CLINICAL, DERMATOSCOPICAL AND HISTOPATHOLOGICAL ASPECTS OF BASAL CELL CARCINOMA – STUDY ON 138 CASES

Andreea - Oana Enache, Virgil Patrascu, Raluca Niculina Ciurea, Loredana Elena Stoica, Alexandru Vaduva, Alex Emilian Stepan, Cristiana Eugenia Simionesc

Abstract


Background: Skin cancer represents 20% of all new diagnosed cancers in the world. The highest incidence rates of basal cell carcinoma have been reported in Australia followed by Europe and the USA. Basal cell carcinoma (BCC) is a slow-growing malignant tumor characterized by local invasiveness but an exceptionally rare metastatic potential.

Patients and methods: We performed a retrospective study on a group of 138 patients diagnosed with basal cell carcinoma, hospitalized in Dermatology Clinic of Craiova, aiming to highlight the clinical, dermatoscopical and histopathological aspects of basal cell carcinoma. Identification data, provenience area, clinical diagnosis, tumor site, particular aspects related to tumor evolution, histological subtype of the lesion, dermoscopic patterns, Fitzpatrick skin type of each patient were all recorded. The histopathological study was based on highlighting the following parameters: tumor stage, histopathological form, size and depth of invasion.

Results: Our study group included 75 men (54.3%) and 63 women. Patients were aged between 17 and 89 years, with a mean age of 70.92 years. Nodular BCC (49.2%) was the most common clinical presentation followed by pearly form and cicatricial BCC.

Dermoscopic structures were observed in all 138 patients. The most common dermoscopic pattern seen in nodular BCCs was featureless areas (90%), atypical red vessels (80%), arborizing vessels >0.2 mm in diameter (78%) and translucency (51.4%). Superficial BCCs mostly presented with comma vessels, white-red structureless areas background, hypopigmented areas and only 50% of them revealed telangiectatic vessels and blue-grey ovoid nests in our study. The most common vascular pattern was the presence of arborizing vessels (53 patients, 38.4%).

In our study, the histological polymorphism was revealed by the existence of various types of BCC: solid (nodular), cystic, keratotic, adenoid, morpheaform, superficial, pigmented, metatypical and mixed patterns. 29/138 cases were invasive, representing 21.01% of all tumors studied. Of these, 20 were at the level of the cephalic extremity.

Conclusions: BCC has an aggressive invasive behavior which is related to the histopathologic type, in our study, adenoid type was the most aggressive followed by solid and keratotic BCCs. Identification of clear diagnostic criteria for the aggressive behavior of basal cell carcinoma will allow the best therapeutic results for the patient.


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