Our analysis shows that clinicopathological features associated with multiple BCC manifestations include male gender, tumor location in the trunk and upper extremities, and superficial histological subtype. Focus on this risk profile may be beneficial for clinical screening and may help clinicians in the selection of individuals, who should be followed-up more closely.Key words: basal cell carcinoma - single and multiple manifestations - clinicopathological differences.

SummaryBackground: Non-melanoma skin cancer (NMSC) is the most common malignancy in Caucasians. It mainly includes two major keratinocyte tumors -basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The objective of the study was to analyze and compare the clinicopathological differences between patients with BCC and SCC of the skin. Material and Methods: A cohort of 541 patients with a total of 719 BCCs, and 126 patients with a total of 162 SCCs were retrospectively analyzed. Results: While there was virtually the same proportion of men (49.91%) and women (50.09%) in BCC patients, SCCs occurred more frequently in men (68.2%) than in women (31.8%). The mean age of the individuals with BCC and SCC was 70.8 and 78.2 years, resp. The number of BCCs rises from 50 years of age and this increase showed a linear trend up to 80 years, subsequently followed by decline. SCC lesions occur more rapidly from 70 years of age followed by a sharp increase that exhibited an exponential relationship. BCCs and SCCs occurred predominantly on the head and neck region, compris ing a total of 69.8% and 81.4% of the cases, resp. However, BCC lesions were seen more often on the face and SCC lesions were dia gnosed more frequently on the extra-facial parts of the head. Further, BCCs occurred more frequently on the trunk, and particularly on the back, compared to SCCs. Conclusion: Although BCC and SCC are covered under common term NMSC, they manifest several clinicopathological differences. Despite shar ing common etiologic determinants, at least from the onco-epidemiologic perspective, they should be considered separately.

Evaluation of tumor cell proliferation status belongs to the basic prognostic indicators in a routine biopsy report. In cutaneous basal cell carcinoma (BCC), however, there are discrepancies about a true prognostic significance of this histopathological parameter. The aim of this study was to assess a proliferative activity (Ki-67 index) in BCCs of the skin. Biopsy specimens from 80 cutaneous BCCs (63 primary, 17 recurrent) of different histological types from 75 subjects (34 men, 41 women) were enrolled into this study. All samples were immunohistochemically stained by antibody against Ki-67 antigen (DAKO, clone MIB-1, dilution 1:100). For the statistical analysis, χ 2 test was employed. We found a striking percentage variability of nuclear Ki-67 expression in individual tumors (range 2-70%). Mean value of Ki-67 index was 27.4% (in primary tumors 28.1 %, in recurrent lesions 25.6%). The highest Ki-67 expression occurred in infiltrative BCCs (average 38.1%), morpheaform BCCs (average 37.0%), and superficial BCCs (average 35.7%), the lowest expression was recorded in nodular BCCs (average 21.7%) and BCCs with adnexal (trichoepithelial) differentiation (18.6%). There were not persuasive and statistically significant quantitative differences in proliferation activity of tumor cells between the individual histological BCC types, as well as between primary and recurrent lesions. A distribution of Ki-67 positive cells in tumor nests was mostly irregular and areas with a high number of Ki-67 labeled cells often occurred adjacent to areas with a lower number of cells expressing this marker. Because of a marked Ki-67 staining variability, we can conclude that the simple quantification of BCC proliferation activity alone may not be sufficient for the prediction of further biological behavior, evolution and clinical outcome of this malignancy.

Východiská: Gorlinov-Goltzov syndróm je autozómovo dominantne dedičné ochorenie charakteristické predispozíciou k rôznym typom nádorov. Klinicko-patologické nálezy syndrómu sú veľmi pestré, pričom mnohé symptómy sa začínajú prejavovať až v určitom období života. Prípad: Autori opisujú prípad muža, ktorý sa vo veku 34 rokov dostavil na dermatologické vyšetrenie s mnohopočetnými tumoróznymi léziami kože. Ich vývoj začal pozorovať približne od 30. roku života a odvtedy sa ich počet zvyšoval. Histologicky išlo o bazocelulárne karcinómy superficiálneho, superficiálno-nodulárneho a nodulárneho typu. Celkovo mal chirurgicky odstránených a mikroskopicky vyšetrených 11 primárnych bazocelulárnych karcinómov. Ostatné boli liečené lokálne imiquimodom a kryoterapiou. Okrem toho mal z čeľuste a sánky exstirpované viacpočetné odontogénne keratocysty a extrahované retinované a nadpočetné zuby. Ďalšie klinické a zobrazovacie vyšetrenia potvrdili makrocefáliu, hypertelorizmus, kalcifikáciu falx cerebri a abnormality krčných stavcov. Spektrum chorobných zmien spĺňalo dia gnostické kritériá Gorlinovho-Goltzovho syndrómu. Záver: Hoci je Gorlinov-Goltzov syndróm v bežnej praxi veľmi zriedkavý, väčšinou predstavuje závažnú chorobnú jednotku s multiorgánovým postihnutím. Z prognostického hľadiska je kľúčová jeho včasná dia gnostika a zahájenie adekvátnej terapie. V prípade potvrdenia dia gnózy je nevyhnutná celoživotná dispenzarizácia pa cienta s medziodborovou lekárskou spoluprácou.

We report a case of an 85-year-old man, who presented with a polypoid skin tumor in the left lumbal region. Histology revealed a malignant tumor composed predominantly of pleomorphic basaloid cell population with a high mitotic and proliferative activity. This cellular component was admixed with aggregates of anuclear cells with eosinophilic cytoplasm reminiscent of "shadow" cells seen in pilomatrixoma, as well as with whorls of keratin material reminiscent of squamoid pearls. Immunohistochemically, the basaloid tumor part was positive for CD10, p120catenin and CD138 and very sporadically positive for cytokeratin 19 and BerEP4. Cytokeratin 20 was negative and epithelial membrane antigen labelled only eosinophilic squamoid structures. In some areas, numerous interspersed dentritic melanocytes strongly immunoreactive for S-100 protein were arranged singly and in larger expansile nests within basaloid tumor mass. Histopathology and immunoprofile of lesion favored a diagnosis of pilomatrical carcinoma with intratumorous melanocytic proliferation. To the best of our knowledge, only a few such cases have been described untill now.

Basal cell carcinoma (BCC) is recently the most common cancer in humans characterized by several histopathological subtypes. Fibroepithelioma of Pinkus (FEP) is traditionally classifi ed as a very rare variant of BCC, however, it manifests clinical and morphological differences that distinguish it from most other types BCCs. This study was performed to evaluate the incidence of FEP and clinical-pathological characteristics of patients diagnosed with this tumor. Four cases of primary FEP (3 females, 1 male, mean age 53.4 y) were analyzed retrospectively. The prevalence of FEP was 0.7 % of all diagnosed BCCs. Topographically, tumors were localized on the right brachium, right gluteal region, left mesogastrium, and right side of the abdomen. Histological examination showed typical anastomosing cords of basaloid cells extending from the overlying epidermis into the loose fi brous stroma in the dermis. Mitotic activity or signifi cant cellular atypia, as well as sign of solar dermatosis were absent. Mean horizontal and vertical diameter of the lesions were 7.7 and 2.8 mm, retrospectively. We did not observe infi ltration of deeper skin structures. All lesions were removed completely and classifi ed as pathological stage pT1. Three cases manifested typical picture of a "pure" FEP, one lesion had partially a feature of nodular type BCC, too. Although FEP is conventionally considered as indolent BCC variant with a favorable clinical outcome, recent evidences also favors its classifi cation as a form of trichoblastoma. This is appropriate example how some types of cutaneous tumors can overlap in terms of dignity and clinical-morphological characteristics. This should be taken into account in differential diagnosis and in predicting of biological behaviour of the individual tumors of the skin (Tab. 2, Fig. 3, Ref. 26). Full Text in PDF www.elis.sk.

1How to cite this article: Bartoš V, Kullová M. Cutaneous squamous cell carcinoma in situ with extensive clear cell change -A report of two cases. Our Dermatol Online. 2017;8(3):311-314.

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