Basal cell carcinoma, the most common human malignancy, has a rare incidence of metastases ranging from 0.0028-0.55%. We report a case of a 74-year-old female with a 10-year history of an enlarging anterior thigh nodule. Wide resection and inguinal lymph node dissection revealed an infiltrative basal cell carcinoma with lymph node metastasis due to the presence of basaloid cells, limited peripheral palisading, loose stroma, extensive spread, perineural invasion and immunoreactivity to p40, BerEP4, and GATA3.

Xeroderma pigmentosum (XP) is a rare DNA repair disorder characterized by sensitivity to sunlight and predisposition to cutaneous malignancies. There are various types, including the Variant type, which does not manifest with acute sunburn reactions. This results to the development of multiple malignancies that are often discovered at late stages, making management more challenging. This is a case of a 54-year-old Filipino female presenting with multiple basal cell carcinomas (BCCs) on several areas of the face and advanced cutaneous squamous cell carcinoma (cSCC) on the right zygomatic area, treated with imiquimod 5% cream and external beam radiation therapy, respectively. There was an excellent response of the BCCs to imiquimod 5% cream and good tumoral response of the SCC to radiation therapy, with tolerable side effects, highlighting the use of these palliative treatment modalities for XP patients with multiple, unresectable, or difficult-to-treat cutaneous malignancies.

Background: Dermoscopy enhances detection of basal cell carcinoma (BCC), especially for the pigmented subtype common among Asians. However, there is limited data on dermoscopic features of BCC in Filipinos. Objectives: The objective of this study is to describe the clinicopathologic profile and dermoscopic features of BCC in Filipinos seen in a tertiary care clinic. Methods: A cross-sectional study was conducted in the Philippines from November 2019 to December 2021 in a tertiary care clinic. Fifty-three (53) lesions suspicious for BCC were analyzed using dermoscopy prior to histologic confirmation. Fifty (50) biopsy-proven BCC lesions were included in the analysis. Results: Lesions were more commonly seen in females (72.50%), and located on the head and neck (88%). The most common histopathologic subtype was nodular (74%). The most common dermoscopic features were large blue-gray ovoid nests (86%) and ulcerations (70%). Conclusion The most common BCC type among the study participants was nodular, with large blue-gray ovoid nests and ulceration seen on dermoscopy.
carcinoma, basal cell ; dermoscopy

Rosacea is a common, chronic condition seen most frequently in lightly pigmented skin presenting with centrofacial redness, papules, pustules, flushing, telangiectasia, and phymatous skin changes. Phymatous rosacea on the nose is called rhinophyma. This condition predominantly affects males in their 5th-7th decade of life. Rosacea has a complex pathophysiology involving the innate and adaptive immune system and its interaction with environmental stimuli. Correlation of non-melanoma skin cancer and rosacea is documented albeit uncommon, and none published from the Philippines.

This is a case of a 76-Year Old British male who presents with a 3 year history of skin colored mass on the nose, which was excised with paramedian forehead flap and was diagnosed with squamous cell carcinoma. In the interim, the patient noted the appearance of rubbery erythematous plaque on the nose with progressively increasing size and erythema and ulceration. Skin punch biopsies were done revealing both infiltrative basal cell carcinoma and rhinophyma. Patient was eventually seen by general surgery and underwent a wide excision.

This case highlights the importance of having a high index of suspicion for malignancies in the appropriate population. The different findings of biopsy sites also reminds us of choosing the appropriate biopsy sites for accurate and timely diagnosis. Lastly, a multidisciplinary approach for successful and comprehensive treatment is of paramount importance.

We are presenting a rare case of a 71-year-old Filipino female with the presence of two skin cancers occurring simultaneously in two different regions of the body.

Patient noted symmetrical, erythematous, pruritic, eczematous patches and plaques on her inguinal areas five years prior to consultation. The patient also had a 2-year history of multiple pigmented papules and plaques on the forehead, left jaw, right cheek, lateral canthus of the left eye, and sternal area associated with occasional bleeding.

Skin examination showed symmetrical, irregularly shaped bright red moist plaques with finger-like projections measuring 26 cm x 9 cm on the vulva, inguinal areas, and intergluteal areas. The patient also had multiple pigmented papules and plaques with rolled borders located on the right forehead, lateral canthus of the left eye, right cheek, left jaw, and sternal area with measurements ranging from 0.3 x 0.4 cm to 1.5 x 2.0 cm in size.

Histological examination of the vulvar skin biopsy is signed out as extramammary Paget’s disease with positive immunohistochemical stain for Cytokeratin 7. A skin punch biopsy on the pigmented plaque on the right forehead is signed out as basal cell carcinoma.

This is the first known case of the simultaneous occurrence of extramammary Paget’s disease and basal cell carcinoma on different regions of the body. We speculate that the two tumors in our patient may have developed independently with no causal relationship, but we are attributing the occurrence of the patient’s carcinomas to her old age, prolonged sun exposure, and immunosuppression.

BACKGROUND

Surgical treatments are the first-line therapy for basal cell carcinoma (BCC). However, for patients who are not candidates for surgery, non-surgical options, such as pulsed dye laser (PDL), may be considered.

This study aimed to review the existing literature on the efficacy, tolerability, and safety of PDL in the treatment of BCC.

A systematic review and meta-analysis of PDL for BCC were conducted. The primary outcomes assessed were clearance and recurrence rates. The secondary outcome was the incidence of adverse events.

The review included 11 studies (4 randomized controlled trials, 6 cohort studies, and 1 case series) comprising a total of 204 patients and 295 BCCs. Most BCCs were low-risk histologically and predominantly located on low-risk areas. The meta-analysis revealed an overall clearance rate of 69% and a recurrence rate of 32%, with follow-up periods ranging from 1 to 72 months. However, there was substantial and statistically significant heterogeneity across all studies. The most frequently reported adverse effects included pigmentary changes, primarily hypopigmentation, and varying degrees of scarring.

PDL is a safe and tolerable option for treating BCC, though it is not recommended as a sole treatment due to the higher clearance rates and lower recurrence rates associated with other modalities. PDL may be considered an alternative for non-surgical candidates with small or superficial BCCs. Further research is needed to establish standardized parameters for its use in BCC treatment.

Introduction: Epidermal nevi are hamartomas of the epidermis and papillary dermis that are usually present during the first years of life. Rarely, malignant transformations develop in association with epidermal nevi. Few cases have been reported worldwide, however the lifetime risk and incidence are unknown. Case Report: This is a case series about basal cell carcinoma arising on epidermal nevus. The first patient is a 42-year-old Filipino female, who presented with a verrucous plaque at birth on the left temple which then developed multiple, discrete to confluent, grayish, papules and nodules on the surface. Histological examination revealed nevus sebaceus and basal cell carcinoma, pigmented type. The second patient is a 53-year-old Filipino male, who presented with a papillomatous plaque on the left temple since the first year of life which then increased in size along with the presence of a solitary bluish-black macule noted by dermoscopic examination. Histologic examination showed verrucous epidermal nevus and basal cell carcinoma, pigmented type. Conclusion Two rare cases of basal cell carcinoma arising on epidermal nevus are reported. Despite the rarity of malignant transformation on epidermal nevus, any suspicious growth warrants a biopsy. Knowledge of these cases is important for probing suspicious growth over an epidermal nevus that would prompt early treatment before these lesions progress in size making it harder to manage.
epidermal nevus ; nevus sebaceus ; verrucous epidermal nevus ; basal cell carcinoma

Introduction: The true incidence of skin cancer, as well as the clinico-demographic and histopathologic profile of skin cancer patients in the Philippines, has not been established. To the authors’ knowledge, no similar studies have been published in recent years. Objectives: To determine the clinico-demographic and histopathologic characteristics of histopathologically-proven skin cancer Filipino pa- tients in a Philippine public tertiary hospital. Methods: This study included 121 patients with histopathologically-proven skin cancers from January 2015 to December 2019 in the dermatology and pathology departments of a public tertiary hospital in Manila, Philippines. Retrospective chart review and descriptive data analysis were conducted for this study. Results: Of the 121 cases, the common skin cancers included basal cell carcinoma (54%), squamous cell carcinoma (27%), cutaneous lymphoma (7%), and melanoma (6%). The mean age was 63 ±16 years. There was a slight female preponderance (56%). The most commonly affected area was the head and neck region (73%). Most cases (54%) were clinically diagnosed by dermatologists, while the remaining patients were seen by non-derma-tologists. Thus, the concordance between clinical diagnosis and histopathologic confirmation was 62% in basal cell carcinoma, 50% in cutaneous lymphoma, 29% in melanoma, and 24% in squamous cell carcinoma. Overall, the skin cancer lesions amongst the patients were significant at the time of diagnosis, with a median length of 20 mm and a median width of 18.5 mm. Conclusion Basal cell carcinoma is the most common skin cancer (54%), followed by squamous cell carcinoma (27%). The head and neck was the most commonly affected region at 73%. Due to the low concordance of clinical and histopathologic confirmation, referral to a dermatologist is necessary to improve clinical accuracy. In the public tertiary hospital setting, whole-body skin examination should be a part of the initial derma- tology screening to catch small skin cancers. A system to ensure regular follow-up of skin cancer patients should be initiated to optimize early detection of recurrence and subsequent treatment as necessary.
Skin Neoplasms ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Melanoma

Objective: To explore the methods for the accurate resection of malignant tumors of the external nose, and the accurate evaluation and repair of tissue defects. Methods: We collected 48 cases with nasal malignant tumors treated in 980 Hospital, Joint Support Force of the People's Liberation Army from January 2010 to June 2020, including 28 males and 20 females, aged 36-86 years. The pathological types of tumors included basal cell carcinomas (n=29), squamous cell carcinomas (n=11), trichilemmal carcinomas(n=6), denoid cystic carcinoma (n=1) and non-Hodgkin lymphoma (n=1). Tumor resection was mainly based on the traditional extended resection determined by the safety margin, and Mohs surgery was used to minimize the scope of resection, for the margin that significantly affected the repairing results, such as the lesion adjacent to the nasal alar margin, nasal columella or deep easy-penetrating margin. All cases obtained tumor resection and primary/secondary defect reconstruction. Results: According to the pathological type and tumor size, the safe resection margin was mainly 4-10 mm, and Mohs surgery was used in 24 cases. Limited-size defects in 38 cases were repaired with double-leaf flaps, kite flaps, nasal dorsum brow flaps, nasolabial flaps or free tissues. Among 10 cases with compound defects, 8 cases were repaired with frontal flaps, including 4 cases with single frontal flaps, 2 cases with additional titanium mesh stent reconstruction and 2 cases with over and out frontal flaps. During follow-up of 1 to 10 years, all the flaps survived without flap necrosis, and the postoperative nasal contour and ventilation were satisfactory. One patient had tumor recurrence 18 months after operation, 2 patients died of cardiovascular and cerebrovascular diseases, and other patients survived without tumors. Conclusions: Mohs surgery can basically meet the requirements for precise resection of external nasal malignant tumors. Individualized application of adjacent tissue flaps and various frontal flaps is a reasonable choice to achieve the satisfactory outcome of external nasal repair and to take into account the complexity of operation.
Carcinoma, Basal Cell/surgery* ; Female ; Humans ; Male ; Nasal Septum ; Nose Neoplasms/surgery* ; Skin Neoplasms ; Surgical Flaps

INTRODUCTION: Trichoepithelioma is a benign hamartoma which may exhibit similar clinical and histopathological features with basal cell carcinoma. Since prognosis is dissimilar, differentiating between them is important. Literature reveals fifteen reports of malignant transformation of multiple trichoepitheliomas into basal cell carcinoma, with none in the local setting. In Brooke-Spiegler syndrome, the incidence rate of malignant transformation of benign neoplasms has been reported in 5-10 % of patients.

CASE REPORT: A 53-year-old Filipino-American female presented with multiple discrete to coalesced, well-defined, skin-colored to hyperpigmented, smooth, dome-shaped, rubbery papules and nodules on the face since childhood. Throughout the years, lesions increased in number and size and spread to the scalp, chest, abdomen, back, upper and posterior right thigh. Some developed ulceration, telangiectasia and pigmentation.

Chest radiography, radiographs of the jaw, whole abdominal ultrasound, cranial CT scan, ophthalmology and otorhinolaryngology assessments were normal. Based on clinical and histopathologic findings, the final diagnosis was Brooke-Spiegler syndrome with transformation into basal cell carcinoma. Carbon dioxide (CO2) laser was used to excise large and ulcerated lesions with good cosmetic results.

CONCLUSION: A case of a Filipino-American adult female diagnosed clinically and histologically with Brooke-Spiegler syndrome with transformation into basal cell carcinoma was presented. Given the similarities in clinical and histopathologic features of trichoepithelioma and basal cell carcinoma, accurate diagnosis should be made because of their difference in prognosis. The use of an acceptable treatment modality such as carbon dioxide (CO2) laser in this case is an important emerging fi eld of study.

KEYWORDS: trichoepithelioma, basal cell carcinoma, Brooke-Spiegler syndrome, malignant transformation, carbon dioxide laser