Transcript Research Presentation

External Ear Basosquamous cell
carcinoma
Instructor: 杜宗陽主任
Reporter:
張廷碩
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Case Presentation
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History
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44-year-old female
Sun exposure (+)
Left progressive auricular mass for 2 years.
2014.1.14 EAR OPD
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Physical Examination
• A PURPLISH MASS LESION ABOUT 2X2 CM
OVER LEFT UPPER AURICULAR.
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Left auricle
tumor
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Operation
• 2014.1.16:
REMOVAL OF EXTERNAL EAR TUMOR +F.T.S.G
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Left auricle
skin defect
FTSG
repair on
the skin
defect skin
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Pathology
• It consists of one piece of grey white soft
tissue and measures 1.6 x 1.4 x 1.3 cm.
• Nodular type basosquamous cell carcinoma.
There is no tumor present at the resection
margin.
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Staging
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Neck CT
Abdominal sonogram
WBBS
Staging: pT1cN0M0
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Risk Factors
• The following are high-risk features for
nonmelanoma skin cancer that is not on the
eyelid:
• The tumor is thicker than 2 millimeters.
• The tumor is described as Clark level IV (has spread into
the lower layer of the dermis) or Clark level V (has
spread into the layer of fat below the skin).
• The tumor has grown and spread along nerve pathways.
• The tumor began on an ear or on a lip that has hair on it.
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Staging
• In stage I, The tumor is not larger than 2 centimeters
at its widest point and may have one high-risk
feature.
• In stage II, the tumor is either:
– larger than 2 centimeters at its widest point; or
– any size and has two or more high-risk features
• In stage III: Jaw, eye socket, or side of the skull /LN
• In stage IV: base of the skull, spine, or ribs /LN>6cm
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Combined Conference
• Pathology:
– Margin less than 1mm
– No perineural invasion
• Wider surgical margin is needed.
• Post-op R/T is not indicated if margin free.
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Operation
• 2014.2.6:
Tumor wide excision with primary closure
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Introduction
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History
• First described in 1928.
• Today’s definition: WHO 2005
• “Metatypical BCC” : Synonym to Basosquamous
Cell Carcinoma
• “Keratotic BCC”
• “Collision tumor”
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Basosquamous Cell Carcinoma
(BSC)
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Basosquamous Cell Carcinoma
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Keratotic BCC
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Collision Tumor
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Diagnosis
• Only made by biopsy.
• BCC:
– Indolent subtypes: Superficial/Nodular
– Aggressive subtypes: Infiltrative/Morpheaform/BSC
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Diagnosis
• Immunochemical Stain:
• Discontinuity of Basement membrane
• High percentage of proliferating cells
• More stromal reactions
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• Incidence: 1.2%~2.7% of all skin carcinoma.
• Location: head and neck (95%) : Nose (33%)
• Increased recurrence and metastatic rates:
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Treatment
• Moh’s surgery
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Treatment
• Wide excision with safe margin
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Thank you for your attention!