背景:基底鳞状细胞癌(BSC)是一种罕见且侵袭性的非黑色素瘤皮肤癌(NMSC),表现出BCC和鳞状细胞癌(SCC)的特征。诊断的金标准是组织病理学检查。由于其混合的组织学特征和攻击行为的潜力,BSC的诊断和管理通常具有挑战性。目的:使用非侵入性诊断技术来识别帮助临床医生区分BSC的特定特征。
方法:我们进行了回顾性描述,流行病学临床的单中心研究,皮肤镜,2010年至2023年间诊断的经组织病理学证实的BSC的反射共聚焦显微镜(RCM)特征。共选取192例。
结果:研究人群包括17名男性(60.9%)。在诊断时,总共95.8%的患者≥50岁。124例(63.1%)发生在头颈部,其中65例(33.9%)发生在H区。对于47.4%的患者,BSC表现为临床边缘未定义的黄斑(43.3%)。98例有皮肤镜图像:最常见的参数是白色无结构区域的存在(59[60.2%]),角蛋白肿块(58[59.2%]),浅表尺度,和溃疡或血痂(49[50%]两者)。血管模式分析显示发夹型血管(仅)和线性不规则血管是最常见的(55[56.1%])。对21例患者进行了RCM检查,显示出特定的SCC特征,例如日光弹性增生(19[90.5%]),非典型蜂窝状图案(17[89%]),非典型角质形成细胞的增殖(16[80%])与作为明亮肿瘤岛的BCC细胞(12[57.8%]),和裂隙状黑暗空间(11[53.4%])。
结论:我们的研究反映了来自单个机构的最大的BSC队列。我们描述了4.7%的发病率,高于文献中的报道,在近96%的病例中,≥50岁的患者参与其中,总体以男性为主。在临床检查中,BSC被描述为具有一个或多个皮肤镜SCC特征的临床边缘未确定的过度角化黄斑。而在不到10%的病例中观察到典型的BCC方面的存在,与以前报道的不同。在RCM分析中,BSC呈现非典型蜂窝状模式,具有非典型角质形成细胞的增殖,角化过度,在近55%的患者中,明亮的肿瘤岛,有裂隙状的黑暗空间。
结论:独特的皮肤观察模式,与RCM特征一起有助于BSC与其他NMSC的分化。
BACKGROUND: Basosquamous carcinoma (BSC) is a rare and aggressive nonmelanoma skin cancer (NMSC) that exhibits features of both BCC and squamous cell carcinoma (SCC). The gold standard for diagnosis is histopathological examination. BSC is often challenging to diagnose and manage due to its mixed histological features and potential for aggressive behavior AIM: To identify specific features aiding clinicians in differentiating BSCs using non-invasive diagnostic techniques.
METHODS: We conducted a retrospective descriptive, monocentric study of the epidemiological clinical, dermoscopic, and reflectance confocal microscopy (RCM) features of histopathologically proven BSCs diagnosed between 2010 and 2023. A total of 192 cases were selected.
RESULTS: The study population consisted of 17 men (60.9%). Total 95.8% of patients at the time of diagnosis were ≥50 years. BSC occurred in the head and neck area in 124 cases (63.1%) of which 65 (33.9%) were in the H-zone. For 47.4% of patients, BSC presented as a macule with undefined clinical margins (43.3%). Dermoscopic images were available for 98 cases: the most common parameter was the presence of whitish structureless areas (59 [60.2%]), keratin masses (58 [59.2%]), superficial scales, and ulceration or blood crusts (49 [50%] both). Vessels pattern analysis revealed hairpin vessels (exclusively) and linear irregular vessels as the most frequent (55 [56.1%] both). RCM examination was performed in 21 cases which revealed specific SCC features such as solar elastosis (19 [90.5%]), atypical honeycomb pattern (17 [89%]), proliferation of atypical keratinocytes (16 [80%]) combined with BCC\' ones as bright tumor islands (12 [57.8%]), and cleft-like dark spaces (11 [53.4%]).
CONCLUSIONS: Our study reflects the largest cohort of BSCs from a single institution. We described an incidence rate of 4.7%, higher than reported in the Literature, with the involvement of patients ≥50years in almost 96% of cases and an overall male predominance. At clinical examination, BSC was described as a hyperkeratotic macule with undefined clinical margins with one or more dermoscopic SCC\' features, whereas the presence of typical BCC aspects was observed in less than 10% of cases, differently from what was previously reported. At RCM analysis, BSCs presented with an atypical honeycomb pattern with proliferation of atypical keratinocytes, hyperkeratosis, and in nearly 55% of patients, bright tumor islands with cleft-like dark spaces.
CONCLUSIONS: The distinctive dermoscopic patterns, along with the RCM features aid in the differentiation of BSCs from other NMSCs.