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Journal of the American Academy of... Jan 2009Basosquamous carcinoma is considered an aggressive type of basal cell carcinoma (BCC) with an increased risk of recurrence and metastases. This concept has been... (Review)
Review
BACKGROUND
Basosquamous carcinoma is considered an aggressive type of basal cell carcinoma (BCC) with an increased risk of recurrence and metastases. This concept has been perpetuated in the literature in spite of confusing terminology, limited scientific data, and the contradictory surgical experiences of some observers.
METHODS
This is a narrative review based on a MEDLINE search of articles in English and a manual search of popular dermatology textbooks to define basosquamous carcinoma, its incidence, clinical behavior, and treatment of choice.
RESULTS
There are no specific clinical features to distinguish basosquamous carcinoma from other BCC types and the diagnosis is made only after biopsy. There are several histologic definitions of basosquamous carcinoma ranging from a characteristic combination of BCC and squamous cell carcinoma with or without a transition zone, to any BCC with evidence of keratinization. The authors confine the use of the term to an infiltrative growth BCC with areas of keratinization and/or intercellular bridge formation in the setting of a prototypic proliferative stromal reaction. The term "metatypical basal cell carcinoma" is considered a synonym but its use is discouraged for the reasons outlined. The reported incidence of basosquamous carcinoma ranges from 1.2% to 2.7%. Published recurrence rates are 12% to 51% for surgical excision and 4% for Mohs micrographic surgery. The incidence of metastasis is at least 5%. The aggressive biological behavior and clinical course distinguish basosquamous carcinoma from other forms of BCC.
LIMITATIONS
This study is a literature review, contains a limited number of patients, and is mostly retrospective studies.
CONCLUSION
The terminology surrounding basosquamous carcinoma is confusing and there is a need for more uniform language. Based on our review and personal experience, we propose a more precise and specific definition. Data regarding the incidence, recurrence, and metastasis rates of basosquamous carcinoma are based mostly on retrospective series with a limited number of cases. We conclude that although the incidence of basosquamous carcinoma is unknown, there is a literature precedent suggesting more aggressive biological behavior. We believe that complete surgical excision is the preferred approach, and that basosquamous carcinoma is an ideal candidate lesion for Mohs micrographic surgery.
Topics: Carcinoma, Basosquamous; Humans; Skin Neoplasms
PubMed: 19103364
DOI: 10.1016/j.jaad.2008.09.036 -
Cells Nov 2023Basosquamous carcinoma (BSC), an uncommon and aggressive nonmelanoma skin cancer exhibiting characteristics ranging from basal cell carcinoma (BCC) to squamous cell... (Review)
Review
Basosquamous carcinoma (BSC), an uncommon and aggressive nonmelanoma skin cancer exhibiting characteristics ranging from basal cell carcinoma (BCC) to squamous cell carcinoma (SCC), is a subject of controversy in terms of its classification, pathogenesis, histologic morphology, biologic behavior, prognosis, and management. This narrative review is based on an electronic search of English-language articles in PubMed that included the terms "basosquamous carcinoma" and/or "metatypical carcinoma of the skin" in their titles. The review aims to succinctly present and assess current data on the epidemiology, clinical presentation, dermoscopic, LC-OCT, and histopathologic characteristics, as well as the genetics and management of BSC, providing insight into this intriguing entity. As a conclusion, dermoscopy, deep incisional biopsies, and immunohistologic techniques should be applied in clinically suspicious lesions to achieve an early diagnosis and better prognosis of this tumor. Surgical treatments, including wide excision and Mohs' micrographic surgery, remain the treatment of choice. Finally, Hedgehog pathway inhibitors and checkpoint inhibitors, must be thoroughly investigated with large controlled trials, since they may offer an alternative solution to irresectable or difficult-to-treat locally advanced cases of basosquamous carcinoma.
Topics: Humans; Carcinoma, Basosquamous; Hedgehog Proteins; Skin Neoplasms; Carcinoma, Basal Cell; Carcinoma, Squamous Cell
PubMed: 38067165
DOI: 10.3390/cells12232737 -
Dermatologic Surgery : Official... Jan 2017Basosquamous carcinoma is a rare cutaneous neoplasm that has caused considerable controversy as to its classification, pathogenesis, and management. (Review)
Review
BACKGROUND
Basosquamous carcinoma is a rare cutaneous neoplasm that has caused considerable controversy as to its classification, pathogenesis, and management.
OBJECTIVE
To review and summarize current literature on the definition, pathogenesis, incidence, and management of basosquamous carcinoma.
MATERIALS AND METHODS
Through December 2015, an electronic search of the Pubmed database was performed using combinations of basosquamous carcinoma and metatypical basal cell carcinoma as search terms.
RESULTS
A selection of 39 publications including case reports and series, retrospective studies, and systematic reviews of the literature were included. Descriptions of the definition of basosquamous carcinoma, clinical behavior, histopathological characteristics, current treatment therapies, and future advances are summarized.
CONCLUSION
This systematic review provides a comprehensive overview of the current understanding of basosquamous carcinoma. Further study is required to elucidate the mechanisms driving the formation of this aggressive tumor.
Topics: Anilides; Antineoplastic Agents; Carcinoma, Basosquamous; Combined Modality Therapy; Humans; Immunohistochemistry; Mohs Surgery; Pyridines; Skin Neoplasms
PubMed: 27340741
DOI: 10.1097/DSS.0000000000000815 -
Cancers Dec 2021Basosquamous carcinoma is a rare, aggressive non-melanoma skin cancer with features that lie between those of basal cell carcinoma and squamous cell carcinoma. A lot of...
Basosquamous carcinoma is a rare, aggressive non-melanoma skin cancer with features that lie between those of basal cell carcinoma and squamous cell carcinoma. A lot of controversy has been raised around the classification, pathogenesis, histologic morphology, biologic behavior, prognosis and management of this tumor. This is a narrative review based on an electronic search of articles published in PubMed in English language which had in their title the terms "basosquamous carcinoma" and/or "metatypical carcinoma of the skin". The aim of this review was to summarize and evaluate current data regarding epidemiology, clinical presentation, dermoscopic and histopathologic characteristics, as well as the genetics and management of BSC, in order to shed some more light onto this intriguing entity. As a conclusion, dermoscopy, deep incisional biopsies and immunohistologic techniques (Ber-EP4) should be applied in clinically suspicious lesions in order to achieve an early diagnosis and better prognosis of this tumor. Surgical treatments, including wide excision and Mohs' micrographic surgery, remain the treatment of choice. Finally, vismodegib, a Hedgehog pathway inhibitor, must be thoroughly investigated, with large controlled trials, since it may offer an alternative solution to irresectable or difficult-to-treat, locally advanced cases of basosquamous carcinoma.
PubMed: 34885255
DOI: 10.3390/cancers13236146 -
Archives of Dermatological Research Nov 2020Basosquamous carcinoma (BSC) is a malignant and aggressive neoplasm with unclear molecular etiology. It is often misdiagnosed as basal cell carcinoma (BCC) or squamous... (Review)
Review
Basosquamous carcinoma (BSC) is a malignant and aggressive neoplasm with unclear molecular etiology. It is often misdiagnosed as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) on biopsy as there are unclear histologic criteria for this neoplasm. It has been interchangeably referred to as metatypical BCC and collision tumor, although these entities are different. On histology, BSC consists of basal cells with areas with nests of squamous cells and an intermediate transition zone. The nature of this transition zone is not clearly defined in literature; however, Ber-EP4 staining is diagnostic for BSC. A gradation of Ber-EP4 staining from strongly positive in basaloid areas to weakly positive in an intermediate zone is demonstrated (no staining of squamous areas). Treatment with an array of modalities including wide local excision, Mohs surgery, radiotherapy, and palliative chemotherapy has been performed. We recommend further molecular studies in understanding the genetic mechanisms leading to BSC. For the purpose of good clinical practice, multiple biopsies and immunohistochemical studies should be performed to avoid samplingĀ error that can lead to a misdiagnosis of BSC.
Topics: Biomarkers, Tumor; Biopsy; Carcinoma, Basal Cell; Carcinoma, Basosquamous; Carcinoma, Squamous Cell; Chemoradiotherapy; Diagnosis, Differential; Diagnostic Errors; Humans; Immunohistochemistry; Mohs Surgery; Skin; Skin Neoplasms
PubMed: 32166375
DOI: 10.1007/s00403-020-02058-1 -
Dermatologic Surgery : Official... Aug 2003Basosquamous carcinoma (BSC) is a rare cutaneous tumor that has been poorly described in the dermatologic literature. It has been depicted as an aggressive tumor with a...
BACKGROUND
Basosquamous carcinoma (BSC) is a rare cutaneous tumor that has been poorly described in the dermatologic literature. It has been depicted as an aggressive tumor with a high incidence of distant metastasis.
OBJECTIVE
To examine the average extent of local tissue invasion and presence of distant metastases in cases of BSC compared with those of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
METHODS
One thousand consecutive Mohs surgery cases performed between January 1993 and May 1995 at the Oschner Clinic in New Orleans, Louisiana, for histologically confirmed BCC, SCC, and BSC were reviewed. Each case was retrospectively evaluated for tumor type, anatomic location, number of Mohs stages performed, and presence of metastases at the time of surgery, as determined by chest radiograph.
RESULTS
Seven hundred forty-five BCCs, 228 SCCs, and 27 BSCs (1,000 tumors total) were treated in 580 patients. The average number of stages required for clear margins in cases of BCC, SCC, and BSC was 1.62, 1.51, and 2.00, respectively. The prevalence of metastasis was 0.87% for SCC and 7.4% for BSC, which was statistically significant (P<0.001).
CONCLUSION
In this retrospective study, BSCs displayed tissue invasion similar to that of BCC or SCC but had a higher frequency of pulmonary metastasis than SCC.
Topics: Carcinoma, Basosquamous; Humans; Mohs Surgery; Neoplasm Invasiveness; Retrospective Studies; Skin Neoplasms
PubMed: 12859383
DOI: 10.1046/j.1524-4725.2003.29217.x -
Acta Dermato-venereologica Jan 2021Basosquamous carcinoma is a rare clinical entity, which comprises 1.7-2.7% of all skin carcinomas. It is described as a basal cell carcinoma with features of squamous...
Basosquamous carcinoma is a rare clinical entity, which comprises 1.7-2.7% of all skin carcinomas. It is described as a basal cell carcinoma with features of squamous differentiation. To date, studies of the epidemiology of basosquamous carcinoma have been few and small in size. We report here the most extensive series of basosquamous carcinomas published to date, highlighting the differences between basosquamous carcinoma and other keratinizing tumours. Patients undergoing surgical excision for keratinizing tumours were enrolled in this study. Age, sex and tumour characteristics were recorded. A total of 1,519 squamous cell carcinomas, 288 basosquamous carcinomas and 4,235 basal cell carcinomas were collected. Basosquamous features were compared with those of basal cell and squamous cell carcinomas. For basosquamous carcinomas, 70.5% were located on the head and neck, particularly on the nose, forehead and cheeks, and represented almost 10% of the keratinizing tumours on the ears. Significant differences were found between basosquamous carcinoma and basal cell or squamous cell carcinomas. Basosquamous carcinoma should be considered a distinct type of keratinizing tumour with different anatomical, sex and age distributions.
Topics: Carcinoma, Basal Cell; Carcinoma, Basosquamous; Carcinoma, Squamous Cell; Cheek; Humans; Skin Neoplasms
PubMed: 33269406
DOI: 10.2340/00015555-3710 -
Dermatologic Surgery : Official... May 2000
Review
Topics: Carcinoma, Basosquamous; Diagnosis, Differential; Humans; Skin Neoplasms
PubMed: 10816246
DOI: 10.1046/j.1524-4725.2000.00057.x -
Journal of Plastic Surgery and Hand... Apr 2015Basosquamous carcinoma is a rare cutaneous tumour that is considered an aggressive type of basal cell carcinoma with an increased risk of recurrence and metastases. This...
Basosquamous carcinoma is a rare cutaneous tumour that is considered an aggressive type of basal cell carcinoma with an increased risk of recurrence and metastases. This impression has been perpetuated in the literature, despite limited scientific data and conflicting results of some authors. This present study was aimed to evaluate the clinical-pathological features of this tumour and follow-up of a series of basosquamous carcinoma. Basosquamous carcinoma patients who underwent surgical excision between January 2000 and February 2012 were analyzed retrospectively. Their medical files were reviewed and the corresponding routinely stained sections (with hematoxylin-eosin) were re-evaluated by two pathologists. Thirty-five patients with basosquamous carcinoma were operated on in this period. Most tumurs were located in the head and neck area (94%), and the mean age of the patients was 69.8 years. Margin involvements were seen in 11 patients (31.4%) and all of them underwent re-excision. There was only one local recurrence. There was neither regional lymph node nor distant metastasis in this series. The recurrence rate of basosquamous carcinoma is found as 4%, lower than that of most other similar studies. Further pathologic studies are needed to better classify basosquamous carcinoma and to increase consistency between the results of studies. Surgical excision and regular follow-up are considered as the treatment of choice.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basosquamous; Female; Head and Neck Neoplasms; Humans; Immunohistochemistry; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Skin Neoplasms
PubMed: 25139415
DOI: 10.3109/2000656X.2014.944188 -
Dermatologic Therapy Jun 2022
Topics: Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Carcinoma, Basosquamous; Humans; Pyridines; Skin Neoplasms
PubMed: 35278014
DOI: 10.1111/dth.15436