Data-Medicos 
Dermagic/Express  No. 2-(91) 
22 Marzo 2.000  22 March 2.000 

~ Carcinoma Basocelular  ~ 
~ Basal Cell Carcinoma  ~ 

EDITORIAL ESPANOL 
================= 
Hola amigos de la red, DERMAGIC hoy con el apasionante tema: CARCINOMA 
BASOCELULAR.  Hace mucho tiempo se creia que este tumor NO se presentaba 
en NIÑOS, que NO tenia relacion con VIRUS, que era BENIGNO, que que NO 
producia METASTASIS., que NO tenia relacion con la GENETICA (Antigenos 
HLA). Hoy el tiempo nos ha mostrado que SI EXISTEN estas relaciones. 
Las modalidades terapeuticas vas desde el simple CURETAJE hasta la 
utilizacion del LASER, CRIOCIRUGIA, y otras mas. Espero disfruten estas 
110 apocalipticas, Referencias (la  numero 1 contiene 30 mas). 
Hubiera sido interesante que a los 3 niños presentados en la referencia 
numero 1, se le hubiese hecho los antigenos HLA, probablemente se 
encontraria alguna asociacion. 

Nos veremos en 2 semanas con otro interesante tema. 
PROXIMA EDICION:      1.) El SIGNO DE LESER-TRELAT 

Saludos a todos !!! 
Dr. Jose Lapenta R.,,, 

EDITORIAL ENGLISH 
================= 
Hello friends of the net, DERMAGIC today with the exciting topic: BASAL 
CELL CARCINOMA. A long time ago it was believed that this tumor was not 
presented in CHILDREN, that he didn't have relationship with VIRUS, that 
was BENIGN  that METASTASIS didn't take place.that didn't have 
relationship with the GENETICS (HLA Antigens). Today the time has shown 
us that these relationships EXIST. 
The therapeutic modalities go from the simple CURETTAGE to the use of 
the LASER, CRYOSURGERY, and other but. I wait enjoy these apocalyptic110 
References (the number 1 contain other 30). 
It had been interesting that to the 3 children presented in the 
reference I number 1, he has been made the antigens HLA, he would 
probably be some association. 

We will see in 2 weeks with other interesting topic. 
NEXT EDITION:  1.) LESER-TRELAT SIGN 

Greetings to ALL,  !! 
Dr. Jose Lapenta R.,,, 
=================================================================== 
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES 
=================================================================== 
1.) Basal Cell Carcinoma in Children  Report of 3 Cases 
2.) Papillomaviruses in non-melanoma skin cancer: epidemiological 
aspects. 
3.) Reconstruction of the scalp and cranium using multiple free-tissue 
transfers following recurrent basal cell carcinoma. 
4.) Prognostic value of apoptotic index in cutaneous basal cell 
carcinomas of head and neck. 
5.) Low levels of urokinase plasminogen activator components in basal 
cell carcinoma of the skin. 
6.) Folliculotropic T cells in regressive basal cell carcinoma of skin. 
7.) Repeated 5-aminolevulinic acid-based photodynamic therapy following 
electro-curettage for pigmented basal cell carcinoma. 
8.) Sporadic Bazex-Dupre-Christol-like Syndrome: Early Onset Basal Cell 
Carcinoma, Hypohidrosis, Hypotrichosis, and Prominent Milia. 
9.) Reporting basal cell carcinoma: a survey of the attitudes of 
histopathologists. 
10.) Host-related and environmental risk factors for cutaneous basal 
cell carcinoma: evidence from an italian case-control study. 
11.) Collagenolytic and gelatinolytic matrix metalloproteinases and 
their inhibitors in basal cell carcinoma of skin: comparison with normal 
skin. 
12.) A Cancer-Registry-Assisted Evaluation of the Accuracy of Digital 
Epiluminescence Microscopy Associated with Clinical Examination 
ofPigmented Skin Lesions. 
13.) Expression of p53 in arsenic-related and sporadic basal cell 
carcinoma. 
14.) Decision support software to help primary care physicians triage 
skin cancer: a pilot study. 
15.) A randomized, 12-year primary-prevention trial of beta carotene 
supplementation for nonmelanoma skin cancer in the physician's health 
study. 
16.) Photofrin photodynamic therapy can significantly deplete or 
preserve oxygenation in human basal cell carcinomas during treatment, 
depending on fluence rate. 
17.) Gamma-irradiation deregulates cell cycle control and apoptosis in 
nevoid basal cell carcinoma syndrome-derived cells. 
18.) Expression of desmoglein I and plakoglobin in skin carcinomas. 
19.) Expression of basement membrane antigens and matrix 
metalloproteinases 2 and 9 in cutaneous basal and squamous cell 
carcinomas. 
20.) Detoxifying enzyme genotypes and susceptibility to cutaneous 
malignancy. 
21.) Tumors arising in nevus sebaceus: A study of 596 cases. 
22.) Liposome-mediated gene transfer into human basal cell carcinoma. 
23.) Proliferative Actinic Keratosis: Three Representative Cases. 
24.) Diet and basal cell carcinoma of the skin in a prospective cohort 
of men. 
25.) Preliminary observations on the use of topical tazarotene to treat 
basal-cell carcinoma. 
26.)HLA phenotypes and multiple basal cell carcinomas. 
27.) Multiple non-melanoma skin cancer: evidence that different MHC 
genes are associated with different cancers. 
28.) HLA DR4 is associated with the development of multiple basal cell 
carcinomas and malignant melanoma. 
29.) Multiple basal cell carcinoma in tropical Australia. 
30.) HLA-DR1 is not a sign of poor prognosis for the development of 
multiple basal cell carcinomas. 
31.) Multiple basal cell carcinomas and HLA frequencies in southern 
Australia. 
32.) Expression of human lymphocyte antigen (HLA)-DR on tumor cells in 
basal cell carcinoma. 
33.) Human leukocyte antigen associations in basal cell carcinoma. 
34.) Translocation (4; 14) and concomitant inv(14) in a basal cell 
carcinoma. 
35.) Long-term therapy with low-dose isotretinoin for prevention of 
basal cell carcinoma: a multicenter clinical trial. Isotretinoin-Basal 
Cell Carcinoma Study Group [see comments] 
36.) Treatment and prevention of basal cell carcinoma with oral 
isotretinoin. 
37.) Chemoprevention of basal cell carcinoma with isotretinoin. 
38.) Chemoprevention of skin cancer in xeroderma pigmentosum. 
39.) Relative importance of prior basal cell carcinomas, continuing sun 
exposure, and circulating T lymphocytes on the development of basal cell 
carcinoma. 
40.) Topical tretinoin in actinic keratosis and basal cell carcinoma. 
41.) Margin assessment of selected basal cell carcinomas utilizing laser 
Doppler velocimetry. 
42.) Carbon dioxide laser vaporization and curettage in the treatment of 
large or multiple superficial basal cell carcinomas. 
43.) The effect of intralesional 5-fluorouracil therapeutic implant (MPI 
5003) for treatment of basal cell carcinoma. 
44.) Cryosurgery and topical fluorouracil: a treatment method for 
widespread basal cell epithelioma in basal cell nevus syndrome. 
45.) Selective cytotoxic effect of topical 5-fluorouracil. 
46.) Nodular superficial pigmented basal cell epitheliomas. 
47.) Metastatic basal cell carcinoma: response to chemotherapy. 
48.) Basal cell carcinoma of the vulva with lymph node and skin 
metastasis--report of a case and review of 20 Japanese cases. 
49.) Basal cell carcinoma of the scalp resulting in spine metastasis in 
a black patient. 
50.) Long-term survival following bony metastases from basal cell 
carcinoma. Report of a case. 
51.)Giant basal cell carcinoma with metastasis and secondary 
amyloidosis: report of case. 
52.) Pulmonary metastases from a basal cell carcinoma. 
53.) Nonrecurrent primary basal cell carcinoma of the lower extremity 
with late metastasis. 
54.) [Metastatic basal cell carcinoma] 
55.) Metastatic basal cell carcinoma: report of twelve cases with a 
review of the literature [see comments] 
56.) Rapid development of metastases from basal cell carcinoma 
presenting as cranial nerve palsies. 
57.) Photodynamic therapy by topical aminolevulinic acid, 
dimethylsulphoxide and curettage in nodular basal cell carcinoma: a 
one-year follow-up study. 
58.) Epidemiologic characteristics and clinical course of patients with 
malignant eyelid tumors in an incidence cohort in Olmstead County, 
Minnesota. 
59.) Does wound healing contribute to the eradication of basal cell 
carcinoma following curettage and electrodessication? 
60.)Does inflammation contribute to the eradication of basal cell 
carcinoma following curettage and electrodesiccation? 
61.) Cryosurgery in dermatology. 
62.) [The treatment of basal cell carcinoma patients by dermatologists 
in Netherland]. 
63.) [Therapy of non-melanocytic skin tumors]. 
64.) [High resolution ultrasound imaging: value in treatment of 
basocellular carcinoma by cryosurgery]. 
65.) Recurrent basal cell carcinoma treated with cryosurgery. 
66.) Fractional cryosurgery. A new technique for basal cell carcinoma of 
the eyelids and periorbital area. 
67.) Long-term follow-up of cryosurgery of basal cell carcinoma of the 
eyelid. 
68.) Five-year results of curettage-cryosurgery of selected large 
primarybasal cell carcinomas on the nose: an alternative treatment in a 
geographical area underserved by Mohs' surgery. 
69.) Laser microsurgery for superficial T1-T2 basal cell carcinoma of 
the eyelid margins. 
70.)[Use of Nd:YAG laser for treatment of basal-cell carcinomas and some 
premalignant conditions]. 
71.) Laser therapy of skin tumors. 
72.) Treatment of superficial basal cell carcinoma and squamous cell 
carcinoma in situ with a high-energy pulsed carbon dioxide laser. 
73.) Prediction of subclinical tumor infiltration in basal cell 
carcinoma. 
74.) Recurrence rates of treated basal cell carcinomas. Part 3: Surgical 
excision. 
75.) Human papillomavirus type 2-associated basal cell carcinoma in two 
immunosuppressed patients. 
76.) Occurrence of human papillomavirus type 16 DNA in cutaneous 
squamous and basal cell neoplasms. 
77.) Basal cell carcinoma of the genitalia. 
78.) Detection of human papillomavirus DNA in PUVA-associated 
non-melanoma skin cancers. 
79.)Premalignant lesions and cancers of the skin in the general 
population: 
evaluation of the role of human papillomaviruses. 
80.) Human papillomavirus type 2-associated basal cell carcinoma in two 
immunosuppressed patients. 
============================================================ 
1.) Basal Cell Carcinoma in Children  Report of 3 Cases 
============================================================ 
Arch Dermatol. 2000;136:370-372 
Benjamin W. LeSueur, BS; Nancy G. Silvis, MD; Ronald C. Hansen, MD 

Background  The peak incidence of basal cell carcinoma occurs in the 
seventh decade of life and is rare in children. When found in the 
pediatric 
age group, basal cell carcinoma is usually associated with a genetic 
defect, such as basal cell nevus syndrome, xeroderma pigmentosum, or 
nevus 
sebaceus. In areas of intense UV radiation exposure, such as the 
southwestern United States, children may be at increased risk of 
developing 
this malignancy de novo. 

Observations  Three children (2 boys, aged 8 and 16 years, and an 
11-year-old girl) from Tucson, Ariz, with isolated basal cell carcinoma 
unassociated with any other disease or syndrome are described. 

Conclusions  Basal cell carcinoma in children is probably the result of 
a 
combination of UV radiation exposure and genetic background. Early 
recognition in children can prevent extensive tissue destruction and 
excess 
scarring after excision. A higher index of suspicion for basal cell 
carcinoma may also aid in prompt diagnosis of a possible genetic 
disorder, 
such as basal cell nevus syndrome. 

BASAL CELL carcinoma (BCC) in children is rare. Cases of BCC in the 
pediatric population have been reported in association with basal cell 
nevus syndrome,1 xeroderma pigmentosum,2 and nevus sebaceus3 and after 
high-dose radiotherapy.4 Isolated cases of BCC unrelated to one of these 

causes are seldom reported in pediatric patients. Consequently, 
clinicians 
often have a low index of suspicion, leading to delay in diagnosis. We 
report 3 cases of de novo BCC in children who presented to the 
dermatology 
clinic at the University of Arizona Medical Center, Tucson. These 
children 
had no known genetic syndromes and had not undergone radiotherapy. 

COMMENT 
========= 
Nonmelanoma skin cancers are the most common malignant neoplasms in the 
United States, representing one third of all cancers diagnosed every 
year.5, 6 Basal cell carcinoma represents 75% of nonmelanoma skin 
cancers 
and has an estimated annual incidence of more than 700,000 cases 
nationally.7, 8 The US average annual incidence of BCC in whites is 
currently 191 per 100,000 and is increasing at a rate of 3% to 7% per 
year.7, 9 

Ultraviolet radiation exposure is partly responsible for both BCC and 
squamous cell carcinoma, as evidenced by their increased prevalence 
after 
chronic exposure to sunlight and the preponderance of these lesions on 
sun-damaged skin. Although squamous cell carcinoma is associated with 
cumulative sun exposure, BCC in younger patients does not show this 
association.10, 11 D'Errico et al10 report that BCC arising before the 
age 
of 40 years corresponds with childhood or recreational sun exposure but 
does not correlate directly with cumulative sun damage. Thus, in areas 
of 
the world where the UV radiation is most intense, such as the Sunbelt in 

the United States, childhood sun exposure is at a maximum and younger 
patients are at a higher risk of developing BCC. 

Other factors besides sunlight are reported to influence the development 
of 
BCC. Gailani et al11 note a strong association between BCC and the 
inactivation of a gene at chromosome 9q22, which is thought to be a 
tumor 
suppressor. Inactivation of this gene was found in tumor tissue in 68% 
of 
BCCs examined and did not correlate directly with sun exposure or age. 
The 
cause of this mutation is unknown, but possible factors may include 
ionizing radiation, arsenicals, and polyaromatic hydrocarbons. Basal 
cell 
nevus syndrome and xeroderma pigmentosum represent inherited genetic 
mutations that predispose those affected to BCC. Patients with basal 
cell 
nevus syndrome are found to have a germline mutation on chromosome 9.12 

The peak incidence of BCC occurs in the seventh decade of life.13 In the 

pediatric age group, BCC usually occurs in the setting of a known 
genetic 
defect (Table 1). Although uncommon, isolated BCC in children without 
these 
conditions has been reported.14-29 Price et al14 described a 17-year-old 

boy with a solitary BCC of the nose. The patient had a history of 
sunburns 
1 or 2 times per year since the age of 9 years. His mother had a BCC 
removed at the age of 44 years. Histologically, the tumor was described 
as 
superficial BCC. Scobie and Preston17 described a 4-year-old boy with a 
BCC 
of the scalp. The patient presented with a small "cyst" on the occipital 

region of the scalp and a family history of skin cancer. The lesion, 
described histologically as well defined, recurred 8 months after 
excision. 
Excision was repeated without recurrence of tumor, based on follow-up 1 
year later.17 A 12-year-old boy living in Arizona was described by 
Comstock 
et al18 with a BCC on the nose. The lesion had been present since his 
nose 
was scratched by a cat 1 year earlier. The youngest patient with BCC, a 
27-month-old infant, was described by Keramidas and Anagnostou.21 In 
this 
case, the lesion grew rapidly and ulcerated after a 4-month delay in 
diagnosis. 

It is debatable whether BCC is more aggressive in children. Leffell et 
al30 
defined aggressive-growth BCC as sclerosing, morpheaform, infiltrative, 
or 
invasive into nerves. Their retrospective review showed an increased 
occurrence of aggressive-growth BCC in patients younger than 35 years 
old 
compared with older patients. In contrast, Betti et al13 and Dinehart et 

al16 found no increase in the frequency of the morpheaform pattern in 
younger patients. All 3 of our patients had histologically less 
aggressive 
forms of BCC. 

As total incidence rates of BCC continue to rise, childhood cases may 
become more common. This increase in pediatric BCC may be especially 
true 
in areas of high-level UV radiation exposure. The percentage of sunny 
days 
during the year, higher altitude, and location closer to the equator may 

place children in these areas at increased risk. Early recognition can 
prevent extensive tissue destruction and scarring after excision and aid 
in 
prompt diagnosis of a possible genetic syndrome. We recommend that 
clinicians have a higher index of suspicion for BCC when evaluating 
questionable lesions in children. 

REFERENCES 
============ 
1. 
Gorlin RJ, Goltz RW. 
Multiple nevoid basal-cell epithelioma, jaw cysts and bifid rib. 
N Engl J Med. 1960;262:908-912. 
2. 
Leibowitz E, Janniger CK, Schwartz RA, Lambert WC. 
Xeroderma pigmentosum. 
Cutis. 1997;60:75-77, 81-84. 

3. 
Goldstein GD, Whitaker DC, Argenyi ZB, Bardach J. 
Basal cell carcinoma arising in a sebaceous nevus during childhood. 
J Am Acad Dermatol.1988;18:429-430. 

4. 
Garcia-Silva J, Velasco-Benito JA, Pena-Penabad C, Armijo M. 
Basal cell carcinoma in a girl after cobalt irradiation to the cranium 
for acute lymphoblastic leukemia: case report and literature review. 
Pediatr Dermatol.1996;13:54-57. 

5. 
Silverberg E, Lubera JA. 
Cancer statistics, 1989. 
CA Cancer J Clin.1989;39:3-20. 

6. 
Boring CC, Squires TS, Tong T 
Cancer statistics, 1991. 
CA Cancer J Clin.1991;41:19-36. 

7. 
Silverberg E, Boring CC, Squires TS. 
Cancer statistics, 1990. 
CA Cancer J Clin.1990;40:9-26. 

8. 
Parker SL, Tang T, Bolden S, Wingo PA. 
Cancer statistics, 1997. 
CA Cancer J Clin.1997;47:5-27. 

9. 
Green A. 
Changing patterns in incidence of nonmelanoma skin cancer. 
Epithelial Cell Biol.1992;1:47-51. 

10. 
D'Errico M, Calcagnile AS, Corona R, et al. 
p53 mutations and chromosome instability in basal cell carcinomas 
developed at an early or late age. 
Cancer Res.1997;57:747-752. 

11. 
Gailani MR, Leffell DJ, Zeigler A, Gross EG, Brash DE, Bale AE. 
Relationship between sunlight exposure and a key genetic alteration in 
basal cell carcinoma. 
J Natl Cancer Inst. 1996;88:349-354. 

12. 
Gailani MR, Bale SJ, Leffel DJ, DiGiovanna JJ, Peck GL, Poliak S. 
Developmental defects in Gorlin syndrome related to a putative tumor 
suppressor gene on chromosome 9. 
Cell. 
1992;69:111-117. 
MEDLINE 
 

13. 
Betti R, Inselvini E, Carducci M, Crosti C. 
Age and site prevalence of histologic subtypes of basal cell carcinomas. 

Int J Dermatol. 1995;34:174-176. 

14. 
Price MA, Goldberg LH, Levy ML. 
Juvenile basal cell carcinoma. 
Pediatr Dermatol.1994;11:176-177. 

15. 
Cox NH. 
Basal cell carcinoma in young adults. 
Br J Dermatol.1992;127:26-29. 

16. 
Dinehart SM, Dodge R, Stanley WE, Franks HH, Pollack SV. 
Basal cell carcinoma treated with Mohs surgery: a comparison of 54 
younger patients with 1050 older patients. 
J Dermatol Surg Oncol.1992;18:560-566. 

17. 
Scobie WG, Preston J. 
Basal cell carcinoma in children. 
J R Coll Surg Edinb.1992;37:46-47. 

18. 
Comstock J, Hansen RC, Korc A. 
Basal cell carcinoma in a 12-year-old boy. 
Pediatrics.1990;86:460-462. 

19. 
Cullen KW, Bleach NR, Green DM. 
Juvenile basal cell carcinoma. 
Br J Clin Pract.1989;43:419-420. 

20. 
Fliss DM, Hauben DJ, Ben-Meir P, Sion-Vardy N. 
Solitary basal cell carcinoma in a child. 
Ann Plast Surg.1989;22:43-46. 

21. 
Keramidas DC, Anagnostou D. 
Basal cell carcinoma of the lower lid in a 27-month-old child. 
Z Kinderchir.1987;42:250-251. 

22. 
Rahbari H, Mehregan AH. 
Basal cell epithelioma (carcinoma) in children and teenagers. 
Cancer. 1982;49:350-353. 

23. 
Henriksson C, Eldh J, Hersle K, Suurkula M. 
Basal cell carcinoma in children: case report. 
Scand J Plast Reconstr Surg.1981;15:157-158. 

24. 
Hernandez-Perez E. 
Basal cell carcinoma in children. 
Dermatologica.1975;150:311-315. 

25. 
Milstone EB, Helwig EB. 
Basal cell carcinoma in children. 
Arch Dermatol.1973;108:523-527. 

26. 
Coskey RJ, Chow C. 
Basal cell epitheliomas in children and young adolescents. 
Cutis.1973;12:224-226. 

27. 
Botvinick I, Mehregan AH, Weissman F. 
Morphea-like basal cell epithelioma in a child. 
Arch Dermatol.1967;95:67-68. 

28. 
Murray JE, Cannon B. 
Basal-cell cancer in children and young adults. 
N Engl J Med.1960;262:440-443. 

29. 
Sewell RL. 
Basal cell carcinoma in youth. 
Arch Surg. 1941;42:909-912. 

30. 
Leffel DJ, Headington JT, Wong DS, Swanson NA. 
Aggressive-growth basal cell carcinoma in young adults. 
Arch Dermatol.1991;127:1663-1667. 
============================================================ 
2.) Papillomaviruses in non-melanoma skin cancer: epidemiological 
aspects. 
============================================================ 
Semin Cancer Biol 1999 Dec;9(6):397-403 

Kiviat NB 
Department of Pathology, University of Washington, Seattle, WA, 98103, 
USA 

[Record supplied by publisher] 
 

Worldwide, non-melanoma skin cancers (NMSCs), which include squamous 
cell 
carcinoma (SCC) and basal cell carcinoma (BCC), are the most commonly 
diagnosed cancers among Caucasians. It is well established that 
ultraviolet 
radiation (UVR) plays a central role in the development of these 
cancers, 
and more recently, a role for specific genetic mutations in the 
pathogenesis of BCC has been identified. The possibility that certain 
types 
of HPV, either alone or in conjunction with UVR, may play a role in the 
pathogenesis of these cancers is suggested by several lines of evidence 
reviewed below.*9 @2depidemiology / non-melanoma skin cancer / 
papillomavirus Copyright 2000 Academic Press. 

============================================================ 
3.) Reconstruction of the scalp and cranium using multiple free-tissue 
transfers following recurrent basal cell carcinoma. 
============================================================ 
J Reconstr Microsurg 2000 Feb;16(2):89-93 

Anderson PJ, Ragbir M, Berry RB, McLean NR 
Department of Plastic and Reconstructive Surgery, Shotley Bridge General 

Hospital, Durham, UK. 

It is well-recognised that recurrent disease can occur following surgery 

for malignancy in the head and neck region. This is particularly true of 

basal cell carcinoma in which recurrences may occur over many years and 
despite the use of different treatment modalities. Reconstruction of 
large 
defects may become increasingly difficult and can be optimally managed 
by 
free tissue transfer. The authors report a case of basal cell carcinoma 
that has required treatment for over 20 years, unique in that on five 
different occasions, free flaps have been used for reconstruction. 

============================================================ 
4.) Prognostic value of apoptotic index in cutaneous basal cell 
carcinomas 
of head and neck. 
============================================================ 
Oral Oncol 1999 Nov 1;35(6):541-547 

Staibano S, Lo Muzio L, Mezza E, Argenziano G, Tornillo L, Pannone G, De 

Rosa G 
Department of Biomorphological and Functional Sciences, Pathology 
Section, 
Faculty of Medicine and Surgery, University "Federico II", Naples, Italy 
 
 

Basal cell carcinoma (BCC) is the most common type of human cancer, 
often 
locally invasive, and following a benign clinical course. However, a 
proportion of BCCs do recur after treatment, causing extensive local 
tissue 
destruction, seldom metastasizing. Morphological methods to 
unequivocally 
distinguish the aggressive forms of these tumors (BCC2) from the 
ordinary 
ones (BCC1) have so far been lacking. Apoptosis, or programmed cell 
death, 
is thought to be important for the death of tumor cells in various 
stages 
of carcinogenesis. We analyzed the extent of apoptosis in BCCs of head 
and 
neck in a morphological, morphometric, and electron-microscopic study, 
to 
estabilish on a retrospective basis, the relative frequency of 
recurrence 
of tumors showing different apoptotic rates. We found that BCC1 showed 
lower apoptotic index (AI) than BCC2 [BCC1: AI from 2.03 to 10.45% (mean 

value: 5.98%) BCC2: AI from 21.91 up to 43.82% (mean value: 39.82%)]. 
The 
morphometric analysis of both BCC1 and BCC2 revealed significant 
differences between the values concerning nuclear area, length, 
perimeter, 
and roundness of the apoptotic cells with respect to the 'viable' 
neoplastic cells. Electron-microscopy confirmed that the features of 
morphological apoptotic cells were characteristic of programmed cell 
death. 
We hypothesized that low apoptotic rates in BCC1 could be indicative of 
a 
good prognosis. In fact, this corresponded to an 'expansive' but not 
still 
invasive neoplastic state. In this phase, however, the tumor cells may 
constitute the target for genetic changes triggered by enviromental 
physical or chemical mutagenic agents, such as UV rays. BCC2, then, 
could 
be the result of newly selected mutated neoplastic cellular clones, with 

more aggressive biological behavior. The high apoptotic level found in 
BCC2 
could thus be used as an indirect alarm signal from pathologists. This 
hypothesis seems to be supported by most of the current data in the 
literature and by the clinical outcome of BCC2 of our series. In our 
opinion, routine evaluation of apoptosis in BCCs could be proposed to 
facilitate their sub-classification, contributing toward the evaluation 
of 
the prospective outcome of the individual patients. 
 

============================================================ 
5.) Low levels of urokinase plasminogen activator components in basal 
cell 
carcinoma of the skin. 
============================================================ 
Int J Cancer 2000 Feb;85(4):457-459 

Maguire T, Chin D, Soutar D, Duffy MJ 
Department of Surgery, St. Vincent's Hospital, Dublin, Ireland. 

Basal cell carcinoma of the skin (BCC) is the most common cancer 
worldwide. 
Unlike most other human malignancies, BCCs rarely metastasise. In this 
investigation, we show that the serine protease urokinase plasminogen 
activator (u-PA), which is causally involved in metastasis, is expressed 
at 
lower levels in BCCs compared to other skin cancers, such as 
squamous-cell 
carcinomas (SCCs) or malignant melanomas. Similarly, the u-PA receptor 
as 
well as the inhibitor PAI-1 were present at lower levels in BCCs 
relative 
to both SCCs and melanomas. In contrast to u-PA, tissue-plasminogen 
activator, which is not thought to be involved in metastasis, was 
present 
at similar levels in the different types of skin lesion investigated. We 

conclude that the failure of BCCs to metastasise may at least be 
partially 
related to low expression of components of the u-PA system. Copyright 
2000 
Wiley-Liss, Inc. 

============================================================ 
6.) Folliculotropic T cells in regressive basal cell carcinoma of skin. 
============================================================ 
Am J Dermatopathol 2000 Feb;22(1):30-3 

Lespi PJ, Gregorini SD 
Department of Pathology, HIGA Dr Jose Penna, Bahia Blanca, Buenos Aires, 

Argentina. 
 

The histologic features of regression may be found in some basal cell 
carcinomas (BCCs), and it is known that T-cell infiltrates have a 
significant role in host defense against this tumor. We examined 945 
hair 
follicles (HFs) adjacent to 150 regressing BCCs of skin for the presence 
of 
inflammatory infiltrates and compared the results against 315 HFs in 50 
samples of normal skin. Focal T-cell infiltrates localized mainly to the 

upper portion of the HFs were found in 14.5% of the follicles adjacent 
to 
regressing BCCs. A statistically significant increase of inflammation in 

HFs was observed in BCCs with active regression compared with BCCs with 
inactive and mixed regression (P < 0.05). An increase in the number of 
HFs 
involved by T lymphocytes was also found in regressing BCCs compared to 
normal skin ( P < 0.00005). These data suggest that the damage to the 
follicles is concordant with active regression of BCCs. We speculate 
that 
the immune-mediated regression of BCCs is not only specifically directed 
to 
the cells of the tumor but may also induce activated lymphocytes with 
cytotoxic capability to cross react with the follicular epithelium. 

============================================================ 
7.) Repeated 5-aminolevulinic acid-based photodynamic therapy following 
electro-curettage for pigmented basal cell carcinoma. 
============================================================ 
J Dermatol 2000 Jan;27(1):10-5 

Itoh Y, Henta T, Ninomiya Y, Tajima S, Ishibashi A 
Department of Dermatology, National Defense Medical College, Tokorozawa, 

Japan. 

5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) in the 
standard 
manner is ineffective for pigmented basal cell carcinoma (pBCC), because 

melanin absorbs the photoactivating light interred for protoporphyrin 
IX. 
The objective of this study was to assess the therapeutic outcome of 
pBCCs 
with repeated ALA-PDT following removal of pigmentation with 
electro-curettage. After electro-curettage, 16 pBCCs were treated with a 

combination of topical application of 20% ALA in O/W emulsion and 
topical 
instillation of 10% ALA solution, followed by photoactivating light. 
ALA-PDT was performed more than three times. Fourteen of 16 pBCCs showed 

CR. Two pBCCs showing PR or NR were excised. Repeated ALA-PDT following 
electro-curettage was effective for pBCC. 

============================================================ 
8.) Sporadic Bazex-Dupre-Christol-like Syndrome: Early Onset Basal Cell 
Carcinoma, Hypohidrosis, Hypotrichosis, and Prominent Milia. 
============================================================ 
Dermatol Surg 2000 Feb;26(2):152-154 

Glaessl A, Hohenlautner U, Landthaler M, Vogt T 
Department of Dermatology, University of Regensburg, Regensburg, 
Germany. 

BACKGROUND: We present the case of a 32-year-old woman with a large 
recurrent multifocal basal cell carcinoma on the scalp. Conspicuous 
accompanying symptoms were multiple periorbital milia, hypotrichosis of 
the 
body and the scalp, and hypohidrosis. The sparse hair of the scalp 
showed 
further abnormalities such as pili torti, as well as flattened, 
irregularly 
curly hairs. OBJECTIVE: In 1964, Bazex et al. described a syndrome 
characterized by congenital hypotrichosis, follicular atrophoderma, and 
basocellular neoplasms that included basal cell nevi and early onset 
basal 
cell carcinomas. The Bazex-Dupre-Christol syndrome is a rare X-linked 
dominant disease. A sporadic occurrence with the typical constellation 
of 
these symptoms has not yet been reported. The lack of a positive family 
history and no signs of follicular atrophoderma argues for a sporadic 
occurrence of a Bazex-Dupre-Christol-like syndrome. The case reported 
shares several features with the classic Bazex-Dupre-Christol syndrome. 
CONCLUSION: Our report documents the necessity to look for early 
development of basal cell carcinomas in patients who show signs of the 
epidermal malformations described. 

============================================================ 
9.) Reporting basal cell carcinoma: a survey of the attitudes of 
histopathologists. 
============================================================ 
J Clin Pathol 1999 Nov;52(11):867-9 

Milroy CJ, Richman PI, Wilson GD, Sanders R 
Restoration of Function and Appearance Trust, Mount Vernon Hospital, 
Northwood, Middlesex, UK. [email protected] 

AIMS: To investigate the histopathological reporting of basal cell 
carcinoma. METHODS: Methods of classification and attitudes to excision 
margins were ascertained from histopathologists in 130 centres; 82 
replies 
were obtained (63% response rate). RESULTS: 24% of those replying did 
not 
use any classification system for basal cell carcinoma. The remainder 
(76%) 
used a wide variety of different classification systems. A small number 
(9%) of those questioned felt reporting on completeness of excision was 
not 
important. The majority of histopathologists considered the excision 
margin 
was worth reporting but there were differences in methods of processing 
and 
reporting biopsies. CONCLUSIONS: There is considerable variation in 
histopathological reporting of basal cell carcinoma. There is a need for 

uniformity of histopathological reporting to allow both improved 
management 
decisions and comparative audit of this extremely common skin cancer. 
 

============================================================ 
10.) Host-related and environmental risk factors for cutaneous basal 
cell 
carcinoma: evidence from an italian case-control study. 
============================================================ 
J Am Acad Dermatol 2000 Mar;42(3):446-52 

Naldi L, DiLandro A, D'Avanzo B, Parazzini F 
[Medline record in process] 
 

BACKGROUND: Despite its frequency, there is a paucity of data on risk 
factors for basal cell carcinoma. OBJECTIVE: We assessed potential risk 
factors for basal cell carcinoma in a population from southern Europe. 
METHODS: This multicenter case-control study involved 528 newly 
diagnosed 
cases and 512 controls. RESULTS: In the multivariate analysis, red hair, 

lighter colored eyes, high nevus counts on the upper limbs, and the 
presence of solar lentigines and actinic keratoses were all associated 
with 
basal cell carcinoma. The risk of the tumor increased in subjects who 
reported burning easily and experiencing sunburn episodes before 15 
years 
of age. An association was documented with indices of recreational sun 
exposure but no clear evidence of exposure-effect relationship was 
found. 
No relation was found with occupational sun exposure. Finally, basal 
cell 
carcinoma appeared to be significantly associated with a family history 
of 
skin tumors, a personal history of tumors other than those on skin, and 
radiotherapy. CONCLUSION: Genetic and environmental factors appear to be 

involved in the onset of basal cell carcinoma. 

============================================================ 
11.) Collagenolytic and gelatinolytic matrix metalloproteinases and 
their 
inhibitors in basal cell carcinoma of skin: comparison with normal skin. 

============================================================ 
Br J Cancer 2000 Feb;82(3):657-65 

Varani J, Hattori Y, Chi Y, Schmidt T, Perone P, Zeigler ME, Fader DJ, 
Johnson TM 
Department of Pathology, The University of Michigan Medical School, Ann 
Arbor 48109, USA. 

Tissue from 54 histologically-identified basal cell carcinomas of the 
skin 
was obtained at surgery and assayed using a combination of functional 
and 
immunochemical procedures for matrix metalloproteinases (MMPs) with 
collagenolytic activity and for MMPs with gelatinolytic activity. 
Collagenolytic enzymes included MMP-1 (interstitial collagenase), MMP-8 
(neutrophil collagenase) and MMP-13 (collagenase-3). Gelatinolytic 
enzymes 
included MMP-2 (72-kDa gelatinase A/type IV collagenase) and MMP-9 
(92-kDa 
gelatinase B/type IV collagenase). Inhibitors of MMP activity including 
tissue inhibitor of metalloproteinases-1 and -2 (TIMP-1 and TIMP-2) were 

also assessed. All three collagenases and both gelatinases were detected 

immunochemically. MMP-1 appeared to be responsible for most of the 
functional collagenolytic activity while gelatinolytic activity 
reflected 
both MMP-2 and MMP-9. MMP inhibitor activity was also present, and 
appeared, based on immunochemical procedures, to reflect the presence of 

TIMP-1 but not TIMP-2. As a group, tumours identified as having 
aggressive-growth histologic patterns were not distinguishable from 
basal 
cell carcinomas with less aggressive-growth histologic patterns. In 
normal 
skin, the same MMPs were detected by immunochemical means. However, only 

low to undetectable levels of collagenolytic and gelatinolytic 
activities 
were present. In contrast, MMP inhibitor activity was comparable to that 

seen in tumour tissue. In previous studies we have shown that exposure 
of 
normal skin to epidermal growth factor in organ culture induces MMP 
up-regulation and activation. This treatment concomitantly induces 
stromal 
invasion by the epithelium (Varani et al (1995) Am J Pathol 146: 
210-217; 
Zeigler et al (1996b) Invasion Metastasis 16: 11-18). Taken together 
with 
these previous data, the present findings allow us to conclude that the 
same profile of MMP/MMP inhibitors that is associated with stromal 
invasion 
in the organ culture model is expressed endogenously in basal cell 
carcinomas of skin. 

============================================================ 
12.) A Cancer-Registry-Assisted Evaluation of the Accuracy of Digital 
Epiluminescence Microscopy Associated with Clinical Examination of 
Pigmented Skin Lesions. 
============================================================ 
Dermatology 2000;200(1):11-16 

Stanganelli I, Serafini M, Bucch L 
Skin Cancer Clinic, Center for Cancer Prevention, Department of 
Prevention, 
Ravenna Health Care District, Ravenna, Italy. 

BACKGROUND: The accuracy of digital epiluminescence microscopy (D-ELM) 
as 
an adjunct to clinical examination for the diagnosis of pigmented skin 
lesions (PSLs) has seldom been evaluated. OBJECTIVE: To compare the 
accuracy of the combined clinical/D-ELM (C/D-ELM) examination with that 
of 
the clinical examination alone. METHODS: A total of 3,372 PSLs from 
1,556 
consecutive patients referred to a skin cancer clinic underwent clinical 

examination and a combined C/D-ELM examination. The reference diagnosis 
was 
established using the histology report of known surgical excisions plus 
a 
cancer-registry-based follow-up (duration 18 months) of benign C/D-ELM 
diagnoses. The two diagnostic approaches were compared for sensitivity, 
predictive value and false-positive rate. RESULTS: The series included 
55 
melanomas and 43 basal cell carcinomas. About 50% of malignant 
misdiagnosed 
cases were identified solely through the cancer registry. The C/D-ELM 
diagnosis showed a greater sensitivity for melanoma <0.76 mm thick (83 
vs. 
46% for clinical examination alone; ratio, 1.82) and basal cell 
carcinoma 
(79 vs. 49%; ratio, 1.62), a greater predictive value for melanoma (81 
vs. 
53%; ratio, 1.53) and a reduced total false-positive rate (0.3 vs. 0.9%; 

ratio, 0.31). CONCLUSION: D-ELM showed a potential to improve the 
clinical 
diagnosis of PSL. Copyright (R) 2000 S.Karger AG, Basel 

============================================================ 
13.) Expression of p53 in arsenic-related and sporadic basal cell 
carcinoma. 
============================================================ 
Arch Dermatol 2000 Feb;136(2):195-8 

Boonchai W, Walsh M, Cummings M, Chenevix-Trench G 
The Queensland Institute of Medical Research, University of Queensland, 
Brisbane, Australia. 

BACKGROUND: The TP53 gene has been shown to have an important role in 
the 
genesis of sporadic, presumably mainly sunlight-related, basal cell 
carcinoma (BCC). However, its role in arsenic-related BCCs is not clear, 

although the trivalent form of arsenic has been long recognized as a 
cause 
of BCC. Arsenic treatment has been shown to cause hypermethylation of 
the 
TP53 gene in lung carcinoma cell lines, but it is not known if this 
occurs 
in vivo in arsenic-related BCCs. OBJECTIVE: To compare the 
immunohistochemical expression of the p53 protein in arsenic-related and 

sporadic BCCs to determine if the expression pattern is consistent with 
gene silencing. SETTING: A research institute and hospital in Australia. 

CASES: One hundred seventeen white patients with 121 sporadic BCCs and 
21 
white patients with 92 arsenic-related BCCs. MAIN OUTCOME MEASURES: The 
expression and the intensity of p53 were scored semiquantitatively. 
Statistical analysis was performed using the chi2 test. RESULTS: 
Arsenic-related BCCs express p53 less often and at a lower intensity 
than 
sporadic BCCs (P = .001; 2-tailed test). The BCCs from sun-exposed 
sites, 
whether arsenic related or sporadic, more frequently showed 
overexpression 
of p53 than those from less-exposed areas (P = .004; 2-tailed test). The 

more aggressive subtypes of BCC show a higher level of expression of p53 

than the less aggressive forms (P = .04; 2-tailed chi2 test). 
CONCLUSIONS: 
These results are consistent with the hypothesis that the TP53 gene is 
down-regulated by methylation in arsenic-related BCC, particularly those 

from less-exposed sites. However, an alternative possibility is that 
mutations in TP53 that stabilize the protein are less common in 
arsenic-related BCCs. Further analysis will be necessary to distinguish 
between these hypotheses. 

============================================================ 
14.) Decision support software to help primary care physicians triage 
skin 
cancer: a pilot study. 
============================================================ 
Arch Dermatol 2000 Feb;136(2):187-92 

Gerbert B, Bronstone A, Maurer T, Hofmann R, Berger T 
Division of Behavioral Sciences, School of Dentistry, University of 
California, San Francisco 94111, USA. [email protected] 

OBJECTIVE: To determine whether decision support software can help 
primary 
care physicians proficiently triage lesions suggestive of basal cell and 

squamous cell carcinoma. DESIGN/MEASURES: Physicians selected triage 
options for 15 digitized images of skin lesions, with and without use of 

the decision support software. PARTICIPANTS/SETTINGS: Twenty primary 
care 
physicians practicing in a health maintenance organization or a city 
health 
clinic. INTERVENTION: Decision support software designed to help 
physicians 
arrive at a triage recommendation consisted of a clinical information 
form, 
a decision tree, and support features (teaching points, example images, 
and 
diagrams). RESULTS: Without using the decision support software, 
physicians 
chose the wrong triage decision 36.7% of the time; using the decision 
support software, they chose the wrong response only 13.3% of the time. 
Not 
using the decision support software, they failed to correctly perform a 
biopsy on or refer patients with cancerous lesions 22.1% of the time; 
using 
the software, they failed to correctly perform a biopsy on or refer 
patients with cancerous lesions only 3.6% of the time. Physicians scored 
an 
average of 3 points (of a possible 15 points) higher when they used the 
software (signed rank, 101.0; P<.001). They scored an average of 1 point 

higher on the 7 cancerous lesions when they used the software (signed 
rank, 
65.5; P<.001). CONCLUSIONS: Use of decision support software could 
improve 
primary care physicians' triage decisions for lesions suggestive of 
nonmelanoma skin cancer, and potentially reduce morbidity and health 
care 
costs. We are designing a larger study to evaluate the accuracy and 
utility 
of the software with patients seen in clinical practice. 

============================================================ 
15.) A randomized, 12-year primary-prevention trial of beta carotene 
supplementation for nonmelanoma skin cancer in the physician's health 
study. 
============================================================ 
Arch Dermatol 2000 Feb;136(2):179-84 

Frieling UM, Schaumberg DA, Kupper TS, Muntwyler J, Hennekens CH 
Division of Preventive Medicine, Brigham and Women's Hospital, Harvard 
Medical School, Boston, Mass, USA. 

CONTEXT: Although basic research provides plausible mechanisms for 
benefits 
of beta carotene supplementation on nonmelanoma skin cancer (NMSC) 
primarily consisting of basal cell carcinoma (BCC) and squamous cell 
carcinoma (SCC), observational studies are inconsistent. Randomized 
trial 
data are limited to 1 trial of secondary prevention that showed no 
effect 
of beta carotene on the incidence of NMSC after 5 years. OBJECTIVE: To 
test 
whether supplementation with beta carotene reduces the risk for 
development 
of a first NMSC, including BCC and SCC. DESIGN: Randomized, 
double-blind, 
placebo-controlled trial with 12 years of beta carotene supplementation 
and 
follow-up. SETTING: Physicians' Health Study in the United States. 
PARTICIPANTS: Apparently healthy male physicians aged 40 to 84 years in 
1982 (N = 22 071). INTERVENTION: Beta carotene, 50 mg, on alternate 
days. 
MAIN OUTCOME MEASURE: Relative risk (RR) and 95% confidence interval 
(CI) 
for a first NMSC, BCC, and SCC. RESULTS: After adjusting for age and 
randomized aspirin assignment, there was no effect of beta carotene on 
the 
incidence of a first NMSC (RR, 0.98; 95% CI, 0.92-1.05), BCC (RR, 0.99; 
95% 
CI, 0.92-1.06), or SCC (RR, 0.97; 95% CI, 0.84-1.13). There was also no 
significant evidence of beneficial or harmful effects of beta carotene 
on 
NMSC by smoking status (current, past, or never). CONCLUSION: This 
large-scale, randomized, primary prevention trial among apparently 
healthy 
well-nourished men indicates that an average of 12 years of 
supplementation 
with beta carotene does not affect the development of a first NMSC, 
including BCC and SCC. 

============================================================ 
16.) Photofrin photodynamic therapy can significantly deplete or 
preserve 
oxygenation in human basal cell carcinomas during treatment, depending 
on 
fluence rate. 
============================================================ 
Cancer Res 2000 Feb 1;60(3):525-9 

Henderson BW, Busch TM, Vaughan LA, Frawley NP, Babich D, Sosa TA, Zollo 

JD, Dee AS, Cooper MT, Bellnier DA, Greco WR, Oseroff AR 
Photodynamic Therapy Center, Roswell Park Cancer Institute, Buffalo, New 

York 14263, USA. 

At high fluence rates in animal models, photodynamic therapy (PDT) can 
photochemically deplete ambient tumor oxygen through the generation of 
singlet oxygen, causing acute hypoxia and limiting treatment 
effectiveness. 
We report that standard clinical treatment conditions (1 mg/kg 
Photofrin, 
light at 630 nm and 150 mW/cm2), which are highly effective for treating 

human basal cell carcinomas, significantly diminished tumor oxygen 
levels 
during initial light delivery in a majority of carcinomas. Oxygen 
depletion 
could be found during at least 40% of the total light dose, but tumors 
appeared well oxygenated toward the end of treatment. In contrast, 
initial 
light delivery at a lower fluence rate of 30 mW/cm2 increased tumor 
oxygenation in a majority of carcinomas. Laser treatment caused an 
intensity- and treatment time-dependent increase in tumor temperature. 
The 
data suggest that high fluence rate treatment, although effective, may 
be 
inefficient. 

============================================================ 
17.) Gamma-irradiation deregulates cell cycle control and apoptosis in 
nevoid basal cell carcinoma syndrome-derived cells. 
============================================================ 
Jpn J Cancer Res 1999 Dec;90(12):1351-7 

Fujii K, Miyashita T, Takanashi J, Sugita K, Kohno Y, Nishie H, Yasumoto 
S, 
Furue M, Yamada M 
Department of Genetics, National Children's Medical Research Center, 
Tokyo. 

The nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal 
dominant 
disorder characterized by nevi, palmar and plantar pits, falx 
calcification, vertebrate anomalies and basal cell carcinomas. It is 
well 
known in NBCCS that gamma-irradiation to the skin induces basal cell 
carcinomas or causes an enlargement of the tumor size, although the 
details 
of the mechanism remain unknown. We have established lymphoblastoid cell 

lines from three NBCCS patients, and we present here the first evidence 
of 
abnormal cell cycle and apoptosis regulations. A novel mutation (single 
nucleotide deletion) in the coding region of the human patched gene, 
PTCH, 
was identified in two sibling patients, but no apparent abnormalities 
were 
detected in the gene of the remaining patient. Nevertheless, the three 
established cell lines showed similar features in the following 
analyses. 
Flow cytometric analyses revealed that the NBCCS-derived cells were 
accumulated in the G2M phase after gamma-irradiation, whereas normal 
cells 
showed cell cycle arrest both in the G0G1 and G2M phases. The fraction 
of 
apoptotic cells after gamma-irradiation was smaller in the NBCCS cells. 
The 
level of p27 expression markedly decreased after gamma-irradiation in 
the 
NBCCS cells, although the effects of the irradiation on the expression 
profiles for p53, p21 and Rb did not differ in normal and NBCCS cells. 
These findings may provide a clue to the molecular mechanisms of 
tumorigenesis in NBCCS. 

============================================================ 
18.) Expression of desmoglein I and plakoglobin in skin carcinomas. 
============================================================ 
J Cutan Pathol 2000 Jan;27(1):24-9 

Tada H, Hatoko M, Tanaka A, Kuwahara M, Muramatsu T 
Division of Plastic Surgery, Nara Medical University, Japan. 

Reduction or absence of cell-cell adhesion molecules has been reported 
in 
various carinomas and the abnormal expression of these molecules 
contributes to the invasive and metastatic behavior of malignant tumor 
cells. In epidermal keratinocytes, the main cell-cell adhesion systems 
are 
adherens junctions and desmosomes. Previous studies have shown that, in 
skin carcinomas, the decreased expression of E-cadherin, major 
constitutional glycoprotein of adherens junctions, is associated with 
the 
invasive and metastatic ability of the tumor cells. In the present 
study, 
we examined the expression of desmoglein I and plakoglobin, the 
constitutional components of desmosomes, in various skin carcinomas such 
as 
basal cell carcinoma (BCC), squamous cell carcinoma (SCC), extramammary 
Paget's disease and Bowen's disease by an immunofluorescence method. In 
normal human skin, desmoglein I and plakoglobin were strongly expressed 
in 
the intercellular space of the epidermis except for the basal cell 
layer. 
In BCC and SCC, the expression of desmoglein I and plakoglobin was 
markedly 
reduced or absent in tumor cells. In carcinoma in situ of Paget's 
disease, 
compared with the normal epidermal cells surrounding tumor cell nests, 
the 
expression of these molecules was reduced in tumor cells. In Paget's 
disease with dermal infiltration of tumor cells, the expression of these 

molecules was almost absent throughout the epidermis. In Bowen's 
disease, 
the expression of desmoglein I was reduced in the dumping cells and 
dyskeratotic cells. These results suggest that the expression of 
desmosomal 
cadherin is reduced or absent in human skin carcinomas, and that 
reduction 
of these molecules may also contribute to the invasiveness and 
metastasis 
of skin carcinomas. 

============================================================ 
19.) Expression of basement membrane antigens and matrix 
metalloproteinases 
2 and 9 in cutaneous basal and squamous cell carcinomas. 
============================================================ 
Anticancer Res 1999 Jul-Aug;19(4B):2929-38 

Dumas V, Kanitakis J, Charvat S, Euvrard S, Faure M, Claudy A 
INSERM U346, Lyon, France. 

BACKGROUND: Basement membrane (BM) antigens and matrix 
metalloproteinases 
(MMP) are involved in tumor invasion and metastasis. Basal (BCC) and 
squamous cell carcinomas (SCC) differ with respect to their biological 
behavior since the former are only locally aggressive whereas the latter 

have a metastatic potential. MATERIALS AND METHODS: We studied the 
immunohistochemical expression of several BM antigens and of MMP2 and 
MMP9, 
in 13 BCC, 13 SCC, and 8 in situ skin carcinomas. RESULTS: The 
expression 
of most BM antigens was reduced in the tumors in comparison with normal 
skin. Hemidesmosome- and lamina lucida-associated antigens (plectin, 
NUT2, 
alpha 6/CD49f and laminin-5) were more decreased in BCC, whereas 
collagens 
type VII and IV were more decreased in SCC as compared with BCC; in BCC 
and 
SCC both collagens tended to be decreased on the leading edge of 
invasive 
tumor masses. In situ carcinomas showed a slightly diminished expression 
of 
alpha 6/CD49f integrin, plectin and NUT2. The expression of both MMP2 
and 
MMP9 was increased in SCC as compared with BCC. CONCLUSION: Our findings 

further upheld the role of BM antigens and MMPs in the process of tumor 
aggressiveness. The reduced expression of collagen IV, combined with an 
increased expression of both MMP2 and MMP9 could account for the 
increased 
metastatic potential of SCC vs BCC through an increased invasion of the 
extracellular matrix and the vascular space. 

============================================================ 
20.) Detoxifying enzyme genotypes and susceptibility to cutaneous 
malignancy. 
============================================================ 
Br J Dermatol 2000 Jan;142(1):8-15 

Lear JT, Smith AG, Strange RC, Fryer AA 
Department of Dermatology, Clinic 6, Bristol Royal Infirmary, Bristol 
BS2 
8HW, U.K.; *Department of Dermatology, North Staffordshire NHS Trust, 
Stoke 
on Trent ST4 7PA, U.K.; Department of Dermatology, Centre for Cell and 
Molecular Medicine, School of Postgraduate Medicine, Keele University, 
North Staffordshire Hospital, Stoke on Trent ST4 7PA, U.K. 

While ultraviolet (UV) exposure is thought to be a major risk factor for 

basal cell carcinoma (BCC) and squamous cell carcinoma, more recent 
research has focused on genetic factors predisposing to these cancers. 
UV 
constitutes an oxidative stress with generation of free radicals, 
leading 
to lipid and DNA damage and gene mutation. It could therefore be 
hypothesized that individual ability to deal with these products may be 
important in cutaneous carcinogenesis. It is clear from recent studies 
that 
polymorphisms in detoxifying enzyme genes are important in determining 
susceptibility to skin cancer. The magnitude of effect in BCC is similar 
to 
that seen with many other previously described risk factors. However, 
uncertainties exist regarding the phenotypic consequences of some of 
these 
polymorphisms and relevant substrates. This review describes the 
influence 
of polymorphisms in detoxifying enzymes in determining susceptibility to 

skin cancer (in particular to BCC) and give a brief overview of the 
biochemistry of the detoxification process. 

============================================================ 
21.) Tumors arising in nevus sebaceus: A study of 596 cases. 
============================================================ 
J Am Acad Dermatol 2000 Feb;42(2 Pt 1):263-8 

Cribier B, Scrivener Y, Grosshans E 
Laboratoire d'Histopathologie Cutanee, Clinique Dermatologique des 
Hopitaux 
Universitaires de Strasbourg, France. 

BACKGROUND: Prophylactic surgical excision of nevus sebaceus (NS) during 

childhood is often recommended because various neoplasms can occur on 
NS. 
The proportion of malignant tumors occurring on NS is highly variable 
among 
the published series, and there are controversies on the nature of these 

neoplasms because many of the previously described basal cell carcinomas 

could actually be trichoblastomas, which are benign follicular tumors. 
OBJECTIVE: We retrospectively analyzed all cases of NS of our 
collection, 
excised during the period from 1932 through 1998, and recorded all 
associated epithelial and nonepithelial changes. We especially 
differentiated basal cell carcinomas from trichoblastomas by silhouette 
analysis and examination of the stroma. These findings were analyzed 
according to gender, age, and localization. METHODS: Microscopic 
analysis 
of NS by two examiners was performed independently of clinical data. 
RESULTS: A total of 596 cases were included from 290 females and 306 
males, 
mean age 25.4 years (range, 1 month to 87 years); 232 were excised in 
children younger than 16 years. NSs were located on the scalp in 49.8% 
of 
cases. Basal cell carcinomas were found in 5 cases (0.8%, mean age 39.3 
years) and benign tumors in 81 cases (13.6%, mean age 46.3 years). 
Syringocystadenoma papilliferum (n = 30, 15 males, 15 females) and 
trichoblastoma (n = 28, 7 males, 21 females) were the most frequent 
benign 
tumors. NS with associated tumors were located on the scalp in 79% of 
cases. Only 4 benign tumors (1.7%) and 2 warts were observed in patients 

younger than 16 years. Various types of epithelial hyperplasia were 
noted 
that could not be considered neoplasms, as well as epidermal and 
apocrine 
cysts. CONCLUSION: The rate of malignant tumors arising on NS was very 
low 
and we did not observe such cases in children, who had associated benign 

tumors in only 1.7% of cases. Benign neoplasms were common and most of 
them 
occurred on the scalp; this was not a bias resulting from a longer 
duration 
before surgery. Trichoblastoma and not basal cell carcinoma was the most 

frequent follicular tumor associated with NS and showed a striking 
female 
predominance. Most trichoblastomas had previously been misdiagnosed but 
could actually be easily recognized by typical histologic features. 
Because 
most tumors occurred in adults older than 40 years, our study suggests 
that 
prophylactic surgery in young children is of uncertain benefit. Clinical 

follow-up is probably sufficient, and even those cases with clinical 
changes often proved to be benign tumors or warts. 

============================================================ 
22.) Liposome-mediated gene transfer into human basal cell carcinoma. 
============================================================ 
Gene Ther 1999 Dec;6(12):1929-35 

Hottiger MO, Dam TN, Nickoloff BJ, Johnson TM, Nabel GJ 
Howard Hughes Medical Institute, University of Michigan Medical Center, 
Departments of Internal Medicine and Biological Chemistry, Ann Arbor, 
MI, 
USA. 

Direct intralesional injection of DNA encoding interferon-alpha2 
(IFN-alpha2) was used in an effort to sustain local protein delivery for 

the treatment of human basal cell carcinoma (BCC). A novel model to 
study 
this malignancy was established by transplantation of human BCC tissue 
on 
to immunodeficient mice with a relatively high rate of engraftment and 
stable phenotype for superficial BCC (20 of 25; 80%). Gene transfer was 
significantly increased by using DNA liposome complexes (lipoplexes). 
Recombinant gene expression was detected predominantly in the epidermis 
and, to a lesser extent, in the dermis. Gene transfer of IFN-alpha2 
using 
this method resulted in sustained production of IFN-alpha2 protein and 
increased expression of a known IFN-inducible gene, the class II major 
histocompatibility (MHC) antigen, and induced BCC regression, presumably 

through a non-immune mechanism. Intralesional injection of DNA 
lipoplexes 
encoding IFN-alpha protein may therefore be applicable to the treatment 
of 
cutaneous BCC. 

============================================================ 
23.) Proliferative Actinic Keratosis: Three Representative Cases. 
============================================================ 
Dermatol Surg 2000 Jan;26(1):65-69 
Goldberg LH, Chang JR, Baer SC, Schmidt JD 

OBJECTIVE: This article describes a new subtype of actinic keratosis 
that 
exhibits proliferative characteristics both histologically and 
clinically. 
We describe three representative cases occuring in the presence of 
infiltrative squamous cell carcinoma (SCC) and/or basal cell carcinoma 
(BCC). METHODS: Histories of each lesion in the three cases discussed 
were 
obtained. The lesions were removed by Mohs micrographic surgery. 
Permanent 
sections, stained with hematoxylin and eosin, were examined and studied 
under light microscopy. RESULTS: All three lesions had failed 
conventional 
treatment with liquid nitrogen and/or 5-fluorouracil (5-FU). Histologic 
examination of the lesions revealed sheets of dysplastic cells growing 
along the basal layer of the epidermis and migrating down hair follicles 

and sweat ducts. An associated infiltrative SCC and/or BCC was found in 
each case. CONCLUSIONS: Proliferative actinic keratosis is resistant to 
standard therapies because of deep migration of abnormal cells along 
hair 
follicles and sweat ducts. It has a strong propensity to develop 
infiltrative SCC and may occur concomitantly with BCC. 

============================================================ 
24.) Diet and basal cell carcinoma of the skin in a prospective cohort 
of men. 
============================================================ 
Am J Clin Nutr 2000 Jan;71(1):135-41 

van Dam RM, Huang Z, Giovannucci E, Rimm EB, Hunter DJ, Colditz GA, 
Stampfer MJ, Willett WC 
Departments of Nutrition and Epidemiology, Harvard School of Public 
Health, 
Boston, MA 02115, USA. 

BACKGROUND: Low intake of fat and high intake of specific vitamins have 
been hypothesized to reduce risk of basal cell carcinoma of the skin 
(BCC). 
OBJECTIVE: Our objective was to examine intakes of fat, antioxidant 
nutrients, retinol, folate, and vitamin D in relation to risk of BCC. 
DESIGN: In 1986, diet was assessed by a validated food-frequency 
questionnaire in 43217 male participants of the Health Professionals 
Follow-up Study who were 40-75 y of age and free of cancer. During 8 y 
of 
follow-up, we ascertained 3190 newly diagnosed cases of BCC. RESULTS: 
Total 
fat consumption was associated with a lower risk of BCC [relative risk 
(RR): 0.81; 95% CI: 0.72, 0.90 for the highest compared with the lowest 
quintile of intake; P for trend < 0.001). Simultaneous modeling of 
specific 
fatty acids suggested that this inverse association was limited to 
monounsaturated fat (RR: 0.79; 95% CI: 0.65, 0.96; P for trend = 0. 02); 

saturated and polyunsaturated fat were not associated with BCC risk. 
Folate 
intake was associated with a slightly higher risk of BCC (RR: 1.19; 95% 
CI: 
1.01, 1.40; P for trend = 0.11), whereas alpha-carotene was associated 
with 
a slightly lower risk (RR: 0.88; 95% CI: 0.79, 0.99; P for trend = 
0.01). 
Intakes of long-chain n-3 fatty acids, retinol, vitamin C, vitamin D, or 

vitamin E were not materially related to BCC risk. CONCLUSIONS: These 
findings do not support the hypothesis that diets low in fat or high in 
specific vitamins lower risk of BCC. 

============================================================ 
25.) Preliminary observations on the use of topical tazarotene to treat 
basal-cell carcinoma. 
============================================================ 
N Engl J Med 1999 Dec 2;341(23):1767-8 

Peris K, Fargnoli MC, Chimenti S 
Publication Types: 
Letter 
============================================================ 
============================================================ 
26.)HLA phenotypes and multiple basal cell carcinomas. 
============================================================ 
SO  - Dermatology  1994;189(3):222-4 
AU  - Rompel R; Petres J; Kaupert K; Mueller-Eckhardt G 
PT  - JOURNAL ARTICLE 
AB  - BACKGROUND: Previous investigators noted an association of 
multiple 
basal cell carcinomas (BCC) with certain HLA antigens; however, these 
findings were contradictory, and the associations were only weak. 
OBJECTIVE: The aim of the study was to objectify the previously found 
associations. METHODS: Serologic HLA typing for class I and class II 
antigens was performed in 49 unrelated patients with 5 or more BCCs. 
RESULTS: HLA-DR4 showed decreased frequencies in the patient group as 
compared with healthy controls (n = 716). Cw7 was found to be increased 
in 
the total group of patients as well as in a subgroup with multiple BCCs 
of 
the face (n = 24), while a subgroup with BCCs mainly on the trunk (n = 
25) 
revealed increased frequencies of HLA-A11, -B17, -B22 and -Cw3. However, 

none of these deviations appeared significant after correction of p 
values. 
CONCLUSION: We conclude that, if at all, the HLA system plays only a 
minor 
role in the development of multiple BCCs. 

============================================================ 
27.) Multiple non-melanoma skin cancer: evidence that different MHC 
genes 
are associated with different cancers. 
============================================================ 
SO  - Dermatology  1994;188(2):88-90 
AU  - Czarnecki D; Tait B; Nicholson I; Lewis A 
PT  - JOURNAL ARTICLE 
AB  - HLA DR frequencies of patients with multiple non-melanoma skin 
cancers were analysed. There were significant differences in the 
frequencies of HLA DR1, DR4 and DR7 between patients who only had basal 
cell carcinomas and patients who had both basal and squamous cell 
carcinomas. There were significant differences in the frequency of HLA 
DR53 
between the two groups. This antigen is in linkage disequilibrium with 
HLA 
DR4 and DR7, and it is not possible to distinguish the primary 
susceptibility locus. 

============================================================ 
28.) HLA DR4 is associated with the development of multiple basal cell 
carcinomas and malignant melanoma. 
============================================================ 
SO  - Dermatology  1993;187(1):16-8 
AU  - Czarnecki D; Nicholson I; Tait B; Nash C 
PT  - JOURNAL ARTICLE 
AB  - An association between HLA DR4 and the development of multiple 
basal 
cell carcinomas (BCC) and malignant melanoma (MM) was detected in 
southern 
Australia. There were highly significant differences in HLA DR 
frequencies 
between patients with multiple BCCs and MM and matched patients with 
multiple BCCs only. These findings suggest that hereditary factors 
associated with the HLA system influence what types of multiple skin 
cancers people develop. 

============================================================ 
29.) Multiple basal cell carcinoma in tropical Australia. 
============================================================ 
SO  - Int J Dermatol  1992 Sep;31(9):635-6 
AU  - Czarnecki D; Collins N; Chow P; Nicholson I; Tait B 
PT  - JOURNAL ARTICLE 
AB  - No association between HLA DR1 and the development of multiple 
basal 
cell carcinomas (BCC) was found among patients who had lived at least 
two-thirds of their lives in the tropics. The percentage of patients 
with 
multiple BCCs increased with age; this was different from what has been 
found in people living in the temperate zone of Australia. 

============================================================ 
30.) HLA-DR1 is not a sign of poor prognosis for the development of 
multiple basal cell carcinomas. 
============================================================ 
SO  - J Am Acad Dermatol  1992 May;26(5 Pt 1):717-9 
AU  - Czarnecki D; Lewis A; Nicholson I; Tait B; Nash C 
PT  - JOURNAL ARTICLE 
AB  - BACKGROUND: HLA-DR1 is associated with the development of multiple 

basal cell carcinomas (BCC). However, the association is weak. 
OBJECTIVE: 
The purpose of our study was to determine whether HLA-DR1 is a marker 
for 
susceptibility to the development of many BCCs during a lifetime. 
METHODS: 
Persons with multiple BCCs were placed into two groups: those with less 
than 10 and those with 20 or more. In addition, the HLA-DR1 frequencies 
were analyzed. RESULTS: HLA-DR1 was associated with multiple BCCs in the 

group with less than 10 BCCs but not with the other group. These 
patients 
were significantly younger on average than those with 20 or more BCCs. 
CONCLUSION: HLA-DR1 is associated with the development of multiple BCCs 
at 
an early age but it is not associated with development of large numbers 
of 
BCCs. The amount of UV light a person receives appears to be more 
important. 

============================================================ 
31.) Multiple basal cell carcinomas and HLA frequencies in southern 
Australia. 
============================================================ 
SO  - J Am Acad Dermatol  1991 Apr;24(4):559-61 
AU  - Czarnecki D; Lewis A; Nicholson I; Tait B 
PT  - JOURNAL ARTICLE 
AB  - An association between HLA-DR1 and the development of multiple 
basal 
cell carcinomas was detected in southern Australia. A reduction in 
HLA-DR4 
was found in patients with basal cell carcinoma compared with a local 
control group. The relative risk for HLA-DR1 was 2.1, which was lower 
than 
that for persons in farther countries from the equator. 

============================================================ 
32.) Expression of human lymphocyte antigen (HLA)-DR on tumor cells in 
basal cell carcinoma. 
============================================================ 
SO  - J Am Acad Dermatol  1987 Apr;16(4):833-8 
AU  - Kohchiyama A; Oka D; Ueki H 
PT  - JOURNAL ARTICLE 
AB  - Immunohistologic studies of eight patients with basal cell 
carcinoma 
were undertaken using a series of monoclonal antibodies. In all of the 
patients, the majority of dermal infiltrates reacted with OKT3 and OKIa1 

(HLA-DR), with a slight predominance of OKT4+ helper/inducer T cells 
(the 
mean OKT4/OKT8 ratio was 1.8). Both OKT4+ and OKT8+ cells were seen 
infiltrating the tumor masses. In addition, in five cases, human 
lymphocyte 
antigen (HLA)-DR was demonstrated on some tumor cells close to a vast 
number of HLA-DR+ infiltrates surrounding the carcinoma, but not on 
epidermal keratinocytes and tumor cells devoid of the HLA-DR+ 
infiltrates. 
A considerable number of OKT6+ dendritic cells were also observed 
surrounding the carcinoma. Staining with OKB7 and OKM1 revealed 
negligible 
reactive cells, and virtually none of the dermal infiltrates reacted 
with 
Leu-7 (HNK-1). These findings suggest that in addition to varied 
immunologically competent cells, expression of HLA-DR antigen on tumor 
cells may participate in a cellular immune reaction, a defense mechanism 

against tumor cell proliferation in basal cell carcinoma. 

============================================================ 
33.) Human leukocyte antigen associations in basal cell carcinoma. 
============================================================ 
SO  - J Am Acad Dermatol  1985 Jun;12(6):997-1000 
AU  - Myskowski PL; Pollack MS; Schorr E; Dupont B; Safai B 
PT  - JOURNAL ARTICLE 
AB  - Basal cell carcinoma is the most common form of skin cancer and is 

one in which both host and environmental factors are thought to play a 
role 
in its pathogenesis. For an investigation of the role of human leukocyte 

antigen (HLA)-associated variations in genetic susceptibility, 
thirty-one 
patients with multiple basal cell carcinomas were typed for HLA-A, B, C, 

and DR antigens. Patients were compared with both local and appropriate 
ethnic group controls. No statistically significant association with 
HLA-A, 
B, or C antigens was noted in any group. However, a significant increase 
in 
HLA-DR1 was noted in non-Irish, non-Ashkenazi patients. A tendency 
toward a 
decrease in HLA-DR3 was also noted among patients of Irish or Ashkenazi 
Jewish descent. The role of HLA-associated genetic factors in this form 
of 
skin cancer needs further investigation. 

============================================================ 
34.) Translocation (4; 14) and concomitant inv(14) in a basal cell 
carcinoma. 
============================================================ 
SO  - Cancer Genet Cytogenet  1991 Oct 15;56(2):177-80 
AU  - Kawasaki RS; Caldeira LF; Andre FS; Gasques JA; Castilho WH; 
Bozola 
AR; Thome JA; Tajara EH 
PT  - JOURNAL ARTICLE 
AB  - Chromosome analysis of short-term cultures from a basal cell 
carcinoma was performed. The analyzed karyotypes showed a pseudodiploid 
clone characterized by a der(4)t(4; 14) (p14; p11) and a concomitant 
inversion of the same chromosome 4 involved in the t(4; 14) with the 
breakpoints at p14 and q25. 

============================================================ 
35.) Long-term therapy with low-dose isotretinoin for prevention of 
basal 
cell carcinoma: a multicenter clinical trial. Isotretinoin-Basal Cell 
Carcinoma Study Group [see comments] 
============================================================ 
SO  - J Natl Cancer Inst  1992 Mar 4;84(5):328-32 
AU  - Tangrea JA; Edwards BK; Taylor PR; Hartman AM; Peck GL; Salasche 
SJ; 
Menon PA; Benson PM; Mellette JR; Guill MA; et al 
PT  - CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED 
CONTROLLED TRIAL 
AB  - BACKGROUND: High-dose isotretinoin has been reported to have a 
prophylactic effect on nonmelanoma skin cancer, although it is 
associated 
with significant toxicity. PURPOSE: To test the effectiveness of the 
long-term administration of low-dose isotretinoin in reducing the 
occurrence of basal cell carcinoma at a new site in patients with 
previously treated basal cell carcinomas and to measure the toxicity 
associated with this regimen, we conducted a clinical trial at eight 
cancer 
centers. METHODS: Nine hundred and eighty-one patients with two or more 
previously confirmed basal cell carcinomas were randomly assigned to 
receive either 10 mg of isotretinoin or a placebo daily. Patients were 
followed for 36 months and monitored at 6-month intervals for skin 
cancer 
and toxic effects. RESULTS: After 36 months of treatment, no 
statistically 
significant difference in either the cumulative percent of patients with 
an 
occurrence of basal cell carcinoma at a new site or the annual rate of 
basal cell carcinoma formation existed between patients receiving 
isotretinoin and those receiving the placebo. Elevated serum 
triglycerides, 
hyperostotic axial skeletal changes, and mucocutaneous reactions were 
more 
frequent in the group receiving isotretinoin than in the control group, 
and 
these differences were all statistically significant (P less than .001). 

CONCLUSION: This low-dose regimen of isotretinoin not only is 
ineffective 
in reducing the occurrence of basal cell carcinoma at new sites in 
patients 
with two or more previously treated basal cell carcinomas but also is 
associated with significant adverse systemic effects. IMPLICATION: The 
toxicity associated with the long-term administration of isotretinoin, 
even 
at the low dose used in this trial, must be weighted in planning future 
prevention trials. 

============================================================ 
36.) Treatment and prevention of basal cell carcinoma with oral 
isotretinoin. 
============================================================ 
SO  - J Am Acad Dermatol  1988 Jul;19(1 Pt 2):176-85 
AU  - Peck GL; Di Giovanna JJ; Sarnoff DS; Gross EG; Butkus D; Olsen TG; 

Yoder FW 
PT  - JOURNAL ARTICLE 
AB  - Twelve patients with multiple basal cell carcinomas resulting from 

varying causes were treated with high-dose oral isotretinoin (mean daily 

dosage: 3.1 mg/kg/day) for a mean of 8 months. Of the 270 tumors 
monitored 
in these patients, only 8% underwent complete clinical and histologic 
regression. All patients developed moderate to severe acute toxicities, 
leading five patients to withdraw from the study. Retinoid skeletal 
toxicity was identified in two patients who were examined after 
long-term 
therapy. Lower doses of isotretinoin (0.25 to 1.5 mg/kg/day) were 
ineffective for chemotherapy but demonstrated a chemopreventive effect 
in a 
subset of three patients who received these lower doses for 3 to 8 
years. 
Two of these three patients have been observed after discontinuation of 
therapy. In one patient with a history of arsenic exposure, only one new 

tumor has appeared in a 27-month posttreatment observation period; in 
the 
other patient with the nevoid basal cell carcinoma syndrome, 29 new 
tumors 
have appeared within a 13-month period. This suggests that the need for 
long-term maintenance therapy with isotretinoin for chemoprevention of 
basal cell carcinoma may depend on the underlying cause of the skin 
cancers. 

============================================================ 
37.) Chemoprevention of basal cell carcinoma with isotretinoin. 
============================================================ 
SO  - J Am Acad Dermatol  1982 Apr;6(4 Pt 2 Suppl):815-23 
AU  - Peck GL; Gross EG; Butkus D; Di Giovanna JJ 
PT  - JOURNAL ARTICLE 
AB  - Three patients with multiple basal cell carcinomas, due either to 
excessive sunlight exposure, the nevoid basal cell carcinoma syndrome, 
or 
arsenical insecticide exposure, were treated with oral isotretinoin for 
2 
1/2 to 4 years. Although higher doses were used initially, approximately 

1.5 mg/kg/day was used for long-term therapy in all three patients. 
Therapeutic effects on existing tumors varied between each patient, and 
only nine of sixty-five lesions underwent complete clinical regression. 
No 
tumors enlarged in two patients; a few tumors enlarged slightly in the 
third patient, particularly during the later courses of therapy when 
isotretinoin was given at lower dosage. No new lesions have been 
observed 
in any of these three patients. With these encouraging preliminary data, 
it 
now may be appropriate to perform larger trials for longer periods of 
time 
to determine the usefulness of isotretinoin in the chemoprevention of 
basal 
cell carcinoma in patients with multiple tumors. 

============================================================ 
38.) Chemoprevention of skin cancer in xeroderma pigmentosum. 
============================================================ 
SO  - J Dermatol  1992 Nov;19(11):715-8 
AU  - Kraemer KH; Di Giovanna JJ; Peck GL 
PT  - JOURNAL ARTICLE 
AB  - Xeroderma pigmentosum is a rare recessive disease with sun 
sensitivity, increased freckling and defective DNA repair. Xeroderma 
pigmentosum patients have more than a 1000-fold increased risk of 
developing skin cancer including basal cell carcinoma, squamous cell 
carcinoma and melanoma. We studied chemoprevention of new skin cancers 
with 
oral retinoids in xeroderma pigmentosum patients who had multiple skin 
cancers. Xeroderma pigmentosum patients were cleared of all pre-existing 

tumors surgically and then treated with high dose (2 mg/kg/day) oral 
isotretinoin (13-cis retinoic acid, Accutane) for two years and then for 

one year off treatment. Patients were examined at regular intervals for 
new 
tumor formation and for side effects. Five xeroderma pigmentosum 
patients 
had a total of 121 basal or squamous cell carcinomas in 2 years before 
treatment and only 25 tumors during 2 years of treatment. The tumor 
frequency increased 8.5-fold after the drug was discontinued (New Engl J 

Med 318: 1633-1637, 1988). Toxicity (cutaneous, triglyceride, 
liver-function or skeletal abnormalities) prompted subsequent use of a 
low 
dose protocol. Patients were treated initially with 0.5 mg/kg/day oral 
isotretinoin and the dose was increased sequentially to 1.0 or 1.5 
mg/kg/day. We found that toxicity was less with the lower doses. The 
lowest 
effective, least toxic dose varied among the xeroderma pigmentosum 
patients. 

============================================================ 
39.) Relative importance of prior basal cell carcinomas, continuing sun 
exposure, and circulating T lymphocytes on the development of basal cell 

carcinoma. 
============================================================ 
SO  - J Invest Dermatol  1992 Aug;99(2):227-31 
AU  - Robinson JK; Rademaker AW 
PT  - JOURNAL ARTICLE 
AB  - This 36-month prospective study of a group of 61 people at high 
risk 
to develop multiple basal cell carcinomas (BCC) examined the circulating 

lymphocyte subsets of the population, patterns of sun exposure, and the 
longitudinal development of basal cell carcinoma. Sun exposure status 
was 
highly correlated with immune status defined by the CD4/CD8 T-lymphocyte 

ratio. There were significantly more BCC at 18 and 36 months in the 35 
patients with high sun exposure and low CD4/CD8 ratio than in the 20 
patients with low sun exposure and high CD4/CD8 ratio. A multivariate 
analysis assessed the relative importance of prior basal cell carcinoma, 

sun exposure, and immune status on the development of the skin cancer. 
Basal cell carcinoma developing in the previous 18 months and sun 
exposure 
during those 18 months were the first and second most important 
variables 
in determining development of basal cell carcinoma during the next 18 
months. CD4/CD8 ratio had no additional predictive ability once prior 
skin 
cancers and sun exposure were accounted for. A low ratio of CD4/CD8 
cells 
correlated with high sun exposure during the preceding 18 months. 

============================================================ 
40.) Topical tretinoin in actinic keratosis and basal cell carcinoma. 
============================================================ 
SO  - J Am Acad Dermatol  1986 Oct;15(4 Pt 2):829-35 
AU  - Peck GL 
PT  - CLINICAL TRIAL; JOURNAL ARTICLE 
AB  - In several studies between 1962 and 1978, topical tretinoin was 
proved capable of producing complete regression of actinic keratosis and 

basal cell carcinoma. But because its efficacy is not comparable to that 
of 
other modalities, topical tretinoin is currently used only as an adjunct 
to 
topical 5-fluorouracil in the treatment of actinic keratosis. One recent 

report found topical tretinoin ineffective in the chemoprevention of 
actinic keratosis. Although the oral synthetic retinoids isotretinoin 
and 
etretinate have been used in the prevention and treatment of cutaneous 
malignancy, the potential exists for chronic toxicity from the prolonged 

systemic therapy that appears necessary for maintaining the 
chemopreventive 
effect. For this reason, it may be appropriate to study further the 
preventive as well as therapeutic effects of topical tretinoin and other 

retinoids for actinic keratosis and skin cancer. If they prove safe and 
effective, the use of topical retinoids in the prevention and treatment 
of 
cutaneous tumors may be the most significant clinical application of 
these 
drugs. 

============================================================ 
41.) Margin assessment of selected basal cell carcinomas utilizing laser 

Doppler velocimetry. 
============================================================ 
SO  - Int J Dermatol  1993 Apr;32(4):290-2 
AU  - Kirsner RS; Haiken M; Garland LD 
PT  - JOURNAL ARTICLE 
AB  - BACKGROUND. Basal cell carcinomas (BCC) have increased 
vasculature, 
therefore, blood flow within the tumor may be greater than normal 
surrounding skin. We attempted to detect the difference in blood flow 
between the tumor and uninvolved surrounding skin utilizing laser 
doppler 
velocimetry (LDV). METHODS. Ten patients with 14 BCC were studied. Using 

LDV, we calculated the size of the tumor based on margin assessment as 
predicted by the measured difference in blood flow and compared this 
size 
with the clinically predicted size and the size of the defect after Mohs 

micrographic surgery (MMS). RESULTS. Clinical evaluation of tumor size 
prior to MMS did not correlate with the size of the surgical defect 
after 
MMS; however, correlation was found between the predicted size of the 
tumor 
as determined by LDV and the defect after MMS. CONCLUSIONS. Tumor size 
of 
BCC as predicted by measured differences in blood flow using LDV 
correlated 
with the size of the surgical defect after MMS. This suggests that LDV 
was 
able to detect the difference in blood flow between the tumor and 
uninvolved surrounding skin. 

============================================================ 
42.) Carbon dioxide laser vaporization and curettage in the treatment of 

large or multiple superficial basal cell carcinomas. 
============================================================ 
SO  - J Dermatol Surg Oncol  1987 Feb;13(2):119-25 
AU  - Wheeland RG; Bailin PL; Ratz JL; Roenigk RK 
PT  - JOURNAL ARTICLE 
AB  - Many of the standard forms of therapy for large or multiple 
superficial basal cell carcinomas are limited by significant 
postoperative 
pain, excessive scarring, and prolonged wound healing time. Combining 
traditional curettage with carbon dioxide laser vaporization creates a 
procedure that allows excellent visualization, due to the bloodless 
surgical field produced by the laser, minimal nonspecific thermal 
damage, 
rapid healing, and diminished postoperative pain. In addition, the speed 

and ease with which this procedure can be performed allow successful 
treatment of many lesions in a single outpatient session. We wish to 
report 
our results using this technique for the treatment of 52 patients with 
370 
superficial basal cell carcinomas. 

============================================================ 
43.) The effect of intralesional 5-fluorouracil therapeutic implant (MPI 

5003) for treatment of basal cell carcinoma. 
============================================================ 
SO  - J Am Acad Dermatol  1992 Nov;27(5 Pt 1):723-8 
AU  - Orenberg EK; Miller BH; Greenway HT; Koperski JA; Lowe N; Rosen T; 

Brown DM; Inui M; Korey AG; Luck EE 
PT  - CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL 
AB  - BACKGROUND: Basal cell carcinomas (BCCs) are usually treated with 
ablative procedures. A nonsurgical treatment alternative would be of 
value 
in selected patients. OBJECTIVE: We evaluated the safety and efficacy of 
a 
new preparation for intralesional sustained-release chemotherapy with 
MPI 
5003, 5-Fluorouracil Therapeutic Implant, for treatment of BCCs. 
METHODS: 
Two doses of intralesional MPI 5003 (0.25 and 0.5 ml) were compared in a 

double-blind study of 20 patients with biopsy-proven BCC. One BCC per 
patient was treated weekly for up to 6 weeks and followed up monthly for 
3 
months until excisional biopsy for histologic examination. Before 
excision 
the cosmetic appearance of the test site was graded. RESULTS: Eighty 
percent of 10 BCCs treated with 0.5 ml of MPI 5003 had histologically 
confirmed cures as compared with 60% of 10 tumors treated with the lower 

dose (0.25 ml). Cosmetic assessments before excision were typically good 
to 
excellent. No systemic side effects occurred. CONCLUSION: Results 
indicate 
the potential of MPI 5003 for targeted local chemotherapy for BCC.  

============================================================ 
44.) Cryosurgery and topical fluorouracil: a treatment method for 
widespread basal cell epithelioma in basal cell nevus syndrome. 
============================================================ 
SO  - J Dermatol  1993 Aug;20(8):507-13 
AU  - Tsuji T; Otake N; Nishimura M 
PT  - JOURNAL ARTICLE 
AB  - A 58-year-old man with basal cell nevus syndrome had variously 
sized 
basal cell epitheliomas (BCEs), mostly of the superficial type, on his 
chest, back, and lumbar areas. BCEs on the lumbar area were treated with 

5-fluorouracil (5-FU) cream which was applied daily under occlusive 
dressings (ODT). Complete erosion occurred in the center, but not at the 

periphery of the lesions. In the latter regions, BCE remained. Then 
cryosurgery (cryo) followed by topical 5-FU (cryo + 5-FU) was tried to 
treat the peripheral, non-eroded lesions; this caused complete erosions. 

Biopsy specimens obtained 6 months after epithelization did not show any 

evidence of recurrence. We also tried either cryo alone or cryo + 5-FU 
on 
the chest lesions, and either 5-FU alone or cryo + 5-FU on the abdominal 

lesions. Cryo alone or 5-FU alone could not clear BCE, but cryo + 5-FU 
could. These results suggest that the cryo + 5-FU was the most effective 
of 
these therapies. 

============================================================ 
45.) Selective cytotoxic effect of topical 5-fluorouracil. 
============================================================ 
SO  - Arch Dermatol  1983 Sep;119(9):774-83 
AU  - Dillaha CJ; Jansen GT; Honeycutt WM; Bradford AC 
PT  - JOURNAL ARTICLE 
AB  - As an investigative procedure, a hydrophilic ointment containing 
20% 
5-fluorouracil (5-FU) was applied to the skin of patients with extensive 

actinic keratoses of the face and neck, for a period of four weeks. This 

resulted in a selective inflammation, erosion, and disappearance of the 
keratoses without significant alteration of the normal skin. Transitory 
adverse reactions included corneal and conjunctival irritations, 
phototoxic 
reactions, and erosion of the lower lip border. No evidence of systemic 
absorption was detected. Only preliminary follow-up observations are 
available, and no conclusion can be drawn as to the long-term results. 

============================================================ 
46.) Nodular superficial pigmented basal cell epitheliomas. 
============================================================ 
SO  - Arch Dermatol  1982 Nov;118(11):928-30 
AU  - Shelley WB; Wood MG 
PT  - JOURNAL ARTICLE 
AB  - Eradication of multiple nodules, papules, and plaques of pigmented 

basal cell epitheliomas of the back of one patient was achieved by nine 
months of daily treatment with 5% fluorouracil cream. Such topical 
chemotherapy offers the physician an alternative to surgery and 
radiation 
in treating patients who have widespread nodular superficial 
epitheliomas. 
The need for a prolonged period of treatment and follow-up is 
emphasized. 

============================================================ 
47.) Metastatic basal cell carcinoma: response to chemotherapy. 
============================================================ 
SO  - J Am Acad Dermatol  1990 May;22(5 Pt 2):905-8 
AU  - Bason MM; Grant-Kels JM; Govil M 
PT  - JOURNAL ARTICLE 
AB  - Basal cell carcinoma is a common cutaneous neoplasm that rarely 
metastasizes. Unfortunately, there is little effective treatment 
available 
when metastasis does occur. Therefore potentially promising therapies 
for 
metastatic basal cell carcinoma should be reported. We report a case of 
basal cell carcinoma metastatic to bone, bone marrow, and the pleural 
cavity in a 51-year-old woman who showed a striking, albeit brief, 
response 
to treatment with a combination of cisplatin, bleomycin, methotrexate, 
and 
5-fluorouracil. 

============================================================ 
48.) Basal cell carcinoma of the vulva with lymph node and skin 
metastasis--report of a case and review of 20 Japanese cases. 
============================================================ 
SO  - J Dermatol  1995 Jan;22(1):36-42 
AU  - Mizushima J; Ohara K 
PT  - JOURNAL ARTICLE; REVIEW (37 references); REVIEW OF REPORTED CASES 
AB  - A 79-year-old Japanese woman who had basal cell carcinoma 
presenting 
as a large ulcer on her vulva with lymph node and skin metastasis is 
described. Histological examination revealed that tumor nests with 
peripheral palisading invaded deeply into the subcutaneous tissue and 
were 
accompanied by marked mucinous changes and fibrous reaction. Vascular 
invasion was also observed. There were inguinal lymph node metastases 
and 
two papular skin metastases on her right thigh. The primary tumor and 
the 
metastases were excised. The defect was repaired by bilateral gracilis 
musculo cutaneous flaps and a skin graft. We surveyed the literature and 

found 20 cases of metastasizing basal cell carcinoma in Japan. 

============================================================ 
49.) Basal cell carcinoma of the scalp resulting in spine metastasis in 
a 
black patient. 
============================================================ 
SO  - J Am Acad Dermatol  1994 Nov;31(5 Pt 2):916-20 
AU  - Oram Y; Orengo I; Alford E; Green LK; Rosen T; Netscher DT 
PT  - JOURNAL ARTICLE 
AB  - Basal cell carcinoma (BCC), the most common skin cancer in the 
United 
States, is locally invasive but has a low risk of metastasis. BCC is 
rare 
in black patients but, regardless of racial origin, most BCC occurs on 
sun-exposed areas. We describe a 67-year-old black man with a large BCC 
on 
the hairy scalp, a relatively sun-protected area, that metastasized to 
the 
spine. To our knowledge, this is the first description of a black 
patient 
with development of metastatic BCC on an otherwise normal scalp. 

============================================================ 
50.) Long-term survival following bony metastases from basal cell 
carcinoma. Report of a case. 
============================================================ 
SO  - Arch Dermatol  1986 Aug;122(8):912-4 
AU  - Hartman R; Hartman S; Green N 
PT  - JOURNAL ARTICLE 
AB  - A patient with recurrent basal cell carcinoma developed 
cervical-vertebral and epidural metastases. He received palliative 
irradiation and had a durable remission for three years. With relapse, 
he 
underwent a laminectomy and chemotherapy and remained asymptomatic at 54 

months following the diagnosis of bony metastases. To our knowledge, he 
is 
the longest reported survivor with bony metastases and is illustrative 
of 
the potential survival advantage from palliative therapy. 

============================================================ 
51.)Giant basal cell carcinoma with metastasis and secondary 
amyloidosis: 
report of case. 
============================================================ 
SO  - Acta Derm Venereol  1983;63(6):564-7 
AU  - Beck HI; Andersen JA; Birkler NE; Ottosen PD 
PT  - JOURNAL ARTICLE 
AB  - Basal cell carcinoma of the skin is a slow growing relatively 
benign 
tumor usually located on the head and neck. Although rare, metastasis to 

lymph nodes or parenchymatous organs has been reported previously (1-9). 
We 
wish to add another case of metastasizing basal cell carcinoma of the 
skin, 
which presented certain unique features only rarely reported (1), namely 

complicating amyloidosis in the kidneys, the lymph nodes, the spleen and 

probably in the intestinal canal. 

============================================================ 
52.) Pulmonary metastases from a basal cell carcinoma. 
============================================================ 
SO  - J Cutan Pathol  1981 Jun;8(3):235-40 
AU  - Keenan R; Hopkinson JM 
PT  - JOURNAL ARTICLE 
AB  - Although basal cell carcinomas are the commonest malignant 
condition 
of the skin (Borel 1973) pulmonary metastases are rare; it appears that 
only 30 authenticated cases have been reported (Sakula 1977). A further 
case is described of a man aged 64 who presented severe dyspnoea and who 

for 12 years had harbored an untreated ulcerating lesion of the 
abdominal 
wall shown histologically to be a basal cell carcinoma. Chest 
radiography 
showed metastatic disease confirmed histologically to be identical to 
the 
ulcerating skin lesion. Unfortunately, because of the severe respiratory 

condition, no definitive treatment was indicated and the patient died of 

respiratory failure 2 weeks following discharge. 

============================================================ 
53.) Nonrecurrent primary basal cell carcinoma of the lower extremity 
with 
late metastasis. 
============================================================ 
SO  - J Dermatol Surg Oncol  1994 Jul;20(7):490-3 
AU  - Siegle RJ; Wood T 
PT  - JOURNAL ARTICLE 
AB  - BACKGROUND. Metastatic basal cell carcinoma (MBCC) is rare, with 
most 
cases of head and neck origin and from large multi-recurrent tumors. 
MBCC 
is very rare from lower extremities and even more rare from primary 
tumors 
that were small and treated without local recurrence. OBJECTIVE. This 
paper 
presents a case of MBCC in a 78-year-old woman who had previously 
undergone 
resection without local recurrence of a small lower extremity basal cell 

carcinoma. CONCLUSION. MBCC can present atypically with site of origin 
on 
lower extremities, initial tumor size small, and nonrecurrence of the 
primary tumor site. The clinician should be aware of this as well as 
understand that prompt and aggressive surgical therapy to localized 
metastases may extend survival. 

============================================================ 
54.) [Metastatic basal cell carcinoma] 
============================================================ 
SO  - Ann Dermatol Venereol  1993;120(2):135-8 
AU  - Beaulieu-Lacoste I; Joly P; Ruto F; Thomine E; Fusade T; 
Chevallier 
B; Ortoli JC; Lauret P 
MC  - English Abstract 
PT  - JOURNAL ARTICLE; REVIEW (16 references); REVIEW OF REPORTED CASES 
AB  - A case of basal cell carcinoma in a 17-year old male patient 
complicated, 5 years later, by inguinal and pulmonary metastases is 
reported. This clinical case raises two problems: the reality of the 
entity 
and the long-term follow-up of this type of tumours. 

============================================================ 
55.) Metastatic basal cell carcinoma: report of twelve cases with a 
review 
of the literature [see comments] 
============================================================ 
SO  - J Am Acad Dermatol  1991 May;24(5 Pt 1):715-9 
AU  - Lo JS; Snow SN; Reizner GT; Mohs FE; Larson PO; Hruza GJ 
PT  - JOURNAL ARTICLE; REVIEW (67 references); REVIEW, TUTORIAL 
AB  - Metastatic basal cell carcinoma was found in 12 patients at the 
University of Wisconsin Mohs Surgery Clinic during the period 1936 to 
1989. 
All patients were white men. The time of onset of the primary tumor 
ranged 
from childhood to 71 years. Eleven patients had previous treatment for 
basal cell carcinoma; two patients had received x-ray radiation to the 
face 
for teenage acne. The locations of the primary basal cell carcinomas 
were 
the face (n = 10), back (n = 1), and arm (n = 1). The primary tumors 
ranged 
from 3.6 x 3.0 to 20.0 x 7.0 cm. The interval from onset to the first 
sign 
of metastases ranged from 7 to 34 years. In all cases, the primary tumor 

was histologically identical to the metastatic lesion. Perineural 
extension 
of the basal cell carcinoma in the primary lesion was found in five 
cases. 
Regional lymph nodes were the most frequent site of metastasis. 
Treatment 
consisted of a combination of surgery, radiation, and chemotherapy. Only 

two patients survived more than 5 years after surgical treatment. One 
patient has survived 25 years and is still alive. 

============================================================ 
56.) Rapid development of metastases from basal cell carcinoma 
presenting 
as cranial nerve palsies. 
============================================================ 
SO  - J Dermatol Surg Oncol  1988 Dec;14(12):1410-2 
AU  - Ambros RA; Standiford SB; Sobel HJ; Haim A; Mohit-Tabatabai MA 
PT  - JOURNAL ARTICLE 
AB  - A case is reported of metastatic basal cell carcinoma presenting 
with 
multiple neurologic deficits 20 months after excision of the primary 
lesion 
with good local control. Many features associated with the development 
of 
metastasis from basal cell carcinoma were not present in this case. 

============================================================ 
57.) Photodynamic therapy by topical aminolevulinic acid, 
dimethylsulphoxide and curettage in nodular basal cell carcinoma: a 
one-year follow-up study. 
============================================================ 
Acta Derm Venereol 1999 May;79(3):204-6 

Soler AM, Warloe T, Tausjo J, Berner A 
Photodynamic Out-patient Clinic, Department of Surgical Oncology, The 
Norwegian Radium Hospital, Oslo. 

Fifty-eight patients with 119 nodular (2 mm or more in thickness) basal 
cell carcinomas successfully treated with photodynamic therapy were 
included in this 1-year follow-up study. The initial cure rate at 3-6 
months was 92% after photodynamic therapy, which included an initial 
debulking procedure and topical application of dimethylsulphoxide in 
order 
to enhance penetration of 5-aminolevulinic acid (20% in cream) to which 
the 
lesions were exposed for 3 h prior to exposure to light. At examination 
12-26 months (mean 17 months) after treatment 113 lesions (95%) were 
still 
in complete response. Six lesions (5%) had recurred, located on the 
face, 
scalp and ear. The cosmetic outcome was evaluated as excellent to good 
in 
91%. Microscopic examination of biopsies taken from healed areas in 7 
patients did not reveal any sign of damage in 5 and only minor 
alterations 
in 2. 

============================================================ 
58.) Epidemiologic characteristics and clinical course of patients with 
malignant eyelid tumors in an incidence cohort in Olmstead County, 
Minnesota. 
============================================================ 
Ophthalmology 1999 Apr;106(4):746-50 

Cook BE Jr, Bartley GB 
Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, 

Minnesota 55905, USA. 

OBJECTIVE: To determine the epidemiologic and clinical characteristics 
of 
patients with malignant eyelid tumors in an incidence cohort. DESIGN: 
Cohort series. PARTICIPANTS: A computerized retrieval system was used to 

identify all patients residing in Olmsted County, Minnesota, who had a 
newly diagnosed malignant eyelid tumor during the 15-year interval from 
1976 through 1990. The patients' medical records were reviewed for 
demographic and clinical data. INTERVENTION: Surgical excision with 
frozen-section histopathologic analysis, Mohs' micrographic excision, 
and 
electrodesiccation and curettage were the primary methods of treatment. 
MAIN OUTCOME MEASURES: Survivorship free of tumor. RESULTS: The 
incidence 
cohort included 174 patients who each had 1 tumor; men and women were 
equally affected, and all patients were white. Tumors developed most 
commonly on the lower eyelid (n = 85; 48.9%) and in the medial canthal 
region (n = 48; 27.6%) but involved the right and left sides with equal 
frequency. Of the 174 tumors, 158 were basal cell carcinomas (90.8%), 15 

were squamous cell carcinomas (8.6%), and 1 (0.6%) was a malignant 
melanoma. The age- and gender-adjusted incidence rates for basal cell 
carcinoma, squamous cell carcinoma, and malignant melanoma were 14.35, 
1.37, and 0.08 per 100,000 individuals per year, respectively. No cases 
of 
sebaceous gland carcinoma were identified. The 5- and 10-year recurrence 

rates for all tumors on the eyelid were 2% and 3%, respectively. The 
probability of an unrelated malignancy developing elsewhere in the body 
was 
approximately 9% at 5 years and 15% at 10 years. CONCLUSIONS: Basal cell 

carcinoma is the most common malignant eyelid tumor in whites. The lower 

eyelid and medial canthus are the most frequent sites of origin. Men and 

women are equally affected. Recurrence after surgical excision is 
uncommon. 

============================================================ 
59.) Does wound healing contribute to the eradication of basal cell 
carcinoma following curettage and electrodessication? 
============================================================ 
Dermatol Surg 1999 Mar;25(3):183-7; discussion 187-8 

Nouri K, Spencer JM, Taylor JR, Hayag M, DeVoursney J, Shah N 
Department of Dermatology and Cutaneous Surgery, University of Miami 
School 
of Medicine, Miami Veterans Affairs Medical Center, Florida, USA. 

BACKGROUND: Histologic studies indicate that C&D fails to mechanically 
remove all the tumor in a percentage of cases that far exceeds the 
5-year 
recurrence rate. This raises the question that if C&D does not 
mechanically 
remove the tumor in a significant number of patients, why don't we 
observe 
tumor recurrence in most of these patients? Our previous study indicates 

that inflammation occurring over 1 month following C&D does not clear 
residual tumor. It may be some other process, requiring more time, that 
clears the residual tumor. Perhaps the proliferative or maturation phase 
of 
wound healing or, alternatively, a slow-acting process such as a 
low-grade 
immune response set in motion earlier, clears the residual tumor. 
OBJECTIVE: To test the hypothesis that wound healing and maturation 
following C&D clear residual tumor that has not mechanically removed by 
the 
procedure. METHODS: The frequency of residual BCC detected 
histologically 
immediately following C&D was compared with the frequency 3 months after 

the C&D, an amount of time in which the maturation phase of wound 
healing 
is well under way. RESULTS: Twenty-two of 29 primary BCC less than 1 cm 
in 
size were tumor-free immediately following the procedure (clearance rate 

75.9%). Twelve primary BCC <1 cm were treated by C&D, allowed to heal 
for 3 
months, and then excised and checked histologically. Ten of the twelve 
BCC 
were free of tumor, for a clearance rate of 83.3%, which is not a 
statistically significant difference (p = 0.7187). CONCLUSION: By 3 
months, 
the proliferative phase of wound healing is complete, and our study 
indicates that this phase has no effect on clearing the tumor. The 
maturation phase is well under way three months following C&D, and no 
statistically significant 

============================================================ 
60.)Does inflammation contribute to the eradication of basal cell 
carcinoma 
following curettage and electrodesiccation? 
============================================================ 
Dermatol Surg 1997 Aug;23(8):625-30; discussion 630-1 

Spencer JM, Tannenbaum A, Sloan L, Amonette RA 
Division of Dermatology, University of Tennessee, Memphis, USA. 

BACKGROUND: Curettage and electrodesiccation (C&D) is probably the 
technique most frequently utilized by dermatologists to treat basal cell 

carcinomas (BCC). From histologic studies, it appears C&D does not 
completely mechanically remove all nests of BCC in a substantial number 
of 
cases. Nevertheless, the reported 5-year reoccurrence rate following C&D 
is 
significantly less than this histologically observed residual tumor 
frequency immediately following C&D. Among the multiple possibilities 
that 
exist to explain why these residual nests do not appear as recurrent 
tumor 
more frequently is the theory that inflammation developing after C&D 
clears 
residual tumor. OBJECTIVE: To test the hypothesis that inflammation 
developing after C&D clears residual tumor not mechanically removed by 
the 
procedure. METHODS: The frequency of residual BCC detected 
histologically 
immediately following C&D was compared with the frequency 1 month after 
the 
C&D, an amount of time in which an effect (if any) of inflammation could 

occur. RESULTS: Twenty-two of 29 primary BCC < 1 cm treated by C&D were 
tumor free immediately following the procedure (clearance rate, 75.9%). 
Eleven of 14 primary BCC < 1 cm treated by C&D then allowed to granulate 
1 
month before excision and histologic analysis were tumor free, for a 
clearance rate of 78.6%. Examination of larger tumors immediately 
following 
C&D revealed size is a significant variable for clearance rates. Eleven 
primary BCC > 1 cm but < 2 cm were examined histologically immediately 
following C&D; only three were tumor free for a clearance rate of 27.3%. 

Only one of five tumors > 2 cm thus treated was tumor free, for a 
clearance 
rate of 20%. Nine recurrent BCC of various sizes were treated by C&D and 

immediately examined histologically. Two were tumor free for a clearance 

rate of 22.2%. Two recurrent BCC were allowed to heal 1 month following 
C&D; one of these was tumor free when excised. CONCLUSION: For primary 
BCC 
< 1 cm, no evidence was found that inflammation occurring over 1 month 
following C&D clears residual tumor. It was also noted that C&D fails to 

completely remove tumor in a large majority of primary BCC > 1 cm, and 
in 
recurrent BCC. 

============================================================ 
61.) Cryosurgery in dermatology. 
============================================================ 
Eur J Dermatol 1998 Oct-Nov;8(7):466-74 

Zouboulis CC 
Department of Dermatology, University Medical Center Benjamin Franklin, 
The 
Free University of Berlin, Hindenburgdamm 30, D-12 200, Berlin, Germany. 

[email protected] 

The aim of this article is to provide current information on the 
clinical 
development of cutaneous cryoreaction and the indications, complications 

and contraindications of cutaneous cryosurgery. Successful cutaneous 
cryosurgery requires rapid freezing and slow thawing, minimum tissue 
temperatures of -25 degrees C to -60 degrees C and, in malignant 
lesions, 
repeated freeze-thaw cycles. Frozen tissue reacts with peripheral 
erythema 
immediately following thawing, and consequently with oedema, bulla 
formation, exudation, mummification, and usually heals with a fine 
atrophic 
scar within a 4-week period. Cryosurgery is now considered the treatment 
of 
choice in hypertrophic scars and keloids, granuloma annulare and 
capillary 
haemangioma of the newborn. It also represents a valuable alternative 
therapy for various skin diseases, including common warts, solar 
lentigo, 
actinic keratoses, superficial basal cell carcinoma and Kaposi's 
sarcoma. 
Cryosurgery is a safe regimen with only a few adverse effects and 
contraindications. Pain during and/or shortly after treatment, bulla 
formation and local oedema are the major, temporary adverse effects; 
lesional hypopigmentation and/or peripheral hyperpigmentation is the 
most 
common by occurring long-term complication. 

============================================================ 
62.) [The treatment of basal cell carcinoma patients by dermatologists 
in 
Netherland]. 
============================================================ 
Ned Tijdschr Geneeskd 1998 Jul 4;142(27):1563-7 

Thissen MR, Neumann HA, Berretty PJ, Ideler AH 
Academisch Ziekenhuis, afd. Dermatologie, Maastricht. 

OBJECTIVE: To determine the policy of dermatologists practising in the 
Netherlands in the treatment of basal cell carcinoma. DESIGN: Written 
enquiry. SETTING: Catharina Hospital, Eindhoven, the Netherlands. 
METHOD: 
All 293 dermatologists practising in the Netherlands were sent a 
questionnaire in May 1996 containing 15 questions about diagnosis and 
treatment of basal cell carcinoma. RESULTS: Eighteen forms dropped off 
because of termination of the practice or joint completion in group 
practices. The response was 76% (208/275). The diagnosis was made 
usually 
on the basis of histological examination (71% of the respondents; 84% in 
a 
tumour recurrence). Excision was the preferred treatment for all 
subtypes 
of basal cell carcinoma; second choices were cryosurgery or 
curettage/electrocoagulation. Roentgen contact therapy has been 
practically 
abandoned. New methods such as photodynamic therapy and immunotherapy 
are 
being used only sporadically on an experimental basis. Most 
dermatologists 
regarded tumour recurrences as a bigger problem than primary tumours. 
They 
attempt to reduce the percentage of recurrences by giving advice about 
risk 
factors (sunlight). CONCLUSION: Too little use is being made of 
diagnostic 
biopsy to enable an optimal choice of therapy of basal cell carcinomas, 
especially in cases of recurrence tumours. 

============================================================ 
63.) [Therapy of non-melanocytic skin tumors]. 
============================================================ 
Ther Umsch 1998 Aug;55(8):515-21 

Hafner J 
Dermatologische Klinik und Poliklinik, Universitatsspital Zurich. 

Actinic keratosis on sun-damaged skin are very common in individuals 
with 
fair complexion. Management encompasses cryosurgery, tretinoin or 
5-fluorouracil-cream. Bowen's disease, however, requires surgical 
excision 
or radiotherapy. Basal cell carcinoma and squamous cell carcinoma are 
the 
two most common malignant skin tumours in Western Europe. Typically 
these 
tumours can be managed either by excision and primary wound closure, by 
cryosurgery or by radiotherapy. The method of choice is determined by 
the 
type and location of the tumour and the general condition of the 
patient. 
For more difficult-to-treat malignant skin tumours surgical resection 
with 
histological margin control is required. Mohs' micrographic surgery is a 

specialized procedure. This method entails to a full work-up of the 
excisional margins. The defect is closed only after histological 
verification of tumour-free surgical margins. Difficult-to-treat tumours 

are recurrent, sclerodermiform and large (diameter more than 20 mm) 
basal 
cell carcinomas. Indications for margin control in squamous cell 
carcinomas 
are tumours with more than 20 mm of diameter, with more than 5 mm 
thickness 
and with poor histologic differentiation (Broders grade III and IV, 
desmoplastic squamous cell carcinoma). Therefore, a skin biopsy is often 

required to plan the optimal treatment of a malignant skin tumour. The 
collaboration of primary care providers and specialists is beneficial in 

the management of difficult skin tumours. Renal transplant recipients 
under 
immunosuppression are prone to have squamous cell carcinoma of a more 
aggressive type. Dermatofibrosarcoma protuberans is another good 
indication 
for Mohs' micrographic surgery. A regular follow-up for recurrences or 
secondary tumours, as well as an effective secondary prevention of sun 
damage are important for skin cancer patients. 

============================================================ 
64.) [High resolution ultrasound imaging: value in treatment of 
basocellular carcinoma by cryosurgery]. 
============================================================ 
Ann Dermatol Venereol 1998 Aug;125(8):500-4 

Vaillant L, Grognard C, Machet L, Cochelin N, Callens A, Berson M, 
Aboumrad 
J, Patat F, Lorette G 
Service de Dermatologie, CHU Tours. 

OBJECTIVE: We conducted a prospective evaluation of the contribution of 
high-resolution ultrasound imaging prior to cryosurgery for basocellular 

carcinoma and in search for recurrence. PATIENTS AND METHODS: All 
patients 
seen between 1992 and 1994 at the skin tumor clinic and treated by 
cryosurgery were included. Ultrasound imaging using 20 MHz prototype was 

performed prior to cryosurgery and 2 months later. RESULTS: Among 101 
patients treated, 112 basocellular carcinomas were treated by 
cryosurgery. 
Ultrasound imaging provided good visualization of the tumor limits in 
all 
cases. The ultrasound aspect was anechogenic, often with rare areas of 
highly dense echoes. The tumor limits described by ultrasound imaging 
were 
larger than the clinical limits in 32% of the cases. In 8 of the 16 
cases 
of recurrent tumors, the ultrasound examination revealed the recurrence 
first. In the other 8 cases, clinical manifestations were confirmed by 
ultrasonography. In our series, recurrence of basocellular carcinoma was 

statistically more frequent when the depth of the tumor was 3 mm 
(ultrasonographic measurement) or when the lateral limits established by 

ultrasound assessment were greater than the clinical evaluation. 
DISCUSSION: These findings demonstrate that high-resolution ultrasound 
imaging of basocellular carcinomas prior to cryosurgery: 1) visualizes 
tumor limits allowing adapted cryosurgery, 2) identifies factors with 
predictive value for recurrence, 3) can identify recurrences early. 
Ultrasound imaging of the skin is a useful non-invasive technique for 
pre- 
and post-therapeutic assessment of skin tumors and could be a 
particularly 
useful tool for "blind" cryosurgery destruction of skin tumors. 

============================================================ 
65.) Recurrent basal cell carcinoma treated with cryosurgery. 
============================================================ 
J Am Acad Dermatol 1997 Jul;37(1):82-4 

Kuflik EG, Gage AA 
Department of Dermatology, University of Medicine and Dentistry, New 
Jersey 
Medical School, Newark, USA. 

BACKGROUND: Although there are reports of cure rates achieved by 
cryosurgery for primary basal cell carcinomas (BCCs), there are few data 
on 
the cryosurgical treatment of recurrent BCCs. OBJECTIVE: Our purpose was 
to 
discuss case selection, cryosurgical management, and results of therapy. 

METHODS: Cryosurgery was performed in 54 patients with 56 recurrent 
BCCs. 
The treatment consisted of aggressive freezing including an adequate 
margin 
of surrounding tissue. RESULTS: Wound healing was favorable and the 
cosmetic results were excellent. Two recurrences were found and were 
referred for Mohs micrographic surgery. CONCLUSION: We conclude that 
cryosurgical treatment of selected recurrent BCCs yields results that 
compare favorably with other methods of treatment. 

============================================================ 
66.) Fractional cryosurgery. A new technique for basal cell carcinoma of 

the eyelids and periorbital area. 
============================================================ 
Dermatol Surg 1997 Jun;23(6):475-81 

Goncalves JC 
Department of Dermatology, Hospital Distrital de Santarem, Portugal. 

BACKGROUND: Cryosurgery is an established method to treat malignant 
tumors 
of the eyelids and periorbital area. Nevertheless, it has been abandoned 

for tumors greater than 10 mm, because it gives irregular esthetic 
results 
and, in some cases, lagophthalmos. OBJECTIVE: To devise a new method for 

the treatment of such tumors. METHOD: Fractional cryosurgery is 
performed 
in stages: the center of the lesion is frozen, resulting in a reduction 
of 
the tumor; this procedure is repeated, as necessary, until the lesion's 
diameter is smaller than 10 mm; the standard cryosurgical procedure is 
then 
carried out. RESULTS: The treatment of the first 20 basal cell 
carcinomas 
with diameters between 10 and 24 mm is described, with excellent 
clinical 
and cosmetic results. CONCLUSION: With fractional cryosurgery, the final 

scar bears no relation to the size of the original tumor but, instead, 
corresponds to the size of the lesion preceding the final cryosurgical 
procedure. 

============================================================ 
67.) Long-term follow-up of cryosurgery of basal cell carcinoma of the 
eyelid. 
============================================================ 
J Am Acad Dermatol 1997 May;36(5 Pt 1):742-6 

Lindgren G, Larko O 
Department of Ophthalmology Goteborg University, Sahlgrenska Hospital, 
Sweden. 

BACKGROUND: Basal cell carcinoma (BCC) is the most common malignant 
tumor 
of the eyelid and its incidence is increasing. It remains to be 
established 
which is the best treatment in terms of safety and cost-effectiveness. 
OBJECTIVE: Our purpose was to analyze the long-term treatment results 
and 
possible side effects of cryosurgery of eyelid BCC. METHODS: During the 
last 14 years 219 patients (222 tumors) treated for eyelid BCC with 
cryosurgery were followed up prospectively for up to 10 years. RESULTS: 
The 
tumors cleared completely after treatment in all patients with no 
recurrence observed to date. Ninety-two patients were followed up for 5 
years or more. Complications were few and minor. In 26 treated eyelids 
conjunctival overgrowth was noted. CONCLUSIONS: We conclude that 
cryosurgery of BCC of the eyelid has a high cure rate, is 
cost-effective, 
and is well tolerated. 

============================================================ 
68.) Five-year results of curettage-cryosurgery of selected large 
primary 
basal cell carcinomas on the nose: an alternative treatment in a 
geographical area underserved by Mohs' surgery. 
============================================================ 
Br J Dermatol 1997 Feb;136(2):180-3 

Nordin P, Larko O, Stenquist B 
Department of Dermatology, Lundby Hospital, Goteborg, Sweden. 

Mohs' micrographic surgery (MMS) is the recommended treatment for large 
basal cell carcinomas (BCCs) of the nose. This 5-year follow-up study 
attempts to evaluate whether curettage-cryosurgery (CC) could be an 
alternative therapy in a country where optimal resources for MMS are 
lacking. All patients with a primary nasal or perinasal BCC, 10 mm or 
larger in diameter, were assessed at a skin tumour clinic. Sixty-one 
BCCs 
of non-morphoeiform type were treated with CC. Most of the tumour was 
removed by careful curettage with different sized curettes. The tumour 
area 
was then frozen with liquid nitrogen in a double freeze-thaw cycle. 
Fifty 
patients were followed for at least 5 years with only one recurrence. 
The 
cosmetic result was good or acceptable in all patients. A thorough 
curettage followed by cryosurgery could be a safe and inexpensive 
alternative therapy even for large primary non-morphoeiform BCCs of the 
nose. 

============================================================ 
69.) Laser microsurgery for superficial T1-T2 basal cell carcinoma of 
the 
eyelid margins. 
============================================================ 
Ophthalmology 1997 Jul;104(7):1179-84 

Bandieramonte G, Lepera P, Moglia D, Bono A, De Vecchi C, Milani F 
Division of Surgical Semiotics and Ambulatory Surgery, Istituto 
Nazionale 
per lo Studio e la Cura dei Tumori, Milano, Italy. 

BACKGROUND: Basal cell carcinoma (BCC), the most common malignancy of 
the 
eyelid margins, poses therapeutic problems. Surgery, radiation therapy, 
and 
cryotherapy are the currently accepted methods for the treatment of this 

affliction. To verify the technical and clinical effectiveness of the 
surgical laser method, a specific approach was developed by performing 
laser-combined procedures under microscopic control. METHODS: A series 
of 
26 patients underwent carbon dioxide (CO2) laser microsurgical excision 
of 
27 primary superficial BCCs of the eyelid margins. Eighteen tumors were 
T1 
and 9 were T2. The lesions were located at the lid margins in 18 and at 
the 
canthus in 9 cases. The eyelash line was involved in all cases, whereas 
intermarginal space was involved in 17 cases, without extension to the 
conjunctival border. Six lesions were in the lacrimal region. Median 
linear 
extent of the lesion was 5 mm (range, 4-10 mm). Treatment was performed 
with the patient under local anesthesia in a Day Hospital regimen. The 
authors used the microscope-mounted CO2 laser as a scalpel to excise the 

tumor mass, thus obtaining the specimen for histologic evaluation. The 
authors treated the deep and lateral resection margins with laser 
vaporization and left the wound bed to heal by secondary intention. 
RESULTS: No significant complications were observed. As full-thickness 
eyelid resections were avoided, the authors noted conservation of lid 
function and cosmetic aspect in all patients. With a median follow-up of 
73 
months (range, 18-118), only one patient had tumor recurrence after 22 
months. This tumor, located at the outer canthus, had a second 
microsurgical laser excision, and the patient is disease free 51 months 
after the last treatment. CONCLUSIONS: Laser microsurgery appears to be 
a 
safe and effective treatment method for primary superficial T1 and T2 
BCC 
of the eyelid margins without conjunctival extension. 

============================================================ 
70.)[Use of Nd:YAG laser for treatment of basal-cell carcinomas and some 

premalignant conditions]. 
============================================================ 
Przegl Dermatol 1990 Nov-Dec;77(6):385-8 
 

Rubisz-Brzezinska J, Bendkowski W 
Katedry i Kliniki Dermatologii Sl. AM w Katowicach. 

In 51 patients, 29 female and 22 male of average 61 years old, 94 
lesions 
were treated with Nd: YAG laser; 70 basal-cell carcinomas, 9 superficial 

basal-cell carcinomas, 12 actinic keratosis and 3 cutaneous horns. Size 
of 
changes varied from 7 to 24 mm. Quantity of energy used in laser-therapy 

was dependent on diagnosis, focus size, location and amounted from 50 to 

240 J/cm2. Authors are of the opinion that Nd:YAG laser-therapy is a 
very 
good method for treatment of skin tumors. Moreover, the advantage of 
this 
method is its possibility of a single procedure in the conditions of 
outpatients clinic. 
 

============================================================ 
71.) Laser therapy of skin tumors. 
============================================================ 
Recent Results Cancer Res 1995;139:417-21 

Landthaler M, Szeimies RM, Hohenleutner U 
Department of Dermatology, University of Regensburg, Germany. 

Malignant skin tumors can be treated by CO2 laser excision or 
vaporization, 
neodymium: yttrium aluminum garnet (Nd:YAG) laser coagulation, and 
systemic 
or topical photodynamic therapy (PDT). Possible indications for CO2 
laser 
vaporization include superficial basal cell carcinomas, actinic 
keratoses, 
Bowen's disease, actinic cheilitis, and leukoplakias. The Nd:YAG laser 
may 
be used for coagulation of basal cell carcinomas, squamous cell 
carcinomas, 
Kaposi's sarcoma, and metastatic skin tumors. Systemic and topical PDT 
is 
still an experimental modality and is mostly applied for treatment of 
basal 
cell carcinomas. However, laser treatment of skin tumors is not yet 
considered as standard therapy and should be confined to selected 
patients. 
Further clinical studies are necessary to determine the role of laser 
therapy in this special indication. 

============================================================ 
72.) Treatment of superficial basal cell carcinoma and squamous cell 
carcinoma in situ with a high-energy pulsed carbon dioxide laser. 
============================================================ 
Arch Dermatol 1998 Oct;134(10):1247-52 

Humphreys TR, Malhotra R, Scharf MJ, Marcus SM, Starkus L, Calegari K 
Department of Medicine, University of Massachusetts Medical Center, 
Worcester, USA. 

BACKGROUND: High-energy pulsed carbon dioxide (CO2) lasers have been 
used 
extensively to resurface wrinkled and photodamaged skin with a low risk 
of 
scarring. Results of histological studies demonstrate precise ablation 
depths in treated skin with minimal thermal damage to underlying tissue. 

Our objective was to determine if a pulsed CO2 laser could effectively 
ablate superficial malignant cutaneous neoplasms (superficial multifocal 

basal cell carcinoma [BCC] and squamous cell carcinoma [SCC] in situ). 
OBSERVATIONS: Thirty superficial neoplasms (17 BCCs and 13 SCCs) and 
their 
surrounding 3-mm margins were treated with either 2 or 3 passes of a 
pulsed 
CO2 laser (500 mJ, 2-4 W) using a 3-mm collimated handpiece. The treated 

areas were subsequently excised and evaluated histologically by serial 
sectioning at 5-micron intervals for residual tumor at the deep and 
lateral 
margins. Average patient age was greater for those with SCCs than for 
those 
with BCCs (76.5 vs 56.7 years; P = .001). The average tumor thickness of 

SCC in situ was significantly greater than that of superficial BCC (0.57 
vs 
0.34 mm; P = .01). All (9 of 9 patients) BCCs were completely ablated 
with 
3 passes, and residual tumor in the deep margins was seen in 5 of 8 
patients treated with 2 passes of the pulsed CO2 laser (P = .005). 
Incomplete vaporization of the SCC depth was seen in 3 of 7 patients 
treated with 3 passes and in 2 of 6 patients treated with 2 passes. 
Those 
SCCs incompletely treated were significantly thicker than those 
completely 
ablated (0.65 vs 0.41 mm; P = .01). Positive lateral margins were seen 
in 1 
BCC and 3 SCC specimens. CONCLUSIONS: Pulsed CO2 laser treatment can be 
effective in ablating superficial BCC. Treatment of the neoplasm and a 
minimum of 4-mm margins with 3 passes (500 mJ, 2-4 W) is recommended for 

complete vaporization using this laser system. Because 3 passes did not 
completely ablate all SCC in situ, use of this modality alone is not 
recommended for treatment of thick or keratotic lesions. No direct 
comparison of efficacy can be made with other destructive modalities 
that 
have not been evaluated with comparably sensitive histological 
techniques. 
Further study is needed to establish any cosmetic advantage of pulsed 
CO2 
lasers over other destructive modalities for treatment of superficial 
malignant neoplasms and long-term cure rates. 
 

============================================================ 
73.) Prediction of subclinical tumor infiltration in basal cell 
carcinoma. 
============================================================ 
J Dermatol Surg Oncol 1991 Jul;17(7):574-8 

Breuninger H, Dietz K 
Department of Dermatology, University Hospital for Dermatology, 
Tubingen, 
Federal Republic of Germany. 

Two thousand-sixteen basal cell carcinomas (BCCs) were documented in 
terms 
of age, anatomic location, tumor diameter, initial excision depth, 
safety 
margin, histologic type, and the position of tumor outgrowths as 
determined 
by three-dimensional histologic study of the tumor margins in paraffin 
sections (micrographic surgery). The extent of each subsequent excision 
was 
recorded until tumor-free tissue was reached. The results showed that 
BCCs 
have a highly irregular infiltration pattern and a predilection for 
small, 
fingerlike outgrowths whose bases occupy 1-30 degrees of the tumor 
circumference. When superficial extension was expressed mathematically, 
the 
resulting exponential functions varied highly significantly (P = .001) 
according to histologic tumor type and diameter. The resulting curves 
permitted very precise prediction of the probability of tumor-positive 
margins (ie, subtotal excision), depending on the safety margin, 
histologic 
tumor type, and tumor diameter. For example, the probability of 
tumor-positive margins after excision of a BCC up to 10 mm in diameter 
is 
30% with a safety margin of 2 mm, 16% with a safety margin of 3 mm, and 
5% 
with a safety margin of 5 mm. The probability of tumor-positive margins 
for 
fibrosing primary BCCs 10-20 mm in diameter is 48, 34, and 18% with 
safety 
margins of 2, 3, and 5 mm, respectively. Recurrent tumors have a 
significantly higher probability of positive margins (P = .001) than 
primary ones. Anatomic location and tumor age affect subclinical 
extension 
only indirectly. 

============================================================ 
74.) Recurrence rates of treated basal cell carcinomas. Part 3: Surgical 

excision. 
============================================================ 
J Dermatol Surg Oncol 1992 Jun;18(6):471-6 

Silverman MK, Kopf AW, Bart RS, Grin CM, Levenstein MS 
Department of Dermatology, New York University School of Medicine. 

This is the third report in a series that reviews the experience in the 
Skin and Cancer Unit, from 1955 through 1982, with the treatment of 
basal 
cell carcinomas (BCCs). It concerns 588 previously untreated (primary) 
BCCs 
removed by surgical excision. The cumulative 5-year recurrence rate was 
4.8%. This is a statistically significant lower recurrence rate (P = 
.034) 
than 135 previously treated BCCs that had a re-recurrence rate of 11.6%. 

For the primary BCCs, multivariate analysis showed that location on the 
head (P = .010) and being male (P = .004) were independent risk factors 
for 
recurrence. The patient's age, the duration of the BCC, its maximum 
diameter, or the time span (1955-1963, 1964-1972, 1973-1982) in which it 

was treated did not significantly affect the recurrence rate. The 5-year 

recurrence rate for BCCs excised from various anatomic sites were as 
follows: 1) neck, trunk, and extremities = 0.7%; 2) head--less than 6 mm 
in 
diameter = 3.2%; 3) head--6 to 9 mm in diameter = 8.0% (treated since 
1964 
= 5.2%); and 4) head--10 mm or more in diameter = 9.0%. Surgical 
excision 
is a highly effective method for removal of BCCs, and achieved a good to 

excellent cosmetic outcome in about 85% of the recurrence-free treatment 

sites. 

============================================================ 
75.) Human papillomavirus type 2-associated basal cell carcinoma in two 
immunosuppressed patients. 
============================================================ 
ARTICLE SOURCE:  Arch Dermatol  (United States), Jun 1988, 124(6) p930-4 

AUTHOR(S):  Obalek S; Favre M; Jablonska S; Szymanczyk J; Orth G 
PUBLICATION TYPE:  JOURNAL ARTICLE 
ABSTRACT:  Human papillomavirus-2 genomes were detected by molecular 
hybridization in two cases of basal cell carcinomas that developed in 
immunosuppressed individuals. This form of human papillomavirus is 
usually 
responsible for common warts in the general population. Although it does 

not appear to have oncogenic potential, it may be, in some cases, 
associated with cutaneous malignancy. 

============================================================ 
76.) Occurrence of human papillomavirus type 16 DNA in cutaneous 
squamous 
and basal cell neoplasms. 
============================================================ 
ARTICLE SOURCE:  J Am Acad Dermatol  (United States), Nov 1990, 23(5 Pt 
1) 
p836-42 
AUTHOR(S):  Eliezri YD; Silverstein SJ; Nuovo GJ 
PUBLICATION TYPE:  JOURNAL ARTICLE 
ABSTRACT:  Sixty-eight cutaneous squamous cell neoplasms (in situ and 
invasive) and 26 basal cell carcinomas from 89 patients were analyzed 
for 
DNA sequences homologous to the human papillomavirus (HPV) types found 
predominantly in the genital tract. Thirty-six (53%) of the squamous 
cell 
neoplasms contained HPV DNA as detected by filter or in situ 
hybridization 
analysis. The frequency of detection of HPV DNA was dependent on the 
site 
of the lesion. Of 40 genital squamous cell neoplasms (penile, vulvar, 
and 
perianal), 27 (68%) had detectable HPV DNA. In 25 of these, the HPV type 

was 16 or HPV-16-related, which was similar to the results for the 
squamous 
cell neoplasms of the finger (HPV DNA in 9 of 11 tumors with HPV-16 in 
seven). None of 16 squamous cell neoplasms from sites other than the 
genital tract or the finger had detectable HPV DNA. HPV DNA was detected 
in 
one of the 26 basal cell carcinomas (4%). We conclude that, for 
cutaneous 
epithelial malignancies, HPV-16 is restricted to squamous cell neoplasms 
of 
the genital tract and finger. These data are consistent with venereal 
transmission of HPV-16 to the periungual region and suggests a role for 
this virus in the evolution of squamous cell carcinoma at this site. 

============================================================ 
77.) Basal cell carcinoma of the genitalia. 
============================================================ 
Dermatol Surg 1998 Dec;24(12):1361-3 

Nehal KS, Levine VJ, Ashinoff R 
Ronald O. Perelman Department of Dermatology, New York University 
Medical 
Center, NY 10016, USA. 

BACKGROUND: Basal cell carcinomas (BCC) arising on the genitalia are 
exceedingly rare with an unclear pathogenesis. OBJECTIVE: To better 
understand risk factors, tumor characteristics, and the possible role of 

human papillomavirus (HPV) in the development of BCC of the genitalia. 
METHODS: 1543 records of Mohs micrographic surgery performed during a 
6-year period were reviewed to identify cases of BCC arising on the 
genitalia. Tumor tissue was analyzed for HPV DNA by in situ 
hybridization. 
RESULTS: Four patients with BCC of the genitalia were treated with Mohs 
micrographic surgery. The malignancies were located on the scrotum, 
perineum, and perianal areas in the three male patients and on the vulva 
in 
the female patient. The mean age was 67 years. None of the patients had 
prior history of skin cancers. Histologic evaluation of the tumors 
revealed 
two nodular subtypes, one superficial subtype, and one with follicular 
differentiation. In situ hybridization failed to reveal DNA of HPV types 
6, 
11, 16, 18, 30, 31, 33, 35, 45, 51, and 52. CONCLUSION: In this small 
series, genital BCC occurred in an older age group with no identifiable 
predisposing risk factors and did not show evidence of HPV infection. 

============================================================ 
78.) Detection of human papillomavirus DNA in PUVA-associated 
non-melanoma 
skin cancers. 
============================================================ 
J Invest Dermatol 1998 Jul;111(1):123-7 

Harwood CA, Spink PJ, Surentheran T, Leigh IM, Hawke JL, Proby CM, 
Breuer 
J, McGregor JM 
Department of Academic Dermatology, Royal Hospitals NHS Trust, London, 
UK. 

Psoralen and UVA (PUVA) photochemotherapy is associated with a 
dose-dependent increased risk of nonmelanoma skin cancer in patients 
treated for psoriasis. Like ultraviolet B radiation, PUVA is both 
mutagenic 
and immunosuppressive and may thus act as a complete carcinogen; 
however, 
the reversed squamous to basal cell carcinoma ratio (SCC:BCC) in 
PUVA-treated patients, also seen in immunosuppressed renal transplant 
recipients, suggests a possible cofactor role for human papillomavirus 
(HPV) infection. In this study we examine a large series of benign and 
malignant cutaneous lesions for the presence of HPV DNA from patients 
treated with high dose (> or =500 J per cm2) ultraviolet A. A panel of 
degenerate primers based on the L1 (major capsid protein) open reading 
frame was employed, designed to detect mucosal, cutaneous, and 
epidermodysplasia verruciformis HPV types with high sensitivity and 
specificity. HPV DNA was detected in 15 of 20 (75%) non-melanoma skin 
cancer, seven of 17 (41.2%) dysplastic PUVA keratoses, four of five 
(80%) 
skin warts, and four of 12 (33%) PUVA-exposed normal skin samples. The 
majority of HPV positive lesions contained epidermodysplasia 
verruciformis-related HPV including HPV-5, -20, -21, -23, -24, and -38. 
Possible novel epidermodysplasia verruciformis types were identified in 
further lesions. Mixed infection with epidermodysplasia verruciformis, 
cutaneous, and/or mucosal types was present in six of 30 (20%) of all 
HPV 
positive lesions, including in normal skin, warts, dysplastic PUVA 
keratoses, and squamous cell carcinomas. The prevalence and type of HPV 
infection in cutaneous lesions from PUVA-treated patients is similar to 
that previously reported in renal transplant-associated skin lesions, 
and 
suggests that the role of HPV in PUVA-associated carcinogenesis merits 
further study. 

============================================================ 
79.)Premalignant lesions and cancers of the skin in the general 
population: 
evaluation of the role of human papillomaviruses. 
============================================================ 
J Invest Dermatol 1990 Nov;95(5):537-42 

Kawashima M, Favre M, Obalek S, Jablonska S, Orth G 
Unite des Papillomavirus, Institut Pasteur, Paris, France. 

To evaluate the role of human papillomaviruses (HPV) in the development 
of 
premalignant lesions and cancers of the skin in the general population, 
314 
biopsies obtained from 227 patients with benign neoplasms, premalignant 
lesions, and cancers of the skin and from 25 patients with squamous cell 

carcinoma of the lip were analyzed by Southern blot hybridization. DNA 
probes specific for various cutaneous and genital HPV types were used in 

hybridizations conducted under nonstringent or stringent conditions. HPV 

DNA sequences were only detected in eight specimens obtained from six 
patients: HPV 34 in one case of periungual Bowen's disease, HPV 36 and 
an 
as yet uncharacterized HPV in two cases of actinic keratosis, HPV 20 in 
one 
case of basal cell carcinoma, an as yet unrecognized HPV in one case of 
squamous cell carcinoma, and HPV 16 in one case of squamous cell 
carcinoma 
of the lip. None of the specimens of cutaneous horn and keratoacanthoma 
contained detectable HPV DNA. In contrast, HPV DNA sequences, mostly HPV 

16, were detected in 13 of 23 cases of anogenital Bowen's disease and 
invasive Bowen's carcinoma. HPV DNA sequences were not detected in 90 
cutaneous samples further analyzed by the polymerase chain-reaction 
technique, using amplification primers that contain conserved sequences 
among the genomes of HPV. These results strongly suggest that the known 
HPV 
types play only a minor role, if any, in skin carcinogenesis in the 
general population. 

============================================================ 
80.) Human papillomavirus type 2-associated basal cell carcinoma in two 
immunosuppressed patients. 
============================================================ 
Arch Dermatol 1988 Jun;124(6):930-4 

Obalek S, Favre M, Jablonska S, Szymanczyk J, Orth G 
Department of Dermatology, Warsaw School of Medicine, Poland. 

Human papillomavirus-2 genomes were detected by molecular hybridization in 
two cases of basal cell carcinomas that developed in immunosuppressed 
individuals. This form of human papillomavirus is usually responsible for 
common warts in the general population. Although it does not appear to 
have oncogenic potential, it may be, in some cases, associated with cutaneous 
malignancy. 
 
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DATA-MEDICOS/DERMAGIC-EXPRESS No 2-(91)  22/03/2.000 DR. JOSE LAPENTA R. 
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