Cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC) are keratinocyte carcinomas, the most frequently diagnosed cancers in fair-skinned populations. Ultraviolet radiation (UVR) is the main driving carcinogen for these tumors, but immunosuppression, pigmentary factors, and aging are also risk factors. Scientific discoveries have improved the understanding of the role of human papillomaviruses (HPV) in cSCC as well as the skin microbiome and a compromised immune system in the development of both cSCC and BCC. Genomic analyses have uncovered genetic risk variants, high-risk susceptibility genes, and somatic events that underlie common pathways important in keratinocyte carcinoma tumorigenesis and tumor characteristics that have enabled development of prediction models for early identification of high-risk individuals. Advances in chemoprevention in high-risk individuals and progress in targeted and immune-based treatment approaches have the potential to decrease the morbidity and mortality associated with these tumors. As the incidence and prevalence of keratinocyte carcinoma continue to increase, strategies for prevention, including effective sun-protective behavior, educational interventions, and reduction of tanning bed access and usage, are essential. Gaps in our knowledge requiring additional research to reduce the high morbidity and costs associated with keratinocyte carcinoma include better understanding of factors leading to more aggressive tumors, the roles of microbiome and HPV infection, prediction of response to therapies including immune checkpoint blockade, and how to tailor both prevention and treatment to individual risk factors and needs.

/pdf/keratinocyte-carcinomas-current-concepts-and-future-research-4ptb49d0im.pdf

Keratinocyte Carcinomas: Current Concepts and Future Research Priorities.

Although basal cell carcinoma can be effectively managed through surgical excision, the most suitable surgical margins have not yet been fully determined. Furthermore, micrographic surgery is not readily available in many places around the world. A review of the literature regarding the surgical treatment of basal cell carcinoma was conducted in order to develop an algorithm for the surgical treatment of basal cell carcinoma that could help the choice of surgical technique and safety margins, considering the major factors that affect cure rates. Through this review, it was found that surgical margins of 4mm seem to be suitable for small, primary, well-defined basal cell carcinomas, although some good results can be achieved with smaller margins and the use of margin control surgical techniques. For treatment of high-risk and recurrent tumors, margins of 5-6 mm or margin control of the surgical excision is required. Previous treatment, histological subtype, site and size of the lesion should be considered in surgical planning because these factors have been proven to affect cure rates. Thus, considering these factors, the algorithm can be a useful tool, especially for places where micrographic surgery is not widely available.

http://www.scielo.br/pdf/abd/v90n3/0365-0596-abd-90-03-0377.pdf

Surgical treatment of basal cell carcinoma: an algorithm based on the literature.

Background Cutaneous basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) have poorer outcomes if treated when large. Objective We sought to estimate the growth rate of BCCs and SCCs and examine the relationship of personal, pathway, and cancer factors with cancer size (diameter). Methods We surveyed patients, pathology, and treatment for invasive BCCs and SCCs in 1 Australian region in 2000 through 2001. Results BCC size increased with increasing time since first noticed. Relative to mean size at 0 to 2 months, the mean size ratio was 1.10 at 2 to 8 months and increased steadily to 1.81 at 5 to 10 years ( P Limitations Patient recall of dates and lack of thickness for SCCs are limitations. Conclusion Earlier diagnosis of BCCs, perhaps through skin checks by a physician, may reduce their size and improve outcome. SCC size did not evidently increase with time.

Basal cell carcinoma and squamous cell carcinoma growth rates and determinants of size in community patients

Background

To determine the proportion of different subtypes of periocular BCC in South Australia.



Design

Retrospective review.



Participants

One thousand seven hundred thirteen consecutive periocular basal cell carcinoma (BCC) excision specimens.



Methods

Histological analysis of consecutive periocular BCC specimens.



Main Outcome Measures

Date of resection, patient age at resection, gender, tumour location, histological subtype and perineural invasion.



Results

From 2006 to 2012, a total of 1713 consecutive periocular BCC excision specimens were analysed. The mean age at resection was 68.8 years (median: 71, range: 21–101). Most specimens (56.4%) were removed from male patients. 52.7% involved the lower eyelid, 29.0% the medial canthus, 10.9% the lateral canthus and 7.5% the upper eyelid. The main histological subtypes identified were nodular (65.7%), infiltrative (17.5%), superficial (12.6%) and micronodular (4.2%). Of the specimens, 25.6% had more than one subtype. The most common subtype combinations were nodular with infiltrative (49.7%), and nodular with superficial (26.0%).



Conclusions

The majority of periocular BCC were located on the lower lid and classified histologically as nodular. Infiltrative BCC occurred more frequently than the superficial subtype. As the proportion of mixed BCC containing aggressive subtypes is high, surgical excision with margin control should be considered for periocular BCC.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/ceo.12298

Histological subtypes of periocular basal cell carcinoma

OBJECTIVE. Basal cell carcinoma (BCC) is the most common malignancy in the United States. The purpose of this article is to provide a comprehensive description of the clinicopathologic features, diagnostic workup, staging, treatment, and follow-up of BCC. CONCLUSION. Radiology plays an important role in the evaluation and staging of locally advanced and metastatic BCC. MRI is the modality of choice for assessing perineural disease and is equivalent or superior to CT for evaluating bony involvement. CT and PET/CT are used to evaluate metastatic disease.

https://www.ajronline.org/doi/pdfplus/10.2214/AJR.14.13160

Basal cell carcinoma: a comprehensive review for the radiologist

Background Pretreatment risk stratification of basal cell carcinoma (BCC) is largely based on histologic subtype reported from biopsy specimens. Objective We sought to determine the degree of concordance between characteristics identified on biopsy specimen and excision and to determine if histologic characteristics other than subtype correlated with depth of invasion. Methods Histologic specimens of 100 BCC biopsy specimens and corresponding excisions were reviewed. Anatomic site, histologic subtype, maximum depth of extension, contour of the lobules at the leading edge, elastosis characteristics, presence of necrosis, calcification, and ulceration were recorded. Concordance between biopsy specimens and their excisions with relation to depth of tumor lobules was analyzed. Results The concordance between the subtype of biopsy specimen and excision was 62%. Micronodular tumors had the greatest mean depth, followed by infiltrative, nodular, and superficial subtypes. Subtype reported from biopsy specimen ( P  = .0002) and excision ( P Limitations Selection bias is present as only standard excisions were included; BCCs treated by other methods were not examined. Conclusions BCC subtype identified on biopsy specimen may not correlate with subtype identified on excision. Morphologic subtype has the highest correlation with depth and reporting should reflect the highest risk growth pattern if a biopsy specimen contains more than one pattern. Consideration should be given to reporting necrosis and degree of solar elastosis.

https://www.jaad.org/article/S0190-9622(11)00353-7/pdf

Basal cell carcinoma characteristics as predictors of depth of invasion

A Firm Nodule on the Arm—Quiz Case

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Basal cell carcinoma characteristics as predictors of depth of invasion

A Firm Nodule on the Arm—Quiz Case