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Histopathology of Basal Cell Carcinoma and Its Variants

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Basal Cell Carcinoma

Abstract

Basal cell carcinomas (BCCs) are epithelial tumors originating from basal layer of the epidermis or follicular infundibulum on sun-exposed skin of adult patients. BCCs in the pediatric population is rare and is almost exclusively seen in association with xeroderma pigmentosum or basal cell nevus syndrome (Gorlin-Goltz syndrome). BCCs can be classified into five principal clinical types: nodular/ulcerative, infiltrative, multifocal/superficial, pigmented and fibroepithelioma of Pinkus. These clinical types generally reflect their respective histopathologic growth patterns, although considerable overlap may occur, not only among the histologic variants, but also with other cutaneous basaloid neoplasms.

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References

  1. McNutt NS. Ultrastructural comparison of the interface between epithelium and stroma in basal cell carcinoma and control human skin. Lab Investig. 1976;35:132–42.

    CAS  PubMed  Google Scholar 

  2. Merot Y, Faucher F, Didierjean L, Saurat JH. Loss of bullous pemphigoid antigen in peritumoral lacunas of basal cell carcinomas. Acta Derm Venereol. 1984;64:209–13.

    CAS  PubMed  Google Scholar 

  3. Lane AT, Goldsmith LA, McCoon PE, Muhlbauer JE. Decreased anchoring-fibril antigens (AF1 and AF2) in basal-cell carcinoma. Arch Dermatol Res. 1985;277:499–501.

    Article  CAS  PubMed  Google Scholar 

  4. Stanley JR, Beckwith JB, Fuller RP, Katz SI. A specific antigenic defect of the basement membrane is found in basal cell carcinoma but not in other epidermal tumors. Cancer. 1982;50:1486–90.

    Article  CAS  PubMed  Google Scholar 

  5. Beer TW, Shepherd P, Theaker JM. Ber EP4 and epithelial membrane antigen aid distinction of basal cell, squamous cell and basosquamous carcinomas of the skin. Histopathology. 2000;37:218–23.

    Article  CAS  PubMed  Google Scholar 

  6. Izikson L, Bhan A, Zembowicz A. Androgen receptor expression helps to differentiate basal cell carcinoma from benign trichoblastic tumors. Am J Dermatopathol. 2005;27:91–5.

    Article  PubMed  Google Scholar 

  7. Astarci HM, Gurbuz GA, Sengul D, Hucumenoglu S, Kocer U, Ustun H. Significance of androgen receptor and CD10 expression in cutaneous basal cell carcinoma and trichoepithelioma. Oncol Lett. 2015;10:3466–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Danialan R, Mutyambizi K, Aung P, Prieto VG, Ivan D. Challenges in the diagnosis of cutaneous adnexal tumours. J Clin Pathol. 2015;68:992–1002.

    Article  CAS  PubMed  Google Scholar 

  9. George E, Swanson PE, Wick MR. Neuroendocrine differentiation in basal cell carcinoma. An immunohistochemical study. Am J Dermatopathol. 1989;11:131–5.

    Article  CAS  PubMed  Google Scholar 

  10. Visser R, Bosman FT. Neuroendocrine differentiation in basal cell carcinomas: a retrospective immunohistochemical and ultrastructural study. J Cutan Pathol. 1985;12:117–24.

    Article  CAS  PubMed  Google Scholar 

  11. Zhang P, Liu W, Yuan X, Li D, Gu W, Gao T. Endothelin-1 enhances the melanogenesis via MITF-GPNMB pathway. BMB Rep. 2013;46:364–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Brenner M, Coelho SG, Beer JZ, et al. Long-lasting molecular changes in human skin after repetitive in situ UV irradiation. J Invest Dermatol. 2009;129:1002–11.

    Article  CAS  PubMed  Google Scholar 

  13. Lan CC, Wu CS, Cheng CM, Yu CL, Chen GS, Yu HS. Pigmentation in basal cell carcinoma involves enhanced endothelin-1 expression. Exp Dermatol. 2005;14:528–34.

    Article  CAS  PubMed  Google Scholar 

  14. de Faria JL, Navarrete MA. The histopathology of the skin basal cell carcinoma with areas of intermediate differentiation. A metatypical carcinoma? Pathol Res Pract. 1991;187:978–85.

    Article  PubMed  Google Scholar 

  15. Garcia C, Poletti E, Crowson AN. Basosquamous carcinoma. J Am Acad Dermatol. 2009;60:137–43.

    Article  PubMed  Google Scholar 

  16. Cunneen TS, Yong JL, Benger R. Lung metastases in a case of metatypical basal cell carcinoma of the eyelid: an illustrative case and literature review to heighten vigilance of its metastatic potential. Clin Exp Ophthalmol. 2008;36:475–7.

    Article  PubMed  Google Scholar 

  17. Pyne JH, Myint E, Barr EM, et al. Superficial basal cell carcinoma: a comparison of superficial only subtype with superficial combined with other subtypes by age, sex and anatomic site in 3150 cases. J Cutan Pathol. 2017;44:677–83.

    Article  PubMed  Google Scholar 

  18. McKay KM, Sambrano BL, Fox PS, Bassett RL, Chon S, Prieto VG. Thickness of superficial basal cell carcinoma (sBCC) predicts imiquimod efficacy: a proposal for a thickness-based definition of sBCC. Br J Dermatol. 2013;169:549–54.

    Article  CAS  PubMed  Google Scholar 

  19. Roozeboom MH, van Kleef L, Arits AH, et al. Tumor thickness and adnexal extension of superficial basal cell carcinoma (sBCC) as determinants of treatment failure for methyl aminolevulinate (MAL)-photodynamic therapy (PDT), imiquimod, and 5-fluorouracil (FU). J Am Acad Dermatol. 2015;73:93–8.

    Article  CAS  PubMed  Google Scholar 

  20. Tozawa T, Ackerman AB. Basal cell carcinoma with follicular differentiation. Am J Dermatopathol. 1987;9:474–82.

    Article  CAS  PubMed  Google Scholar 

  21. Walsh N, Ackerman AB. Infundibulocystic basal cell carcinoma: a newly described variant. Mod Pathol. 1990;3:599–608.

    CAS  PubMed  Google Scholar 

  22. Brownstein MH. Basaloid follicular hamartoma: solitary and multiple types. J Am Acad Dermatol. 1992;27:237–40.

    Article  CAS  PubMed  Google Scholar 

  23. Bowen AR, LeBoit PE. Fibroepithelioma of pinkus is a fenestrated trichoblastoma. Am J Dermatopathol. 2005;27:149–54.

    Article  PubMed  Google Scholar 

  24. Pinkus H. Premalignant fibroepithelial tumors of skin. AMA Arch Derm Syphilol. 1953;67:598–615.

    Article  CAS  PubMed  Google Scholar 

  25. Katona TM, Ravis SM, Perkins SM, Moores WB, Billings SD. Expression of androgen receptor by fibroepithelioma of Pinkus: evidence supporting classification as a basal cell carcinoma variant? Am J Dermatopathol. 2007;29:7–12.

    Article  PubMed  Google Scholar 

  26. Haddock ES, Cohen PR. Fibroepithelioma of Pinkus revisited. Dermatol Ther (Heidelb). 2016;6:347–62.

    Article  Google Scholar 

  27. Stern JB, Haupt HM, Smith RR. Fibroepithelioma of Pinkus. Eccrine duct spread of basal cell carcinoma. Am J Dermatopathol. 1994;16:585–7.

    Article  CAS  PubMed  Google Scholar 

  28. Jones CC, Ansari SJ, Tschen JA. Cystic fibroepithelioma of pinkus. J Cutan Pathol. 1991;18:220–2.

    Article  CAS  PubMed  Google Scholar 

  29. Crowson AN. Basal cell carcinoma: biology, morphology and clinical implications. Mod Pathol. 2006;19(Suppl 2):S127–47.

    Article  PubMed  Google Scholar 

  30. Richman T, Penneys NS. Analysis of morpheaform basal cell carcinoma. J Cutan Pathol. 1988;15:359–62.

    Article  CAS  PubMed  Google Scholar 

  31. East E, Fullen DR, Arps D, et al. Morpheaform basal cell carcinomas with areas of predominantly single-cell pattern of infiltration: diagnostic utility of p63 and cytokeratin. Am J Dermatopathol. 2016;38:744–50.

    Article  PubMed  Google Scholar 

  32. Misago N, Ogusu Y, Narisawa Y. Keloidal basal cell carcinoma after radiation therapy. Eur J Dermatol. 2004;14:182–5.

    PubMed  Google Scholar 

  33. Requena L, Martin L, Farina MC, Pique E, Escalonilla P. Keloidal basal cell carcinoma. A new clinicopathological variant of basal cell carcinoma. Br J Dermatol. 1996;134:953–7.

    Article  CAS  PubMed  Google Scholar 

  34. Jones M, Bresch M, Alvarez D, Boer A. Keloidal basal cell carcinoma: not a distinctive clinicopathological entity. Br J Dermatol. 2009;160:127–31.

    Article  CAS  PubMed  Google Scholar 

  35. Sarma DP, Olson D, Olivella J, Harbert T, Wang B, Ortman S. Clear cell Basal cell carcinoma. Pathol Res Int. 2011;2011:386921.

    Google Scholar 

  36. Forman SB, Ferringer TC. Clear-cell basal cell carcinoma: differentiation from other clear-cell tumors. Am J Dermatopathol. 2007;29:208–9.

    Article  PubMed  Google Scholar 

  37. Barr RJ, Alpern KS, Santa Cruz DJ, Fretzin DF. Clear cell basal cell carcinoma: an unusual degenerative variant. J Cutan Pathol. 1993;20:308–16.

    Article  CAS  PubMed  Google Scholar 

  38. Elston DM, Bergfeld WF, Petroff N. Basal cell carcinoma with monster cells. J Cutan Pathol. 1993;20:70–3.

    Article  CAS  PubMed  Google Scholar 

  39. Cutlan RT, Maluf HM. Immunohistochemical characterization of pleomorphic giant cells in basal cell carcinoma. J Cutan Pathol. 1999;26:353–6.

    Article  CAS  PubMed  Google Scholar 

  40. Tschen JP, Cohen PR, Schulze KE, Tschen JA, Nelson BR. Pleomorphic basal cell carcinoma: case reports and review. South Med J. 2006;99:296–302.

    Article  PubMed  Google Scholar 

  41. Foley P, Mason G. Keratotic basal cell carcinoma of the upper eyelid. Australas J Dermatol. 1995;36:95–6.

    Article  CAS  PubMed  Google Scholar 

  42. Ambrojo P, Aguilar A, Simon P, Requena L, Sanchez Yus E. Basal cell carcinoma with matrical differentiation. Am J Dermatopathol. 1992;14:293–7.

    Article  CAS  PubMed  Google Scholar 

  43. Kyrpychova L, Carr RA, Martinek P, et al. Basal cell carcinoma with matrical differentiation: clinicopathologic, immunohistochemical, and molecular biological study of 22 cases. Am J Surg Pathol. 2017;41:738–49.

    Article  PubMed  Google Scholar 

  44. Del Sordo R, Cavaliere A, Sidoni A. Basal cell carcinoma with matrical differentiation: expression of beta-catenin [corrected] and osteopontin. Am J Dermatopathol. 2007;29:470–4.

    Article  PubMed  Google Scholar 

  45. Misago N, Satoh T, Narisawa Y. Basal cell carcinoma with ductal and glandular differentiation: a clinicopathological and immunohistochemical study of 10 cases. Eur J Dermatol. 2004;14:383–7.

    PubMed  Google Scholar 

  46. Zbacnik AP, Rawal A, Lee B, Werling R, Knapp D, Mesa H. Cutaneous basal cell carcinosarcoma: case report and literature review. J Cutan Pathol. 2015;42:903–10.

    Article  PubMed  Google Scholar 

  47. Bourgeault E, Alain J, Gagne E. Primary cutaneous carcinosarcoma of the basal cell subtype should be treated as a high-risk basal cell carcinoma. J Cutan Med Surg. 2015;19:407–11.

    Article  PubMed  Google Scholar 

  48. Clark JJ, Bowen AR, Bowen GM, et al. Cutaneous carcinosarcoma: a series of six cases and a review of the literature. J Cutan Pathol. 2017;44:34–44.

    Article  PubMed  Google Scholar 

  49. Harms PW, Fullen DR, Patel RM, et al. Cutaneous basal cell carcinosarcomas: evidence of clonality and recurrent chromosomal losses. Hum Pathol. 2015;46:690–7.

    Article  CAS  PubMed  Google Scholar 

  50. Crowson AN, Magro CM, Kadin ME, Stranc M. Differential expression of the bcl-2 oncogene in human basal cell carcinoma. Hum Pathol. 1996;27:355–9.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  52. Miller SJ. Biology of basal cell carcinoma (Part I). J Am Acad Dermatol. 1991;24:1–13.

    Article  CAS  PubMed  Google Scholar 

  53. Silverman MK, Kopf AW, Bart RS, Grin CM, Levenstein MS. Recurrence rates of treated basal cell carcinomas. Part 3: surgical excision. J Dermatol Surg Oncol. 1992;18:471–6.

    Article  CAS  PubMed  Google Scholar 

  54. Randle HW. Basal cell carcinoma. Identification and treatment of the high-risk patient. Dermatol Surg. 1996;22:255–61.

    CAS  PubMed  Google Scholar 

  55. Sahl WJ. Basal cell carcinoma: influence of tumor size on mortality and morbidity. Int J Dermatol. 1995;34:319–21.

    Article  CAS  PubMed  Google Scholar 

  56. Archontaki M, Stavrianos SD, Korkolis DP, et al. Giant basal cell carcinoma: clinicopathological analysis of 51 cases and review of the literature. Anticancer Res. 2009;29:2655–63.

    PubMed  Google Scholar 

  57. Fortina AB, Piaserico S, Caforio AL, et al. Immunosuppressive level and other risk factors for basal cell carcinoma and squamous cell carcinoma in heart transplant recipients. Arch Dermatol. 2004;140:1079–85.

    Article  PubMed  Google Scholar 

  58. Yanik EL, Pfeiffer RM, Freedman DM, et al. Spectrum of immune-related conditions associated with risk of keratinocyte cancers among elderly adults in the United States. Cancer Epidemiol Biomark Prev. 2017;26:998–1007.

    Article  CAS  Google Scholar 

  59. Nagarajan P, Asgari MM, Green AC, et al. Keratinocyte carcinomas: current concepts and future research priorities. Clin Cancer Res. 2019;25:2379–91.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The University of Texas MD Anderson Cancer Center, Department of Pathology, Anatomical, Houston, TX, USA

    Priyadharsini Nagarajan, Michael T. Tetzlaff & Jonathan L. Curry

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  1. Priyadharsini Nagarajan
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  2. Michael T. Tetzlaff
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  3. Jonathan L. Curry
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Correspondence to Priyadharsini Nagarajan .

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Editors and Affiliations

  1. The University of Texas MD Anderson Cancer Center, Departments of Dermatology and Head and Neck Surgery, Mohs Surgery Center, Houston, TX, USA

    Michael R. Migden

  2. The University of Texas MD Anderson Cancer Center, Department of Dermatology, Houston, TX, USA

    Leon Chen

  3. University of Texas McGovern Medical School at Houston, Department of Dermatology, Houston, TX, USA

    Sirunya Silapunt

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Nagarajan, P., Tetzlaff, M.T., Curry, J.L. (2020). Histopathology of Basal Cell Carcinoma and Its Variants. In: Migden, M., Chen, L., Silapunt, S. (eds) Basal Cell Carcinoma. Springer, Cham. https://doi.org/10.1007/978-3-030-26887-9_3

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  • DOI: https://doi.org/10.1007/978-3-030-26887-9_3

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  • Online ISBN: 978-3-030-26887-9

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