1. External Ear Basosquamous cell carcinoma 1 Instructor: 杜宗陽主任 Reporter: 張廷碩

2. Case Presentation 2

3. History 44-year-old female Sun exposure (+) Left progressive auricular mass for 2 years. 2014.1.14  EAR OPD 3

4. Physical Examination A PURPLISH MASS LESION ABOUT 2X2 CM OVER LEFT UPPER AURICULAR. 4

5. 5 Left auricle tumor

6. Operation 2014.1.16:  REMOVAL OF EXTERNAL EAR TUMOR +F.T.S.G 6

7. 7 Left auricle skin defect FTSG repair on the skin defect skin

8. 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

9. Staging Neck CT Abdominal sonogram WBBS Staging: pT1cN0M0 9

10. 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

11. 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

12. 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

13. Operation 2014.2.6:  Tumor wide excision with primary closure 13

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15. Introduction 15

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20. History First described in 1928. Today’s definition: WHO 2005 “Metatypical BCC” : Synonym to Basosquamous Cell Carcinoma “Keratotic BCC” “Collision tumor” 20

21. Basosquamous Cell Carcinoma (BSC) 21

22. Basosquamous Cell Carcinoma 22

23. Keratotic BCC 23

24. Collision Tumor 24

25. Diagnosis Only made by biopsy. BCC: – Indolent subtypes: Superficial/Nodular – Aggressive subtypes: Infiltrative/Morpheaform/BSC 25

26. Diagnosis Immunochemical Stain: Discontinuity of Basement membrane High percentage of proliferating cells More stromal reactions 26

27. 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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31. Treatment Moh’s surgery 31

32. Treatment Wide excision with safe margin 32

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40. Thank you for your attention!