Abstract
With exponentially increasing numbers of basal cell carcinoma (BCC) of the head and neck region, also the locally advanced BCCs are increasing in number. These tumours are associated with aggressive biological behaviour with invasion of soft tissues, organs or bone and present with wide variation in management strategies. The objectives of the study was to describe the biological behaviour of aggressive BCCs and their clinical presentation in the head and neck region with a series of cases treated in our tertiary hospital, discuss management plans of such complex cases in terms of surgical planning and reconstruction. A series of five cases of aggressive BCC in the head and neck region with involvement of organs such as nose, orbit, temporal bone, facial nerve, paranasal sinuses and mandible was studied. Locally advanced, aggressive BCC should be evaluated and treated as head and neck tumours. Multidisciplinary team (MDT) discussion is advisable wherein the strategies on surgical excision, reconstruction options, facial nerve rehabilitation, indications for prosthesis and further adjuvant treatment such as radiotherapy and chemotherapy are carefully planned.
Similar content being viewed by others
References
Wu S, Han J, Li WQ, Li T, Quereshi AA (2013) Basal cell carcinoma incidence and associated risk factors in US women and men. A J Epidemiol 178(6):890–897
Bath-Hextall F, Leonardi-Bee J, Smith C, Meal A, Hubbard R (2007) Trends in incidence of skin basal cell carcinoma. Additional evidence from a UK primary care database study. Int J Cancer 121:2105–2108
Miller DL, Weinstock MA (1994) Nonmelanoma skin cancer in the United States: incidence. J Am Acad Dermatol 30:774–778
Walling HW, Fosko SW, Geraminejad PA, Whitaker DC, Arpey CJ (2004) Aggressive basal cell carcinoma: presentation, pathogenesis and management. Cancer Metastasis Rev 23:389–402
Telfer NR, Colver GB, Morton CA (2008) Guidelines for the management of basal cell carcinoma. Br J Dermatal 159:35–48
Randle H (1996) Basal cell carcinoma: identification and treatment of the high risk patient. Dermatol Surg 22:255–261
Jacobs GH, Rippey JJ, Altini M (1982) Prediction of aggressive behaviour in basal cell carcinoma. Cancer 42:533–537
Vico P, Fourez T, Nemec E, Andry G, Deraemaecker R (1995) Aggressive basal cell carcinoma of head and neck areas. Eur J Surg Oncol 21:490–497
Boonchai W, Walsh M, Cummings M, Chenevix-Trench G (2000) Expression of p53 in arsenic-related and sporadic basal cell carcinoma. Arch Dermatol 136:195–198
Robarge KD, Brunton SA, Castanedo GM (2009) GDC-0449—a potent inhibitor of the Hedgehog pathway. Bioorg Med Chem Lett 60:137–143
Tsukifuji R, Sakai Y, Hatamochi A, Shinkai H (1997) Gene expression of matrix metalloproteinase-1 (interstitial collagenase) and matrix metalloproteinase-3 (stromelysin-1) in basal cell carcinoma in in situ hybridization using chondroitin ABC lyase. Histology 29:401–407
Christian M, Moy RL, Wagner RF, Yen-Moore A (2001) A correlation of alpha-smooth muscle actin and invasion in micronodular basal cell carcinoma. Dermatol Surg 27:441–445
Ciurea ME, Cernea D, Georgescu CC, Cotoi OS, Patrascu V, Parvanescu H et al (2013) Expression of CXCR4, MMP-13 and beta-catenin in different histological subtypes of facial basal cell carcinoma. Romanian J Morphol Embryol (Revue Roum Morphol Embryol) 54:939–951
Edge SB, Byrd DR, Compton CC et al (eds) (2010) AJCC—cutaneous squamous cell carcinoma and other cutaneous carcinomas. AJCC cancer staging manual, 7th edn. Springer, New York, pp 301–314
Farley RL, Manolidis S, Ratner D (2006) Aggressive basal cell carcinoma with invasion of the parotid gland, facial nerve and temporal bone. Dermatol Surg 32:307–315
Brown C, Perry AE (2000) Incidence of perineural invasion in histologically aggressive types of basal cell carcinoma. Am J Dermatopathol 22:123–125
Hanke CW, Wolf RL, Hochman SA, O’Brian JJ (1983) Chemosurgical reports: perineural spread of basal cell carcinoma. J Dermatol Surg Oncol 9:742–747
Dreier J, Cheng PF, Alleman IB, Gugger A, Hafner J, Tschopp A, Goldinger SM, Levesque MP, Dummer R (2014) Basal cell carcinomas in a tertiary referral centre: a systematic analysis. Br J Dermatol 171:1066–1072
Van den Brekel MWM, Castelijns JA, Stel HV et al (1991) Occult metastatic neck disease: detection with US and US-guided fine needle aspiration cytology. Radiology 178:457–461
Chang ALS, Solomon JA, Hainsworth JD et al (2014) Expanded access study of patients with advanced basal cell carcinoma treated with the Hedgehog pathway inhibitor, vismodegib. J Am Acad Dermatol 70:60–69
Orouji A, Goerdt S, Utikal J et al (2014) Multiple highly and moderately differentiated squamous cell carcinomas of the skin during vismodegib treatment of inoperable basal cell carcinoma. Br J Dermatol 171:431–433
Tavin E, Persky MS, Jacobs J (1995) Metastatic basal cell carcinoma of the head and neck. Laryngoscope 105:814–817
Snow S, Saul WJ, Lo J, Mohs FE, Warner T, Dekkingo JA, Feyzi J (1994) Metastatic basal cell carcinoma: report of 5 cases. Cancer 73:328–335
Levy RM, Hanke CW (2010) Mohs micrographic surgery: facts and controversies. Clin Dermatol 28:269–274
Miller P, Roenigk RK, Brodland DG, Randle HW (1992) Cutaneous micrographic surgery: Moh’s procedure. Mayo Clin Proc 67:971–980
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This article did not require any funding.
Disclosure of potential conflicts of interest
All the authors declare that he/she has no conflict of interest.
Research involving human participants and/or animals
This article does not contain any studies with human participants or animals performed by any of the authors.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
All the patients have given written consent to use their photographs for this article.
Rights and permissions
About this article
Cite this article
Lohuis, P.J.F.M., Joshi, A., Borggreven, P.A. et al. Aggressive basal cell carcinoma of the head and neck: challenges in surgical management. Eur Arch Otorhinolaryngol 273, 3881–3889 (2016). https://doi.org/10.1007/s00405-016-4039-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-016-4039-9