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External Ear Basosquamous cell carcinoma 1 Instructor: 杜宗陽主任 Reporter: 張廷碩
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Case Presentation 2
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History 44-year-old female Sun exposure (+) Left progressive auricular mass for 2 years. 2014.1.14 EAR OPD 3
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Physical Examination A PURPLISH MASS LESION ABOUT 2X2 CM OVER LEFT UPPER AURICULAR. 4
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5 Left auricle tumor
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Operation 2014.1.16: REMOVAL OF EXTERNAL EAR TUMOR +F.T.S.G 6
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7 Left auricle skin defect FTSG repair on the skin defect skin
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Pathology It consists of one piece of grey white soft tissue and measures 1.6 x 1.4 x 1.3 cm. Nodular type basosquamous cell carcinoma. There is no tumor present at the resection margin. 8
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Staging Neck CT Abdominal sonogram WBBS Staging: pT1cN0M0 9
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Risk Factors The following are high-risk features for nonmelanoma skin cancer that is not on the eyelid: The tumor is thicker than 2 millimeters.millimeters The tumor is described as Clark level IV (has spread into the lower layer of the dermis) or Clark level V (has spread into the layer of fat below the skin).Clark level IVdermisClark level V The tumor has grown and spread along nerve pathways.nerve The tumor began on an ear or on a lip that has hair on it. 10
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Staging In stage I, The tumor is not larger than 2 centimeters at its widest point and may have one high-risk feature.stage Itumorcentimeters In stage II, the tumor is either:stage IItumor – larger than 2 centimeters at its widest point; orcentimeters – any size and has two or more high-risk features In stage III: Jaw, eye socket, or side of the skull /LNstage III In stage IV: base of the skull, spine, or ribs /LN>6cmstage IV: 11
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Combined Conference Pathology: – Margin less than 1mm – No perineural invasion Wider surgical margin is needed. Post-op R/T is not indicated if margin free. 12
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Operation 2014.2.6: Tumor wide excision with primary closure 13
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Introduction 15
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History First described in 1928. Today’s definition: WHO 2005 “Metatypical BCC” : Synonym to Basosquamous Cell Carcinoma “Keratotic BCC” “Collision tumor” 20
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Basosquamous Cell Carcinoma (BSC) 21
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Basosquamous Cell Carcinoma 22
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Keratotic BCC 23
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Collision Tumor 24
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Diagnosis Only made by biopsy. BCC: – Indolent subtypes: Superficial/Nodular – Aggressive subtypes: Infiltrative/Morpheaform/BSC 25
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Diagnosis Immunochemical Stain: Discontinuity of Basement membrane High percentage of proliferating cells More stromal reactions 26
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Incidence: 1.2%~2.7% of all skin carcinoma. Location: head and neck (95%) : Nose (33%) Increased recurrence and metastatic rates: 27
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Treatment Moh’s surgery 31
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Treatment Wide excision with safe margin 32
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Thank you for your attention!
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