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Aggressive basal cell carcinoma of the head and neck: challenges in surgical management

  • Head and Neck
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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript


With exponentially increasing numbers of basal cell carcinoma (BCC) of the head and neck region, also the locally advanced BCCs are increasing in number. These tumours are associated with aggressive biological behaviour with invasion of soft tissues, organs or bone and present with wide variation in management strategies. The objectives of the study was to describe the biological behaviour of aggressive BCCs and their clinical presentation in the head and neck region with a series of cases treated in our tertiary hospital, discuss management plans of such complex cases in terms of surgical planning and reconstruction. A series of five cases of aggressive BCC in the head and neck region with involvement of organs such as nose, orbit, temporal bone, facial nerve, paranasal sinuses and mandible was studied. Locally advanced, aggressive BCC should be evaluated and treated as head and neck tumours. Multidisciplinary team (MDT) discussion is advisable wherein the strategies on surgical excision, reconstruction options, facial nerve rehabilitation, indications for prosthesis and further adjuvant treatment such as radiotherapy and chemotherapy are carefully planned.

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  1. Wu S, Han J, Li WQ, Li T, Quereshi AA (2013) Basal cell carcinoma incidence and associated risk factors in US women and men. A J Epidemiol 178(6):890–897

    Article  Google Scholar 

  2. Bath-Hextall F, Leonardi-Bee J, Smith C, Meal A, Hubbard R (2007) Trends in incidence of skin basal cell carcinoma. Additional evidence from a UK primary care database study. Int J Cancer 121:2105–2108

    Article  CAS  PubMed  Google Scholar 

  3. Miller DL, Weinstock MA (1994) Nonmelanoma skin cancer in the United States: incidence. J Am Acad Dermatol 30:774–778

    Article  CAS  PubMed  Google Scholar 

  4. Walling HW, Fosko SW, Geraminejad PA, Whitaker DC, Arpey CJ (2004) Aggressive basal cell carcinoma: presentation, pathogenesis and management. Cancer Metastasis Rev 23:389–402

    Article  PubMed  Google Scholar 

  5. Telfer NR, Colver GB, Morton CA (2008) Guidelines for the management of basal cell carcinoma. Br J Dermatal 159:35–48

    Article  CAS  Google Scholar 

  6. Randle H (1996) Basal cell carcinoma: identification and treatment of the high risk patient. Dermatol Surg 22:255–261

    CAS  PubMed  Google Scholar 

  7. Jacobs GH, Rippey JJ, Altini M (1982) Prediction of aggressive behaviour in basal cell carcinoma. Cancer 42:533–537

    Article  Google Scholar 

  8. Vico P, Fourez T, Nemec E, Andry G, Deraemaecker R (1995) Aggressive basal cell carcinoma of head and neck areas. Eur J Surg Oncol 21:490–497

    Article  CAS  PubMed  Google Scholar 

  9. Boonchai W, Walsh M, Cummings M, Chenevix-Trench G (2000) Expression of p53 in arsenic-related and sporadic basal cell carcinoma. Arch Dermatol 136:195–198

    CAS  PubMed  Google Scholar 

  10. Robarge KD, Brunton SA, Castanedo GM (2009) GDC-0449—a potent inhibitor of the Hedgehog pathway. Bioorg Med Chem Lett 60:137–143

    Google Scholar 

  11. Tsukifuji R, Sakai Y, Hatamochi A, Shinkai H (1997) Gene expression of matrix metalloproteinase-1 (interstitial collagenase) and matrix metalloproteinase-3 (stromelysin-1) in basal cell carcinoma in in situ hybridization using chondroitin ABC lyase. Histology 29:401–407

    CAS  Google Scholar 

  12. Christian M, Moy RL, Wagner RF, Yen-Moore A (2001) A correlation of alpha-smooth muscle actin and invasion in micronodular basal cell carcinoma. Dermatol Surg 27:441–445

    CAS  PubMed  Google Scholar 

  13. Ciurea ME, Cernea D, Georgescu CC, Cotoi OS, Patrascu V, Parvanescu H et al (2013) Expression of CXCR4, MMP-13 and beta-catenin in different histological subtypes of facial basal cell carcinoma. Romanian J Morphol Embryol (Revue Roum Morphol Embryol) 54:939–951

    CAS  Google Scholar 

  14. Edge SB, Byrd DR, Compton CC et al (eds) (2010) AJCC—cutaneous squamous cell carcinoma and other cutaneous carcinomas. AJCC cancer staging manual, 7th edn. Springer, New York, pp 301–314

    Google Scholar 

  15. Farley RL, Manolidis S, Ratner D (2006) Aggressive basal cell carcinoma with invasion of the parotid gland, facial nerve and temporal bone. Dermatol Surg 32:307–315

    CAS  PubMed  Google Scholar 

  16. Brown C, Perry AE (2000) Incidence of perineural invasion in histologically aggressive types of basal cell carcinoma. Am J Dermatopathol 22:123–125

    Article  CAS  PubMed  Google Scholar 

  17. Hanke CW, Wolf RL, Hochman SA, O’Brian JJ (1983) Chemosurgical reports: perineural spread of basal cell carcinoma. J Dermatol Surg Oncol 9:742–747

    Article  CAS  PubMed  Google Scholar 

  18. Dreier J, Cheng PF, Alleman IB, Gugger A, Hafner J, Tschopp A, Goldinger SM, Levesque MP, Dummer R (2014) Basal cell carcinomas in a tertiary referral centre: a systematic analysis. Br J Dermatol 171:1066–1072

    Article  CAS  PubMed  Google Scholar 

  19. Van den Brekel MWM, Castelijns JA, Stel HV et al (1991) Occult metastatic neck disease: detection with US and US-guided fine needle aspiration cytology. Radiology 178:457–461

    Article  Google Scholar 

  20. Chang ALS, Solomon JA, Hainsworth JD et al (2014) Expanded access study of patients with advanced basal cell carcinoma treated with the Hedgehog pathway inhibitor, vismodegib. J Am Acad Dermatol 70:60–69

    Article  CAS  PubMed  Google Scholar 

  21. Orouji A, Goerdt S, Utikal J et al (2014) Multiple highly and moderately differentiated squamous cell carcinomas of the skin during vismodegib treatment of inoperable basal cell carcinoma. Br J Dermatol 171:431–433

    Article  CAS  PubMed  Google Scholar 

  22. Tavin E, Persky MS, Jacobs J (1995) Metastatic basal cell carcinoma of the head and neck. Laryngoscope 105:814–817

    Article  CAS  PubMed  Google Scholar 

  23. Snow S, Saul WJ, Lo J, Mohs FE, Warner T, Dekkingo JA, Feyzi J (1994) Metastatic basal cell carcinoma: report of 5 cases. Cancer 73:328–335

    Article  CAS  PubMed  Google Scholar 

  24. Levy RM, Hanke CW (2010) Mohs micrographic surgery: facts and controversies. Clin Dermatol 28:269–274

    Article  PubMed  Google Scholar 

  25. Miller P, Roenigk RK, Brodland DG, Randle HW (1992) Cutaneous micrographic surgery: Moh’s procedure. Mayo Clin Proc 67:971–980

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Anil Joshi.

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Lohuis, P.J.F.M., Joshi, A., Borggreven, P.A. et al. Aggressive basal cell carcinoma of the head and neck: challenges in surgical management. Eur Arch Otorhinolaryngol 273, 3881–3889 (2016).

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