8090/3 Rodent ulcer



Definitions

Skin
ICD-O-3 topography code: C44
ICD10: C44
           

Basal cell carcinoma (BCC) is the most common skin cancer. It arises from basal cells of the epidermis and pilosebaceous units and is histologically characterized by lobules, columns, bands or cords of basaloid "germinative" cells, surrounded by an outer palisade of cells. The associated stroma is loose and fibromucinous 1
 
LeBoit PE, Burg G, Weedon D, Sarasin A (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Skin Tumours
3rd Edition
IARC Press: Lyon 2005



.
BCCs develop on hair-bearing skin, most commonly on sun-exposed areas. About 85% are found on the head and neck, the remaining 15% on the trunk and extremities. Less frequent sites of involvement are penis and vulva.
The tumour usually grows in a slow and indolent fashion. However, if untreated, it may invade subcutaneous fat, skeletal muscle and bone. Clinically, BCC is divided into the following types: nodular, ulcerative, superficial, multicentric, erythematous, and sclerosing or morphea-like.
More than 95% of basal cell carcinomas occur in patients over 40, predominantly in fair-skinned individuals who are prone to sunburn. Treatment options include surgical excision, irradiation and topical application of imiquimod
2
Click to access Pubmed
A Gaspari A, Tyring SK, Rosen T (2009)
Beyond a decade of 5% imiquimod topical therapy.
J Drugs Dermatol 8: 467-74



3
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Mosterd K, Arits AH, Thissen MR, Kelleners-Smeets NW (2009)
Histology-based treatment of basal cell carcinoma.
Acta Derm Venereol 89: 454-8



. Inhibitors of the hedgehog pathway are currently being tested 4
Click to access Pubmed
Von Hoff DD, Lorusso PM, Rudin CM, Reddy JC, Yauch RL, Tibes R, Weiss GJ, Borad MJ, Hann CL, Brahmer JR, Mackey HM, Lum BL, Darbonne WC, Marsters JC, de Sauvage FJ, Low JA (2009)
Inhibition of the Hedgehog Pathway in Advanced Basal-Cell Carcinoma.
N Engl J Med 361:1164-72



. Distant metastases are rare 5
 
LeBoit PE, Burg G, Weedon D, Sarasin A (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Skin Tumours
3rd Edition
IARC Press: Lyon 2005



.



Penis
ICD-O-3 topography code: C60
ICD10: C60
           

Basal cell carcinoma is the most common skin cancer. It arises from basal cells of the epidermis and pilosebaceous units. Clinically it is divided into the following types: nodular, ulcerative, superficial, multicentric, erythematous, and sclerosing or morphea-like. More than 95% of these carcinomas occur in patients over 40. They develop on hair-bearing skin, most commonly on sun-exposed areas. Approximately 85% are found on the head and neck and the remaining 15% on the trunk and extremities. Basal cell carcinoma usually grows in a slow and indolent fashion. However, if untreated, the tumor may invade the subcutaneous fat, skeletal muscle and bone. Distant metastases are rare. Excision, curettage and irradiation cure most basal cell carcinomas.
Less frequent sites of involvement are penis and vulva.



Vulva
ICD-O-3 topography code: C51
ICD10: C51
           

Basal cell carcinoma (BCC) is the most common skin cancer. It arises from basal cells of the epidermis and pilosebaceous units and is histologically characterized by lobules, columns, bands or cords of basaloid "germinative" cells, surrounded by an outer palisade of cells. The associated stroma is loose and fibromucinous
6
 
LeBoit PE, Burg G, Weedon D, Sarasin A (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Skin Tumours
3rd Edition
IARC Press: Lyon 2005



.
BCCs develop on hair-bearing skin, most commonly on sun-exposed areas. About 85% are found on the head and neck, the remaining 15% on the trunk and extremities. Less frequent sites of involvement are penis and vulva.
The tumour usually grows in a slow and indolent fashion. However, if untreated, it may invade subcutaneous fat, skeletal muscle and bone. Clinically, BCC is divided into the following types: nodular, ulcerative, superficial, multicentric, erythematous, and sclerosing or morphea-like.
More than 95% of basal cell carcinomas occur in patients over 40, predominantly in fair-skinned individuals who are prone to sunburn. Treatment options include surgical excision, irradiation and topical application of imiquimod
7
Click to access Pubmed
A Gaspari A, Tyring SK, Rosen T (2009)
Beyond a decade of 5% imiquimod topical therapy.
J Drugs Dermatol 8: 467-74



8
Click to access Pubmed
Mosterd K, Arits AH, Thissen MR, Kelleners-Smeets NW (2009)
Histology-based treatment of basal cell carcinoma.
Acta Derm Venereol 89: 454-8



. Inhibitors of the hedghog pathway are currently being tested 9
Click to access Pubmed
Von Hoff DD, Lorusso PM, Rudin CM, Reddy JC, Yauch RL, Tibes R, Weiss GJ, Borad MJ, Hann CL, Brahmer JR, Mackey HM, Lum BL, Darbonne WC, Marsters JC, de Sauvage FJ, Low JA (2009)
Inhibition of the Hedgehog Pathway in Advanced Basal-Cell Carcinoma.
N Engl J Med 361:1164-72



. Distant metastases are rare 10
 
LeBoit PE, Burg G, Weedon D, Sarasin A (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Skin Tumours
3rd Edition
IARC Press: Lyon 2005



11
 
Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003



.



Anus and anal canal
ICD-O-3 topography code: C21
ICD10: C21
           

Basal cell carcinoma is the most common skin cancer. It arises from basal cells of the epidermis and pilosebaceous units. Clinically it is divided into the following types: nodular, ulcerative, superficial, multicentric, erythematous, and sclerosing or morphea-like. More than 95% of these carcinomas occur in patients over 40. They develop on hair-bearing skin, most commonly on sun-exposed areas. Approximately 85% are found on the head and neck and the remaining 15% on the trunk and extremities. Basal cell carcinoma usually grows in a slow and indolent fashion. However, if untreated, the tumor may invade the subcutaneous fat, skeletal muscle and bone. Distant metastases are rare. Excision, curettage and irradiation cure most basal cell carcinomas. Less frequent sites of involvement are penis and vulva.

Basal cell carcinoma of the anal margin
Basal cell carcinoma, the most common skin cancer, is primarily found on areas of the skin that are exposed to the sun, and little more than 100 cases have been reported to occur in the anal area
12
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Gibson GE, Ahmed I (2001)
Perianal and genital basal cell carcinoma: A clinicopathologic review of 51 cases.
J Am Acad Dermatol 45: 68-71



13
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Nielsen OV, Jensen SL (1981)
Basal cell carcinoma of the anus-a clinical study of 34 cases.
Br J Surg 68: 856-7



. The etiology is unknown and there is no evidence for a role of infection by HPV 14
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Nehal KS, Levine VJ, Ashinoff R (1998)
Basal cell carcinoma of the genitalia.
Dermatol Surg 24: 1361-3



. The tumour commonly presents as an indurated area with raised edges and central ulceration, located in the perianal skin, but occasionally involves the squamous zone below the dentate line. Histologically, it can show the same variability in morphology as basal cell carcinoma elsewhere, most reported cases having had a solid or adenoid pattern. Basal cell carcinoma is treated adequately by local excision and metastases are extremely rare. It is therefore important to distinguish basal cell from squamous cell carcinoma; this may be particularly difficult when relying solely on small biopsies. Both types of tumours can be found in the squamous zone, and both can show a combination of basaloid, squamous and adenoid features and an inflammatory infiltrate in the stroma 15
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Alvarez-Cañas MC, Fernández FA, Rodilla IG, Val-Bernal JF (1996)
Perianal basal cell carcinoma: a comparative histologic, immunohistochemical, and flow cytometric study with basaloid carcinoma of the anus.
Am J Dermatopathol 18: 371-9



. Numerous and even atypical mitoses may be present in basal cell carcinomas 16
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Pritchard BN, Youngberg GA (1993)
Atypical mitotic figures in basal cell carcinoma. A review of 208 cases.
Am J Dermatopathol 15: 549-52



. However, basaloid areas in squamous carcinoma usually show less conspicuous peripheral palisading, more cellular pleomorphism, and often large, eosinophilic necrotic areas. Immunohistochemistry may be helpful in establishing the diagnosis. Basal cell carcinoma is positive for Ber-EP4 and negative for keratins 13, 19 and 22, and for carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), erythroid band 3 (AE1) and Ulex europaeus agglutinin 1 (UEA1), while basaloid variants SCC usually show the opposite pattern 17
Click to access Pubmed
Alvarez-Cañas MC, Fernández FA, Rodilla IG, Val-Bernal JF (1996)
Perianal basal cell carcinoma: a comparative histologic, immunohistochemical, and flow cytometric study with basaloid carcinoma of the anus.
Am J Dermatopathol 18: 371-9



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