Collision tumor of cutaneous malignant melanoma and basal cell carcinoma

BACKGROUND: Enhanced external counterpulsation (EECP) has been demonstrated to be an effective treatment for angina and exertional ischemia in patients with coronary disease. HYPOTHESIS: It is hypothesized that the ability of EECP to enhance the recruitment or development of coronary collaterals in coronary artery disease may be determined by the relative magnitude of diastolic augmentation (DA) and systolic unloading (SU). This study examines the relation between the proposed EECP effectiveness ratio (DA/SU), as assessed by finger plethysmography, and changes in descending aortic flow as assessed by Doppler echocardiography in 15 patients during EECP. METHODS: Varying external cuff pressures (0-275 mmHg) were used to generate a range of DA/SU ratios. The effect on aortic antegrade systolic and retrograde diastolic flow was assessed by Doppler echocardiography to determine whether there was an optimal EECP effectiveness ratio that maximizes the hemodynamic effects of EECP. With increasing DA/SU there was an initial positive linear increase in both systolic and diastolic flow volume. Systolic flow maximized at an effectiveness ratio of 1.5 and diastolic flow at a ratio of 2.0 RESULT: Therefore, effectiveness ratios (DA/SU) in the range of 1.5-2.0 are optimal for maximizing the hemodynamic effects of EECP.     

Risk of cancer among patients with cutaneous basal cell carcinoma

A population-based cohort of 37,674 patients diagnosed during the period 1978-1991 and registered in the Danish Cancer Registry with basal cell carcinoma of the skin (BCC) were followed for the occurrence of new malignancies. BCC patients experienced significantly increased cancer incidence rates compared with the general Danish population. The elevated cancer risk was not restricted to new cutaneous malignancies. Cancers at various sites, including lip, salivary glands, larynx, lung, breast, kidney and non-Hodgkin lymphoma occurred in significant excess. Patients diagnosed with BCC before the age of 60 years were at higher risk of developing new malignancies than patients diagnosed with BCC at an older age. This age association pertained particularly to breast cancer, testicular cancer and non-Hodgkin lymphoma.     

Urocanic acid isomers in patients with basal cell carcinoma and cutaneous malignant melanoma

Urocanic acid (UCA) is a major chromophore for ultraviolet (UV) radiation in the skin. On UV exposure, the naturally occurring trans-isomer converts to the cis-isomer in a dose-dependent manner. Accumulating evidence indicates that cis-UCA acts as an initiator of the UV-induced suppression of certain skin immune functions. This immunomodulation is recognized as an important factor in the development of skin cancer. In this study, pigmentation and UCA isomers were measured in 29 patients with previous basal cell carcinoma (BCC), 23 patients with previous cutaneous malignant melanoma (MM), and 32 healthy controls. Measurements were performed on UV-exposed (forehead, upper back) and UV non-exposed (buttock) skin. No significant differences in pigmentation percentage, total UCA concentration, relative (%) or absolute (nmol/cm2) cis-UCA concentration were observed between the groups in any of the body sites studied. The net production of cis-UCA after irradiation with a single test UV dose was evaluated. The relative production of cis-UCA following irradiation was significantly higher in both cancer groups when compared with the control group, while no significant difference was found between the BCC and the MM patients.     

Infiltrative basal cell carcinoma occurring in sites of biopsy-proven nodular basal cell carcinoma

OBJECTIVE: The authors studied factors associated with short-term treatment response in 38 nondepressed subjects with DSM-III-R obsessive-compulsive disorder (OCD). METHOD: The subjects completed 12 weeks of treatment with paroxetine (N = 20), placebo (N = 8), or cognitive-behavioral therapy (N = 10). Clinician and self-rated measures were gathered at baseline, during treatment, and after treatment. RESULTS: Seventeen (45%) subjects had "much" or "very much" improvement and achieved at least a 40% decrease in their total Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score. Responders had lower obsessive-compulsive scores on the Symptom Checklist 90-Revised, had a lower checking score on the Maudsley Obsessive-Compulsive Inventory, were less likely to have had prior drug therapy, and in general suffered more obsessive-compulsive symptoms. They were significantly less likely to have hoarding obsessions and corresponding compulsions. The latter finding was confirmed using multiple regression analysis. CONCLUSION: Hoarding is an important symptom that predicts poor treatment response in patients with OCD.     

Metastasizing auricular basal cell carcinoma

Basal cell carcinoma represents the most common skin cancer and involves the head and neck area in 80% to 85% of all patients treated. Despite their frequent occurrence, metastatic spread from these tumors is rare. This paper presents a case of a patient who had a metastasizing basal cell carcinoma. Despite control of primary disease by radical surgery and adjunctive irradiation, bony metastasis was found within nine months of therapy. Palliative therapy was given, but the patient died five months later. The pathophysiology of the metastasizing basal cell carcinomas is described, and a rationale for therapy presented.     

Merkel cell carcinoma: primary cutaneous neuroendocrine tumor

Merkel cell carcinoma is a neuroendocrine primitive tumor of the skin. We report a case who develops node and visceral metastasis, and dead. The clinical presentation, diagnosis, histology, immunocytochemistry, treatment and prognosis of this tumor will be discussed.     

Diagnosing basal cell carcinoma by dermatoscopy

BACKGROUND: Dermatoscopy (DS) has been used primarily to evaluate pigmented skin lesions. Little information is available on DS findings of basal cell carcinoma (BCC). Dermatoscopy is a noninvasive technique that allows visualization of cutaneous features from the skin surface to the papillary dermis. Basal cell carcinoma, the most common cutaneous malignancy, is traditionally diagnosed clinically and confirmed with biopsy. OBJECTIVE: To determine the dermatoscopic features of nonpigmented basal cell carcinomas. Methods: The dermatoscopic findings of 27 lesions that clinically were suspicious for BCC were analyzed. RESULTS: Of these 27 clinically suspect lesions, the biopsies revealed BCC in 20 specimens and squamous cell carcinoma (SCC) in two specimens. Twenty of these 22 specimens had dermatoscopic findings of BCC: diffusely distributed, branching blood vessels, asymmetric, and narrow blood vessels distributed deeper in the dermis, or a milky-red corona with superficial wide blood vessels. One nodular BCC in our study showed no distinct findings. CONCLUSIONS: Many BCCs have characteristic DS findings; however, dermatoscopic examination of some tumours will not demonstrate any known characteristic findings. As such, the DS criteria we propose for BCC are best utilized as an adjunctive study of clinical impressions. Biopsy remains the definitive diagnostic tool.     

Recurrent basal cell carcinoma treated with cryosurgery

OBJECTIVE: Ureteral stenosis secondary to vasculitis is a rare disease. The etiology and treatment of this unusual cause of ureteral obstruction are discussed. METHODS/RESULTS: We report a case of ureteral obstruction secondary to Churg-Strauss vasculitis in a 45-year-old man. The patient was treated with prednisone and cyclophosphamide. Subsequently ureteral resection and reanastomosis were performed. CONCLUSIONS: Vasculitis of the ureter should be considered in patients with connective tissue disorders who present with ureteral dilatation. In some cases ureteral stenosis may require surgery in combination with steroid and/or immunosuppressive therapy.     

Adhesion molecule expression in basal cell carcinoma

OBJECTIVE: Extending recall intervals can be an important strategy for making children's dental care more efficient. The purpose of this study was to describe the recall intervals that the clinicians decided were appropriate for children and adolescents when they were instructed to extend and individualise the routines based on clinical judgement. In addition, the effect on recall interval of the profession of the clinician (dentist or dental hygienist), the child's age and the need for fillings were studied. DESIGN: In a four week period in 1995, all dentists and dental hygienists in one county in Norway reported recall intervals for 2,513 children aged 3 to 18 years. RESULTS: The mean current interval since the previous examination was 17.1 months (SD = 4.7 months) and the mean proposed interval until the next examination was 16.4 months (SD = 4.4 months). Approximately 50% of children were evaluated by the clinicians to be suitable for recall intervals of 20 months or more and 10% were assessed as requiring a new examination within 12 months. The length of the current recall interval, the age of the child, whether or not the child received fillings, and whether the decision-maker was a dentist or a dental hygienist were statistically significantly associated with the length of the proposed recall interval. CONCLUSIONS: Basing recall intervals on clinical judgement resulted in intervals longer than 12 months for the majority of the children.     

Extensive rodent ulcer (type: solid basal cell carcinoma)

Pulmonary disease, including thromboembolic problems, accounts for a large portion of the morbidity of sickle cell disease. Chronic transfusion therapy is now a part of long-term treatment of sickle cell patients with stroke and chest syndrome. The resultant iron overload must be treated with chelation therapy using deferoxamine. Poor compliance with subcutaneous chelation therapy has necessitated intravenous deferoxamine treatment. We describe two patients with sickle cell disease on such a regimen, who became hypoxic as a result of pulmonary thromboembolism, secondary to venous thrombophlebitis. The thrombophlebitis and subsequent pulmonary embolism probably reflect the hypercoagulable state seen in sickle cell and are not due to the deferoxamine therapy.     

Cryotherapy of basal cell carcinoma in oculoplastic surgery

Cryotherapy was an effective modality in the treatment of basal cell carcinoma in the eyelid and periorbital area and cured 93% of the 29 lesions in 25 patients. This method was especially advantageous in patients with blood clotting disorders; those with medical contraindications to, or who refused, classical surgery; patients who had prior radiation or surgery; patients with the basal cell nevus syndrome or xeroderma pigmentosa; and in patients with medial canthal tumors. Experimental cryotherapy in the albino rabbit showed their lacrimal system is not adversely affected by freezing in the temperature range required for tumor death.     

Metastatic basal cell carcinoma presenting as unilateral lymphedema

BACKGROUND: Metastatic basal cell carcinoma (MBCC) is rare, occurring in only 0.0028-0.55% of all basal cell carcinomas (BCCs). Patients with MBCC may present with a variety of findings, related to the site of metastasis. OBJECTIVE: Clinical presentation of a MBCC that became symptomatic due to unilateral lymphedema and a review of the relevant literature. METHODS: Case report with literature review. RESULTS: Patients may present with lymphadenopathy, ulcerations, anemia, bone pain, or muscle weakness related to the site of metastasis. In this reported case, MBCC presented as unilateral lymphedema. Risk factors for MBCC include radiation, large and invasive tumors, and a history of recurrence. The average survival time for localized lymph node metastasis in BCC is 3.6 years. This patient is currently 2 years since MBCC presentation and is currently without evidence of recurrence. CONCLUSION: To our knowledge, we report the first case of MBCC that presented as unilateral lymphedema.     

Primary basal cell carcinoma of the limbal conjunctiva

BACKGROUND: The authors describe a 66-year-old man with primary basal cell carcinoma of the conjunctiva. He presented with a fleshy nodular conjunctival lesion of 4 months' duration, located at the nasal limbus of the left eye. No associated cutaneous lesions were present. RESULTS: The lesion was completely excised, and results of histopathologic examination showed a primary basal cell carcinoma of the conjunctiva. CONCLUSION: This report provides clinicopathologic evidence that primary basal cell carcinoma can rarely occur in the conjunctiva. The authors summarize two well-documented previously reported cases of this unusual lesion.     

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

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.     

Mohs' method of micrographic surgery as treatment for recurrent basal cell carcinoma

OBJECTIVE: Evaluation of Mohs' micrographic surgery as treatment for recurrent basal cell carcinoma of the skin. DESIGN: Retrospective. SETTING: University Hospital Maastricht, the Netherlands. METHOD: In the period April 1992 to December 1995, 91 recurrent basal cell carcinomas (88 patients) were treated by Mohs' micrographic surgery. Medical records were analysed retrospectively with respect to different aspects. RESULTS: The mean age of the patients was 69 years. The recurrent basal cell carcinomas, with an mean diameter of 19.7 mm, were mainly localized on the nose and forehead. There were equal numbers of solid and morphea-like types of basal cell carcinomas. Most of these tumours had been treated by means of surgical excision in the past. The last treatment had taken place 3 years previously on average. Reconstruction was performed by means of primary closure, a graft or a flap. The mean follow-up period after Mohs' micrographic surgery was 12 months, in which one tumour recurred. CONCLUSION: Mohs' micrographic surgery is a surgical technique which provides the best prospect of total tumour removal together with maximal functional and cosmetic preservation. Mohs' micrographic surgery is of particular value for the treatment of recurrent basal cell carcinomas.     

The heterogenous nature of in vivo basal cell carcinoma

The effects of tetramethylpyrazine, an alkaloid isolated from a Chinese herb Ligusticum wallichii Franch have been assessed in portal hypertensive rats. Portal hypertension was induced by partial portal vein ligation in Sprague-Dawley rats. Two weeks after ligation, when the hyperdynamic state had stabilized, rats were anaesthetized after an overnight fast and cannulated for measurement of mean arterial pressure, portal venous pressure, cardiac index and heart rate. Tetramethylpyrazine (3.0, 9.9 and 30mgkg(-1)) induced dose-dependent reductions of portal venous pressure and mean arterial pressure after intravenous infusion. The maximum percentage reduction of portal venous pressure after tetramethylpyrazine was 6.0+/-0.8, 9.3+/-1.6 and 20+/-2% of baseline for doses of 3.0, 9.9 and 30.0mgkg(-1), respectively. Also, total peripheral resistance was significantly reduced by tetramethylpyrazine and cardiac index was slightly increased. Our results showed that tetramethylpyrazine induced portal pressure reduction in portal hypertensive rats.     

Hereditary factors in basal cell carcinoma of the skin: a population-based cohort study in twins

The contribution of hereditary factors in basal cell carcinoma of the skin has not been well defined at the population level. We aimed to assess the hereditary component in basal cell carcinoma by comparing its occurrence in monozygotic and dizygotic twin pairs. The Finnish Twin Cohort, comprising 12,941 adult, like-sex twin pairs with established zygosity and resident in Finland in 1975, was linked with the Finnish Cancer Registry. We identified 335 twin pairs in which at least one twin had basal cell carcinoma diagnosed between 1953 and 1996. Standardized incidence ratios, concordances, tetrachoric correlations and pairwise relative risks were computed by standard methods. Components of variance in liability were estimated by structural equation modelling. There was an elevated risk of basal cell carcinoma for the co-twin of a diseased twin, but no difference in risk by zygosity. During the prospective follow-up in 1976-96, the probandwise concordance was 7.7% in monozygotic and 7.0% in dizygotic pairs. Model fitting indicated that genetic factors were not needed to account for the distribution of basal cell carcinoma in twin pairs. These results confirm the major role of environmental factors in the aetiology of basal cell carcinoma.     

Pigmented basal cell carcinoma of the eyelid. Apropos of a clinical case

A clinico-pathologic case of a 83-year-old female patient with a deeply pigmented inferior lid tumor is reported. The histopathological study of the tumor demonstrated a pigmented basal cell carcinoma. Numerous different tumors may affect the eyelids, melanocytic or not in nature. True melanomas are infrequent compared with the numerous other pigmented tumors, which always need a histological analysis.