Morpheic Basal Cell Carcinoma: Transformation Or Original Pathology?

摘要

Morpheic basal cell carcinomas (BCC) are considered aggressive and difficult to control. Can prior treatment of a regular BCC initiate its change to a morpheic pattern? 36 patients with diagnosed morpheic BCC were selected. Details of previous surgery and histologic diagnosis were recorded. Out of the 36 patients only 11 had morpheic BCC without previous treatment. Of the 21 who had had prior treatment, 9 had previous histological results available, of which only 1 had an original diagnosis of morpheic BCC. The study prompts the following questions:1.After treatment can a BCC transform into a more aggressive morpheic type?2. Can a background of fibrosis such as that produced by freezing, curetting or that seen with chronic wounds initiate a change in the character of the basal cell to the morpheic form to allow its survival in the scar tissue? Presented at the Annual Meeting of The Association of Plastic And Reconstructive Surgeons of Southern Africa, Sun City, South Africa, October 2001. Introduction Morpheic or primary sclerosing basal cell carcinomas (BCC) appear as flat, firm, atrophic, rubbery tan or yellowish tumors characteristically present beneath the skin surface with actual margins usually wider than they appear clinically. They tend to spread laterally and superficially with little dermal penetration. Induration is almost always present with ulceration being very rare. Under the microscope, the neoplasm is seen as thin elongated cords of cells with sharp angulated ends. Traditionally they are considered more aggressive and difficult to control, with this consistent pattern of growth. This makes complete excision more difficult and consequently recurrences are more common (1,2). Very little information is available in world literature relating to the specifics of this variation of BCC. Does the morpheaform pattern evolve from an initial non specific BCC, is it present abinitio, or do both forms exist? Can prior treatment of a regular BCC initiate its change to a morpheic pattern in some cases? Materials And Methods The aim of the study was to determine the percentage of patients diagnosed with morpheic BCCs who had prior treatment of these same lesions. Available histology of the originally treated BCCs was reviewed and the modality of treatment used for removal of the initial lesion was noted. More specifically, the aim of the study was to question if morpheaform changes may have taken place in certain BCCs following treatment, altering the original pathology. Thirty six patients with diagnosed morpheic BCC were selected from the records of a private pathology group. Details were sought regarding previous surgery of the lesions, histologic diagnosis and method of treatment. Results were then be analysed as follows: Age, sex, of patient and site of lesion Percentage of morpheic BCCs with previous surgery at the site of the same lesion Initial treatment/management of the lesion Initial histologic diagnosis where available Efficacy of treatment of morpheic BCC (%recurrent lesions) Results This series showed an increased incidence of morpheic BCC with increasing age. (Table 1) This is in keeping with previous studies(3). Morpheic BCC,s were found to be twice as common in females with a strong predilection for the nose (Table 2.) This differs from reports relating to common basal cell carcinomas (4).