision with  frozen-section histopathologic analysis, Mohs' micrographic excision,  and  electrodesiccation and curettage were the primary methods of treatment. 

MAIN OUTCOME MEASURES: Survivorship free of tumor.

RESULTS: The  incidence  cohort included 174 patients who each had 1 tumor; men and women were  equally affected, and all patients were white. Tumors developed most  commonly on the lower eyelid (n = 85; 48.9%) and in the medial canthal  region (n = 48; 27.6%) but involved the right and left sides with equal  frequency. Of the 174 tumors, 158 were basal cell carcinomas (90.8%), 15  were squamous cell carcinomas (8.6%), and 1 (0.6%) was a malignant  melanoma. The age- and gender-adjusted incidence rates for basal cell  carcinoma, squamous cell carcinoma, and malignant melanoma were 14.35,  1.37, and 0.08 per 100,000 individuals per year, respectively. No cases  of  sebaceous gland carcinoma were identified. The 5- and 10-year recurrence  rates for all tumors on the eyelid were 2% and 3%, respectively. The  probability of an unrelated malignancy developing elsewhere in the body  was  approximately 9% at 5 years and 15% at 10 years.

CONCLUSIONS: Basal cell  carcinoma is the most common malignant eyelid tumor in whites. The lower  eyelid and medial canthus are the most frequent sites of origin. Men and  women are equally affected. Recurrence after surgical excision is  uncommon. 

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59.) Does wound healing contribute to the eradication of basal cell  carcinoma following curettage and electrodessication? 

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Dermatol Surg 1999 Mar;25(3):183-7; discussion 187-8 

Nouri K, Spencer JM, Taylor JR, Hayag M, DeVoursney J, Shah N  Department of Dermatology and Cutaneous Surgery, University of Miami  School  of Medicine, Miami Veterans Affairs Medical Center, Florida, USA. 

BACKGROUND:

Histologic studies indicate that C&D fails to mechanically  remove all the tumor in a percentage of cases that far exceeds the  5-year  recurrence rate. This raises the question that if C&D does not  mechanically  remove the tumor in a significant number of patients, why don't we  observe  tumor recurrence in most of these patients? Our previous study indicates  that inflammation occurring over 1 month following C&D does not clear  residual tumor. It may be some other process, requiring more time, that  clears the residual tumor. Perhaps the proliferative or maturation phase  of  wound healing or, alternatively, a slow-acting process such as a  low-grade  immune response set in motion earlier, clears the residual tumor. 

OBJECTIVE:

To test the hypothesis that wound healing and maturation  following C&D clear residual tumor that has not mechanically removed by  the  procedure. METHODS: The frequency of residual BCC detected  histologically  immediately following C&D was compared with the frequency 3 months after 

the C&D, an amount of time in which the maturation phase of wound  healing  is well under way.

RESULTS:

Twenty-two of 29 primary BCC less than 1 cm  in  size were tumor-free immediately following the procedure (clearance rate  75.9%). Twelve primary BCC <1 cm were treated by C&D, allowed to heal  for 3  months, and then excised and checked histologically. Ten of the twelve  BCC  were free of tumor, for a clearance rate of 83.3%, which is not a  statistically significant difference (p = 0.7187).

 CONCLUSION:

By 3  months,  the proliferative phase of wound healing is complete, and our study  indicates that this phase has no effect on clearing the tumor. The  maturation phase is well under way three months following C&D, and no  statistically significant 

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60.)Does inflammation contribute to the eradication of basal cell  carcinoma  following curettage and electrodesiccation? 

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Dermatol Surg 1997 Aug;23(8):625-30; discussion 630-1 

Spencer JM, Tannenbaum A, Sloan L, Amonette RA  Division of Dermatology, University of Tennessee, Memphis, USA. 

BACKGROUND: Curettage and electrodesiccation (C&D) is probably the  technique most frequently utilized by dermatologists to treat basal cell  carcinomas (BCC). From histologic studies, it appears C&D does not  completely mechanically remove all nests of BCC in a substantial number  of  cases. Nevertheless, the reported 5-year reoccurrence rate following C&D  is  significantly less than this histologically observed residual tumor  frequency immediately following C&D. Among the multiple possibilities  that  exist to explain why these residual nests do not appear as recurrent  tumor  more frequently is the theory that inflammation developing after C&D  clears  residual tumor.

OBJECTIVE: To test the hypothesis that inflammation  developing after C&D clears residual tumor not mechanically removed by  the  procedure.

METHODS: The frequency of residual BCC detected  histologically  immediately following C&D was compared with the frequency 1 month after  the  C&D, an amount of time in which an effect (if any) of inflammation could  occur.

RESULTS: Twenty-two of 29 primary BCC < 1 cm treated by C&D were  tumor free immediately following the procedure (clearance rate, 75.9%).  Eleven of 14 primary BCC < 1 cm treated by C&D then allowed to granulate  1  month before excision and histologic analysis were tumor free, for a  clearance rate of 78.6%. Examination of larger tumors immediately  following  C&D revealed size is a significant variable for clearance rates. Eleven  primary BCC > 1 cm but < 2 cm were examined histologically immediately  following C&D; only three were tumor free for a clearance rate of 27.3%.  Only one of five tumors > 2 cm thus treated was tumor free, for a  clearance  rate of 20%. Nine recurrent BCC of various sizes were treated by C&D and  immediately examined histologically. Two were tumor free for a clearance  rate of 22.2%. Two recurrent BCC were allowed to heal 1 month following  C&D; one of these was tumor free when excised.

CONCLUSION: For primary  BCC  < 1 cm, no evidence was found that inflammation occurring over 1 month  following C&D clears residual tumor. It was also noted that C&D fails to  completely remove tumor in a large majority of primary BCC > 1 cm, and  in  recurrent BCC. 

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61.) Cryosurgery in dermatology. 

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Eur J Dermatol 1998 Oct-Nov;8(7):466-74 

Zouboulis CC  Department of Dermatology, University Medical Center Benjamin Franklin, 

The  Free University of Berlin, Hindenburgdamm 30, D-12 200, Berlin, Germany. 

zoubbere@zedat.fu-berlin.de 

The aim of this article is to provide current information on the  clinical  development of cutaneous cryoreaction and the indications, complications  and contraindications of cutaneous cryosurgery. Successful cutaneous  cryosurgery requires rapid freezing and slow thawing, minimum tissue  temperatures of -25 degrees C to -60 degrees C and, in malignant  lesions,  repeated freeze-thaw cycles. Frozen tissue reacts with peripheral  erythema  immediately following thawing, and consequently with oedema, bulla  formation, exudation, mummification, and usually heals with a fine  atrophic  scar within a 4-week period. Cryosurgery is now considered the treatment  of  choice in hypertrophic scars and keloids, granuloma annulare and  capillary  haemangioma of the newborn. It also represents a valuable alternative  therapy for various skin diseases, including common warts, solar  lentigo,  actinic keratoses, superficial basal cell carcinoma and Kaposi's  sarcoma.  Cryosurgery is a safe regimen with only a few adverse effects and  contraindications. Pain during and/or shortly after treatment, bulla  formation and local oedema are the major, temporary adverse effects;  lesional hypopigmentation and/or peripheral hyperpigmentation is the  most  common by occurring long-term complication. 

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62.) [The treatment of basal cell carcinoma patients by dermatologists  in  Netherland]. 

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Ned Tijdschr Geneeskd 1998 Jul 4;142(27):1563-7 

Thissen MR, Neumann HA, Berretty PJ, Ideler AH  Academisch Ziekenhuis, afd. Dermatologie, Maastricht. 

OBJECTIVE: To determine the policy of dermatologists practising in the  Netherlands in the treatment of basal cell carcinoma. DESIGN: Written  enquiry.

SETTING: Catharina Hospital, Eindhoven, the Netherlands. 

METHOD:  All 293 dermatologists practising in the Netherlands were sent a  questionnaire in May 1996 containing 15 questions about diagnosis and  treatment of basal cell carcinoma.

RESULTS: Eighteen forms dropped off  because of termination of the practice or joint completion in group  practices. The response was 76% (208/275). The diagnosis was made  usually  on the basis of histological examination (71% of the respondents; 84% in  a  tumour recurrence). Excision was the preferred treatment for all  subtypes  of basal cell carcinoma; second choices were cryosurgery or  curettage/electrocoagulation. Roentgen contact therapy has been  practically  abandoned. New methods such as photodynamic therapy and immunotherapy  are  being used only sporadically on an experimental basis. Most  dermatologists  regarded tumour recurrences as a bigger problem than primary tumours.  They  attempt to reduce the percentage of recurrences by giving advice about  risk  factors (sunlight).

CONCLUSION: Too little use is being made of  diagnostic  biopsy to enable an optimal choice of therapy of basal cell carcinomas,  especially in cases of recurrence tumours. 

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63.) [Therapy of non-melanocytic skin tumors]. 

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Ther Umsch 1998 Aug;55(8):515-21 

Hafner J  Dermatologische Klinik und Poliklinik, Universitatsspital Zurich. 

Actinic keratosis on sun-damaged skin are very common in individuals  with  fair complexion. Management encompasses cryosurgery, tretinoin or  5-fluorouracil-cream. Bowen's disease, however, requires surgical  excision  or radiotherapy. Basal cell carcinoma and squamous cell carcinoma are  the  two most common malignant skin tumours in Western Europe. Typically  these  tumours can be managed either by excision and primary wound closure, by  cryosurgery or by radiotherapy.

The method of choice is determined by  the  type and location of the tumour and the general condition of the  patient.  For more difficult-to-treat malignant skin tumours surgical resection  with  histological margin control is required. Mohs' micrographic surgery is a  specialized procedure. This method entails to a full work-up of the  excisional margins.

The defect is closed only after histological  verification of tumour-free surgical margins. Difficult-to-treat tumours  are recurrent, sclerodermiform and large (diameter more than 20 mm)  basal  cell carcinomas. Indications for margin control in squamous cell  carcinomas  are tumours with more than 20 mm of diameter, with more than 5 mm  thickness  and with poor histologic differentiation (Broders grade III and IV,  desmoplastic squamous cell carcinoma). Therefore, a skin biopsy is often  required to plan the optimal treatment of a malignant skin tumour. The  collaboration of primary care providers and specialists is beneficial in  the management of difficult skin tumours.

Renal transplant recipients  under  immunosuppression are prone to have squamous cell carcinoma of a more  aggressive type. Dermatofibrosarcoma protuberans is another good  indication  for Mohs' micrographic surgery. A regular follow-up for recurrences or  secondary tumours, as well as an effective secondary prevention of sun  damage are important for skin cancer patients. 

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64.) [High resolution ultrasound imaging: value in treatment of  basocellular carcinoma by cryosurgery]. 

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Ann Dermatol Venereol 1998 Aug;125(8):500-4 

Vaillant L, Grognard C, Machet L, Cochelin N, Callens A, Berson M,  Aboumrad  J, Patat F, Lorette G  Service de Dermatologie, CHU Tours. 

OBJECTIVE: We conducted a prospective evaluation of the contribution of  high-resolution ultrasound imaging prior to cryosurgery for basocellular  carcinoma and in search for recurrence.

PATIENTS AND METHODS: All  patients  seen between 1992 and 1994 at the skin tumor clinic and treated by  cryosurgery were included. Ultrasound imaging using 20 MHz prototype was  performed prior to cryosurgery and 2 months later.

 RESULTS: Among 101  patients treated, 112 basocellular carcinomas were treated by  cryosurgery.  Ultrasound imaging provided good visualization of the tumor limits in  all  cases. The ultrasound aspect was anechogenic, often with rare areas of  highly dense echoes. The tumor limits described by ultrasound imaging  were  larger than the clinical limits in 32% of the cases. In 8 of the 16  cases  of recurrent tumors, the ultrasound examination revealed the recurrence  first. In the other 8 cases, clinical manifestations were confirmed by  ultrasonography. In our series, recurrence of basocellular carcinoma was  statistically more frequent when the depth of the tumor was 3 mm  (ultrasonographic measurement) or when the lateral limits established by  ultrasound assessment were greater than the clinical evaluation. 

DISCUSSION:

These findings demonstrate that high-resolution ultrasound  imaging of basocellular carcinomas prior to cryosurgery: 1) visualizes  tumor limits allowing adapted cryosurgery, 2) identifies factors with  predictive value for recurrence, 3) can identify recurrences early.  Ultrasound imaging of the skin is a useful non-invasive technique for  pre-  and post-therapeutic assessment of skin tumors and could be a  particularly  useful tool for "blind" cryosurgery destruction of skin tumors. 

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65.) Recurrent basal cell carcinoma treated with cryosurgery. 

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J Am Acad Dermatol 1997 Jul;37(1):82-4 

Kuflik EG, Gage AA  Department of Dermatology, University of Medicine and Dentistry, New 

Jersey  Medical School, Newark, USA. 

BACKGROUND: Although there are reports of cure rates achieved by  cryosurgery for primary basal cell carcinomas (BCCs), there are few data  on  the cryosurgical treatment of recurrent BCCs.

 OBJECTIVE: Our purpose was  to  discuss case selection, cryosurgical management, and results of therapy. 

METHODS: Cryosurgery was performed in 54 patients with 56 recurrent  BCCs.  The treatment consisted of aggressive freezing including an adequate  margin  of surrounding tissue.

RESULTS: Wound healing was favorable and the  cosmetic results were excellent. Two recurrences were found and were  referred for Mohs micrographic surgery.

CONCLUSION: We conclude that  cryosurgical treatment of selected recurrent BCCs yields results that  compare favorably with other methods of treatment. 

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66.) Fractional cryosurgery. A new technique for basal cell carcinoma of  the eyelids and periorbital area. 

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Dermatol Surg 1997 Jun;23(6):475-81 

Goncalves JC  Department of Dermatology, Hospital Distrital de Santarem, Portugal. 

BACKGROUND: Cryosurgery is an established method to treat malignant  tumors  of the eyelids and periorbital area. Nevertheless, it has been abandoned  for tumors greater than 10 mm, because it gives irregular esthetic  results  and, in some cases, lagophthalmos. OBJECTIVE: To devise a new method for  the treatment of such tumors.

 METHOD: Fractional cryosurgery is  performed  in stages: the center of the lesion is frozen, resulting in a reduction  of  the tumor; this procedure is repeated, as necessary, until the lesion's  diameter is smaller than 10 mm; the standard cryosurgical procedure is  then  carried out.

RESULTS: The treatment of the first 20 basal cell  carcinomas  with diameters between 10 and 24 mm is described, with excellent  clinical  and cosmetic results.

CONCLUSION: With fractional cryosurgery, the final  scar bears no relation to the size of the original tumor but, instead,  corresponds to the size of the lesion preceding the final cryosurgical  procedure. 

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67.) Long-term follow-up of cryosurgery of basal cell carcinoma of the  eyelid. 

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J Am Acad Dermatol 1997 May;36(5 Pt 1):742-6 

Lindgren G, Larko O  Department of Ophthalmology Goteborg University, Sahlgrenska Hospital,  Sweden. 

BACKGROUND: Basal cell carcinoma (BCC) is the most common malignant  tumor  of the eyelid and its incidence is increasing. It remains to be  established  which is the best treatment in terms of safety and cost-effectiveness. 

OBJECTIVE: Our purpose was to analyze the long-term treatment results  and  possible side effects of cryosurgery of eyelid BCC.

 METHODS: During the  last 14 years 219 patients (222 tumors) treated for eyelid BCC with  cryosurgery were followed up prospectively for up to 10 years.

RESULTS:  The  tumors cleared completely after treatment in all patients with no  recurrence observed to date. Ninety-two patients were followed up for 5  years or more. Complications were few and minor. In 26 treated eyelids  conjunctival overgrowth was noted.

CONCLUSIONS: We conclude that  cryosurgery of BCC of the eyelid has a high cure rate, is  cost-effective,  and is well tolerated. 

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68.) Five-year results of curettage-cryosurgery of selected large  primary  basal cell carcinomas on the nose: an alternative treatment in a  geographical area underserved by Mohs' surgery. 

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Br J Dermatol 1997 Feb;136(2):180-3 

Nordin P, Larko O, Stenquist B  Department of Dermatology, Lundby Hospital, Goteborg, Sweden. 

Mohs' micrographic surgery (MMS) is the recommended treatment for large  basal cell carcinomas (BCCs) of the nose. This 5-year follow-up study  attempts to evaluate whether curettage-cryosurgery (CC) could be an  alternative therapy in a country where optimal resources for MMS are  lacking. All patients with a primary nasal or perinasal BCC, 10 mm or  larger in diameter, were assessed at a skin tumour clinic. Sixty-one  BCCs  of non-morphoeiform type were treated with CC. Most of the tumour was  removed by careful curettage with different sized curettes. The tumour  area  was then frozen with liquid nitrogen in a double freeze-thaw cycle.  Fifty  patients were followed for at least 5 years with only one recurrence.  The  cosmetic result was good or acceptable in all patients. A thorough  curettage followed by cryosurgery could be a safe and inexpensive  alternative therapy even for large primary non-morphoeiform BCCs of the  nose. 

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69.) Laser microsurgery for superficial T1-T2 basal cell carcinoma of  the  eyelid margins. 

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Ophthalmology 1997 Jul;104(7):1179-84 

Bandieramonte G, Lepera P, Moglia D, Bono A, De Vecchi C, Milani F  Division of Surgical Semiotics and Ambulatory Surgery, Istituto  Nazionale  per lo Studio e la Cura dei Tumori, Milano, Italy. 

BACKGROUND:

Basal cell carcinoma (BCC), the most common malignancy of  the  eyelid margins, poses therapeutic problems. Surgery, radiation therapy,  and  cryotherapy are the currently accepted methods for the treatment of this  affliction. To verify the technical and clinical effectiveness of the  surgical laser method, a specific approach was developed by performing  laser-combined procedures under microscopic control.

METHODS:

A series  of  26 patients underwent carbon dioxide (CO2) laser microsurgical excision  of  27 primary superficial BCCs of the eyelid margins. Eighteen tumors were  T1  and 9 were T2. The lesions were located at the lid margins in 18 and at  the  canthus in 9 cases. The eyelash line was involved in all cases, whereas  intermarginal space was involved in 17 cases, without extension to the  conjunctival border. Six lesions were in the lacrimal region. Median  linear  extent of the lesion was 5 mm (range, 4-10 mm). Treatment was performed  with the patient under local anesthesia in a Day Hospital regimen. The  authors used the microscope-mounted CO2 laser as a scalpel to excise the  tumor mass, thus obtaining the specimen for histologic evaluation. The  authors treated the deep and lateral resection margins with laser  vaporization and left the wound bed to heal by secondary intention. 

 RESULTS:

No significant complications were observed. As full-thickness  eyelid resections were avoided, the authors noted conservation of lid  function and cosmetic aspect in all patients. With a median follow-up of  73  months (range, 18-118), only one patient had tumor recurrence after 22  months. This tumor, located at the outer canthus, had a second  microsurgical laser excision, and the patient is disease free 51 months  after the last treatment.

CONCLUSIONS:

Laser microsurgery appears to be  a  safe and effective treatment method for primary superficial T1 and T2  BCC  of the eyelid margins without conjunctival extension. 

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70.)[Use of Nd:YAG laser for treatment of basal-cell carcinomas and some  premalignant conditions]. 

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Przegl Dermatol 1990 Nov-Dec;77(6):385-8 

 

Rubisz-Brzezinska J, Bendkowski W  Katedry i Kliniki Dermatologii Sl. AM w Katowicach. 

In 51 patients, 29 female and 22 male of average 61 years old, 94  lesions  were treated with Nd: YAG laser; 70 basal-cell carcinomas, 9 superficial  basal-cell carcinomas, 12 actinic keratosis and 3 cutaneous horns. Size  of  changes varied from 7 to 24 mm. Quantity of energy used in laser-therapy  was dependent on diagnosis, focus size, location and amounted from 50 to  240 J/cm2. Authors are of the opinion that Nd:YAG laser-therapy is a  very  good method for treatment of skin tumors. Moreover, the advantage of  this  method is its possibility of a single procedure in the conditions of  outpatients clinic.   

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71.) Laser therapy of skin tumors. 

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Recent Results Cancer Res 1995;139:417-21 

Landthaler M, Szeimies RM, Hohenleutner U  Department of Dermatology, University of Regensburg, Germany. 

Malignant skin tumors can be treated by CO2 laser excision or  vaporization,  neodymium: yttrium aluminum garnet (Nd:YAG) laser coagulation, and  systemic  or topical photodynamic therapy (PDT). Possible indications for CO2  laser  vaporization include superficial basal cell carcinomas, actinic  keratoses,  Bowen's disease, actinic cheilitis, and leukoplakias. The Nd:YAG laser  may  be used for coagulation of basal cell carcinomas, squamous cell  carcinomas,  Kaposi's sarcoma, and metastatic skin tumors. Systemic and topical PDT  is  still an experimental modality and is mostly applied for treatment of  basal  cell carcinomas. However, laser treatment of skin tumors is not yet  considered as standard therapy and should be confined to selected  patients.  Further clinical studies are necessary to determine the role of laser  therapy in this special indication. 

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72.) Treatment of superficial basal cell carcinoma and squamous cell  carcinoma in situ with a high-energy pulsed carbon dioxide laser. 

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Arch Dermatol 1998 Oct;134(10):1247-52 

Humphreys TR, Malhotra R, Scharf MJ, Marcus SM, Starkus L, Calegari K  Department of Medicine, University of Massachusetts Medical Center,  Worcester, USA. 

BACKGROUND:

High-energy pulsed carbon dioxide (CO2) lasers have been  used  extensively to resurface wrinkled and photodamaged skin with a low risk  of  scarring. Results of histological studies demonstrate precise ablation  depths in treated skin with minimal thermal damage to underlying tissue.  Our objective was to determine if a pulsed CO2 laser could effectively  ablate superficial malignant cutaneous neoplasms (superficial multifocal  basal cell carcinoma [BCC] and squamous cell carcinoma [SCC] in situ). 

OBSERVATIONS: Thirty superficial neoplasms (17 BCCs and 13 SCCs) and  their  surrounding 3-mm margins were treated with either 2 or 3 passes of a  pulsed  CO2 laser (500 mJ, 2-4 W) using a 3-mm collimated handpiece.

The treated  areas were subsequently excised and evaluated histologically by serial  sectioning at 5-micron intervals for residual tumor at the deep and  lateral  margins. Average patient age was greater for those with SCCs than for  those  with BCCs (76.5 vs 56.7 years; P = .001). The average tumor thickness of  SCC in situ was significantly greater than that of superficial BCC (0.57  vs  0.34 mm; P = .01). All (9 of 9 patients) BCCs were completely ablated  with  3 passes, and residual tumor in the deep margins was seen in 5 of 8  patients treated with 2 passes of the pulsed CO2 laser (P = .005).  Incomplete vaporization of the SCC depth was seen in 3 of 7 patients  treated with 3 passes and in 2 of 6 patients treated with 2 passes.  Those  SCCs incompletely treated were significantly thicker than those  completely  ablated (0.65 vs 0.41 mm; P = .01). Positive lateral margins were seen  in 1  BCC and 3 SCC specimens.

CONCLUSIONS:

Pulsed CO2 laser treatment can be  effective in ablating superficial BCC. Treatment of the neoplasm and a  minimum of 4-mm margins with 3 passes (500 mJ, 2-4 W) is recommended for  complete vaporization using this laser system. Because 3 passes did not  completely ablate all SCC in situ, use of this modality alone is not  recommended for treatment of thick or keratotic lesions. No direct  comparison of efficacy can be made with other destructive modalities  that  have not been evaluated with comparably sensitive histological  techniques.  Further study is needed to establish any cosmetic advantage of pulsed  CO2  lasers over other destructive modalities for treatment of superficial  malignant neoplasms and long-term cure rates.   

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73.) Prediction of subclinical tumor infiltration in basal cell  carcinoma. 

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J Dermatol Surg Oncol 1991 Jul;17(7):574-8 

Breuninger H, Dietz K 

Department of Dermatology, University Hospital for Dermatology,  Tubingen,  Federal Republic of Germany. 

Two thousand-sixteen basal cell carcinomas (BCCs) were documented in  terms  of age, anatomic location, tumor diameter, initial excision depth,  safety  margin, histologic type, and the position of tumor outgrowths as  determined  by three-dimensional histologic study of the tumor margins in paraffin  sections (micrographic surgery). The extent of each subsequent excision  was  recorded until tumor-free tissue was reached. The results showed that  BCCs  have a highly irregular infiltration pattern and a predilection for  small,  fingerlike outgrowths whose bases occupy 1-30 degrees of the tumor  circumference. When superficial extension was expressed mathematically,  the  resulting exponential functions varied highly significantly (P = .001)  according to histologic tumor type and diameter. The resulting curves  permitted very precise prediction of the probability of tumor-positive  margins (ie, subtotal excision), depending on the safety margin,  histologic  tumor type, and tumor diameter. For example, the probability of  tumor-positive margins after excision of a BCC up to 10 mm in diameter  is  30% with a safety margin of 2 mm, 16% with a safety margin of 3 mm, and  5%  with a safety margin of 5 mm. The probability of tumor-positive margins  for  fibrosing primary BCCs 10-20 mm in diameter is 48, 34, and 18% with  safety  margins of 2, 3, and 5 mm, respectively. Recurrent tumors have a  significantly higher probability of positive margins (P = .001) than  primary ones. Anatomic location and tumor age affect subclinical  extension  only indirectly. 

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74.) Recurrence rates of treated basal cell carcinomas. Part 3: Surgical  excision. 

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J Dermatol Surg Oncol 1992 Jun;18(6):471-6 

Silverman MK, Kopf AW, Bart RS, Grin CM, Levenstein MS  Department of Dermatology, New York University School of Medicine. 

This is the third report in a series that reviews the experience in the  Skin and Cancer Unit, from 1955 through 1982, with the treatment of  basal  cell carcinomas (BCCs). It concerns 588 previously untreated (primary)  BCCs  removed by surgical excision.

The cumulative 5-year recurrence rate was  4.8%. This is a statistically significant lower recurrence rate (P =  .034)  than 135 previously treated BCCs that had a re-recurrence rate of 11.6%.  For the primary BCCs, multivariate analysis showed that location on the  head (P = .010) and being male (P = .004) were independent risk factors  for  recurrence. The patient's age, the duration of the BCC, its maximum  diameter, or the time span (1955-1963, 1964-1972, 1973-1982) in which it  was treated did not significantly affect the recurrence rate.

 The 5-year  recurrence rate for BCCs excised from various anatomic sites were as  follows: 1) neck, trunk, and extremities = 0.7%; 2) head--less than 6 mm  in  diameter = 3.2%; 3) head--6 to 9 mm in diameter = 8.0% (treated since  1964  = 5.2%); and 4) head--10 mm or more in diameter = 9.0%. Surgical  excision  is a highly effective method for removal of BCCs, and achieved a good to  excellent cosmetic outcome in about 85% of the recurrence-free treatment  sites. 

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75.) Human papillomavirus type 2-associated basal cell carcinoma in two  immunosuppressed patients. 

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ARTICLE SOURCE:  Arch Dermatol  (United States), Jun 1988, 124(6) p930-4 

AUTHOR(S):  Obalek S; Favre M; Jablonska S; Szymanczyk J; Orth G 

PUBLICATION TYPE:  JOURNAL ARTICLE 

 ABSTRACT:  Human papillomavirus-2 genomes were detected by molecular  hybridization in two cases of basal cell carcinomas that developed in  immunosuppressed individuals. This form of human papillomavirus is  usually  responsible for common warts in the general population. Although it does  not appear to have oncogenic potential, it may be, in some cases,  associated with cutaneous malignancy. 

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76.) Occurrence of human papillomavirus type 16 DNA in cutaneous  squamous  and basal cell neoplasms. 

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ARTICLE SOURCE:  J Am Acad Dermatol  (United States), Nov 1990, 23(5 Pt  1)  p836-42 

AUTHOR(S):  Eliezri YD; Silverstein SJ; Nuovo GJ 

PUBLICATION TYPE: 

JOURNAL ARTICLE 

ABSTRACT: 

 Sixty-eight cutaneous squamous cell neoplasms (in situ and  invasive) and 26 basal cell carcinomas from 89 patients were analyzed  for  DNA sequences homologous to the human papillomavirus (HPV) types found  predominantly in the genital tract. Thirty-six (53%) of the squamous  cell  neoplasms contained HPV DNA as detected by filter or in situ  hybridization  analysis. The frequency of detection of HPV DNA was dependent on the  site  of the lesion. Of 40 genital squamous cell neoplasms (penile, vulvar,  and  perianal), 27 (68%) had detectable HPV DNA. In 25 of these, the HPV type  was 16 or HPV-16-related, which was similar to the results for the  squamous  cell neoplasms of the finger (HPV DNA in 9 of 11 tumors with HPV-16 in  seven). None of 16 squamous cell neoplasms from sites other than the  genital tract or the finger had detectable HPV DNA. HPV DNA was detected  in  one of the 26 basal cell carcinomas (4%). We conclude that, for  cutaneous  epithelial malignancies, HPV-16 is restricted to squamous cell neoplasms  of  the genital tract and finger. These data are consistent with venereal  transmission of HPV-16 to the periungual region and suggests a role for  this virus in the evolution of squamous cell carcinoma at this site. 

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77.) Basal cell carcinoma of the genitalia. 

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Dermatol Surg 1998 Dec;24(12):1361-3 

Nehal KS, Levine VJ, Ashinoff R  Ronald O. Perelman Department of Dermatology, New York University  Medical  Center, NY 10016, USA. 

BACKGROUND: Basal cell carcinomas (BCC) arising on the genitalia are  exceedingly rare with an unclear pathogenesis. OBJECTIVE: To better  understand risk factors, tumor characteristics, and the possible role of  human papillomavirus (HPV) in the development of BCC of the genitalia. 

METHODS: 1543 records of Mohs micrographic surgery performed during a  6-year period were reviewed to identify cases of BCC arising on the  genitalia. Tumor tissue was analyzed for HPV DNA by in situ  hybridization. 

RESULTS: Four patients with BCC of the genitalia were treated with Mohs  micrographic surgery. The malignancies were located on the scrotum,  perineum, and perianal areas in the three male patients and on the vulva  in  the female patient. The mean age was 67 years. None of the patients had  prior history of skin cancers. Histologic evaluation of the tumors  revealed  two nodular subtypes, one superficial subtype, and one with follicular  differentiation. In situ hybridization failed to reveal DNA of HPV types  6,  11, 16, 18, 30, 31, 33, 35, 45, 51, and 52.

CONCLUSION: In this small  series, genital BCC occurred in an older age group with no identifiable  predisposing risk factors and did not show evidence of HPV infection. 

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78.) Detection of human papillomavirus DNA in PUVA-associated  non-melanoma  skin cancers. 

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J Invest Dermatol 1998 Jul;111(1):123-7 

Harwood CA, Spink PJ, Surentheran T, Leigh IM, Hawke JL, Proby CM,  Breuer  J, McGregor JM  Department of Academic Dermatology, Royal Hospitals NHS Trust, London,  UK. 

Psoralen and UVA (PUVA) photochemotherapy is associated with a  dose-dependent increased risk of nonmelanoma skin cancer in patients  treated for psoriasis. Like ultraviolet B radiation, PUVA is both  mutagenic  and immunosuppressive and may thus act as a complete carcinogen;  however,  the reversed squamous to basal cell carcinoma ratio (SCC:BCC) in  PUVA-treated patients, also seen in immunosuppressed renal transplant  recipients, suggests a possible cofactor role for human papillomavirus  (HPV) infection. In this study we examine a large series of benign and  malignant cutaneous lesions for the presence of HPV DNA from patients  treated with high dose (> or =500 J per cm2) ultraviolet A.

 A panel of  degenerate primers based on the L1 (major capsid protein) open reading  frame was employed, designed to detect mucosal, cutaneous, and  epidermodysplasia verruciformis HPV types with high sensitivity and  specificity. HPV DNA was detected in 15 of 20 (75%) non-melanoma skin  cancer, seven of 17 (41.2%) dysplastic PUVA keratoses, four of five  (80%)  skin warts, and four of 12 (33%) PUVA-exposed normal skin samples. The  majority of HPV positive lesions contained epidermodysplasia  verruciformis-related HPV including HPV-5, -20, -21, -23, -24, and -38.  Possible novel epidermodysplasia verruciformis types were identified in  further lesions.

Mixed infection with epidermodysplasia verruciformis,  cutaneous, and/or mucosal types was present in six of 30 (20%) of all  HPV  positive lesions, including in normal skin, warts, dysplastic PUVA  keratoses, and squamous cell carcinomas. The prevalence and type of HPV  infection in cutaneous lesions from PUVA-treated patients is similar to  that previously reported in renal transplant-associated skin lesions,  and  suggests that the role of HPV in PUVA-associated carcinogenesis merits  further study. 

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79.)Premalignant lesions and cancers of the skin in the general  population:  evaluation of the role of human papillomaviruses. 

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J Invest Dermatol 1990 Nov;95(5):537-42 

Kawashima M, Favre M, Obalek S, Jablonska S, Orth G  Unite des Papillomavirus, Institut Pasteur, Paris, France. 

To evaluate the role of human papillomaviruses (HPV) in the development  of  premalignant lesions and cancers of the skin in the general population,  314  biopsies obtained from 227 patients with benign neoplasms, premalignant  lesions, and cancers of the skin and from 25 patients with squamous cell  carcinoma of the lip were analyzed by Southern blot hybridization. DNA  probes specific for various cutaneous and genital HPV types were used in  hybridizations conducted under nonstringent or stringent conditions. HPV  DNA sequences were only detected in eight specimens obtained from six  patients: HPV 34 in one case of periungual Bowen's disease, HPV 36 and  an  as yet uncharacterized HPV in two cases of actinic keratosis, HPV 20 in  one  case of basal cell carcinoma, an as yet unrecognized HPV in one case of  squamous cell carcinoma, and HPV 16 in one case of squamous cell  carcinoma  of the lip. None of the specimens of cutaneous horn and keratoacanthoma  contained detectable HPV DNA. In contrast, HPV DNA sequences, mostly HPV  16, were detected in 13 of 23 cases of anogenital Bowen's disease and  invasive Bowen's carcinoma. HPV DNA sequences were not detected in 90  cutaneous samples further analyzed by the polymerase chain-reaction  technique, using amplification primers that contain conserved sequences  among the genomes of HPV. These results strongly suggest that the known  HPV  types play only a minor role, if any, in skin carcinogenesis in the  general population. 

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80.) Human papillomavirus type 2-associated basal cell carcinoma in two  immunosuppressed patients. 

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Arch Dermatol 1988 Jun;124(6):930-4 

Obalek S, Favre M, Jablonska S, Szymanczyk J, Orth G  Department of Dermatology, Warsaw School of Medicine, Poland. 

Human papillomavirus-2 genomes were detected by molecular hybridization in  two cases of basal cell carcinomas that developed in immunosuppressed  individuals. This form of human papillomavirus is usually responsible for  common warts in the general population. Although it does not appear to  have oncogenic potential, it may be, in some cases, associated with cutaneous malignancy. 

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DATA-MÉDICOS/DERMAGIC-EXPRESS No 2-(91)  22/03/2.000 DR. JOSÉ LAPENTA

                                               UPDATED 04 SEPTEMBER 2025

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Produced by Dr. José Lapenta R. Dermatologist

Venezuela 1.998-2.025

Producido por Dr. José Lapenta R. Dermatólogo Venezuela 1.998-2.025

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