Basal cell carcinoma sclerodermiformes C44.L

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

desmoplastic basal cell carcinoma; fibrosing basal cell carcinoma; fibrotic basal cell carcinoma; Keloid basal cell carcinoma; Micronodular basal cell carcinoma; morpheaform basal cell carcinoma; morpheiform basal cell carcinoma; scar-like basal cell carcinoma; sclerosing basal cell carcinoma

Definition
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Special variant of basal cell carcinoma with formation of a strong, connective tissue tumour stromas and clinically "scar-like" aspect.

Localization
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Especially nose, forehead, cheeks.

Clinical features
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Largely at skin level, waxy or ivory-coloured, only vaguely distinguishable from the surroundings, rough, shiny infiltrate plate with telangiectasia. Edge accentuation in the form of a nodule seam may be present, but is often missing.

Histology
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In most cases, a blurred epithelial tumor consisting of disordered, narrow, sometimes only 2-3 cell layers thick, mostly branched basaloid epithelial strands. The typical palisade position is almost always missing. The epithelial strands are embedded in a compact, fibrous, connective tissue stroma (cirrhotic aspect). The relation to the surface epithelium is often only detectable in serial sections.

Diagnosis
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Clinic, demarcation before surgery using reflected light microscopy and high-frequency 20 MHz sonography.

Differential diagnosis
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Scar (important differential diagnosis, palpation findings different, usually not increased in consistency).

Elastosis actinica (important differential diagnosis)

benign adnexal tumors

microcystic adnexal carcinoma (rare).

Therapy
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S.u. Basal cell carcinoma. Due to the high recurrence rates, excision must be performed by means of microscopically controlled surgery in specialised centres.

Progression/forecast
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Higher risk of recurrence than with the other basal cell carcinoma types.

Literature
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  1. Eklind J et al (2003) Imiquimod to treat different cancers of the epidermis. Dermatol Surge 29: 890-896
  2. Lodde JP et al (1998) Sclerodermiform basal cell carcinoma. Speaking of a study of 83 cases. Ann Chir Plast Esthet 43: 373-382
  3. Monroe JR (2012) A facial lesion concerns an at-risk patient. Sclerosing basal cell carcinoma
    . JAAPA 25:16

  4. Sellheyer K et al (2013) The immunohistochemical differential
    diagnosis of microcystic adnexal carcinoma, desmoplastictrichoepithelioma
    and morpheaform basal cell carcinoma using BerEP4 and stem cellmarkers
    . J Cutan catheter 40:363-370

  5. Wortsman X et al (2014) Ultrasound as predictor of histologic subtypes linked
    torecurrence in basal cell carcinoma of the skin. J Eur Acad Dermatol Venereol doi: 10.1111/jdv.12660.

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Last updated on: 29.10.2020