Facial extensive ulcer

Abstract

suMMaryBasosquamous carcinoma (BSC), as described in 1910, is a distinctive variety of skin cancer and its etiology and pathological characteristics have generated much controversy over the years. Currently, BSC is considered a basal cell carcinoma (BCC) subtype with aggressive behavior and greater tendency for recurrence and metastases. We present a clinical case recently reported in our unit.Keywords: skin neoplasms, skin ulcer.Basosquamous carcinoma (BSC), as described in 1910, is a distinctive variety of skin cancer and its etiology and pathological characteristics have generated much controversy over the years.1 Currently, BSC is considered a basal cell carcinoma (BCC) subtype with aggressive behavior and greater tendency for recurrence and metastases. caseA 52-year-old male presented with a 6-year history of an impressive extensive ulcer on his right cheek ( Figure 1). It appeared over the old scar of a previous BCC excised ten years ago. It had painless steady increase in size with progressive difficulty in ocular movements and epiphora. A facial CT scan demonstrated a destruction of the right maxilla and nasal bone with no lymphadenopathies in the head and neck regions. Blood cell counts, urea, sedimentation rate, electrolytes, urinalysis tests were within reference ranges and antinuclear and anti-neutrophil cytoplasmic antibodies (ANCA) were negative. Mycological and bacterial cultures were also negative. A skin biopsy was performed and sent for hematoxylin-eosin and immunohistological staining (Figure 2). discussionThe incidence of BSC is between 1.5-2.7% in the largest studies reported.2 Local aggressive growth pattern and high potential for distant metastases are the main concerning facts. The rate of local recurrence of the BSC is 45%, almost twice as much as squamous cell carcinoma (SCC) and BCC. 3 This rare skin carcinoma has a metastatic rate of 5-8.4%. Prognostic factors for recurrence include positive resection margins, lymphatic invasion, perineural invasion and male gender. 4 Clinical image of the lesion is non-specific but long--standing time of evolution is a common feature in all the patients reported. The majority of these tumors arise on the head and the neck (80%), the central face and perinasal areas being the most prevalent locations. 5Histological examination exhibits findings of both BCC and SCC with a transition zone. It is not clear if BSC develops de novo or evolves from a pre-existing lesion, but the "squamatization theory" is the most commonly accepted. Unfortunately, the patient's previous BCC that was excised 10 years before could not be re-evaluated. Immunohistochemical stains have helped to a better characterization of BSC. Areas of BCC are Ber-EP4, AE1 and AE3 positive. In contrast, CAM5.2 and a variable positivization of epithelial membrane antigen are identified in the SCC areas. Ber-EP4 stain is gradually negative in the transition zone. Non-prospective trials to compare the different therapeutic regimes to approach BSC are available. There are