Division of Dermatologic Surgery, Department of Dermatology, Stanford University Medical Center, Redwood City, California, USA.
Dermatol Surg. 2012 Aug;38(8):1346-50. doi: 10.1111/j.1524-4725.2012.02416.x. Epub 2012 May 2.
Identifying histopathologic subtypes of basal cell carcinoma (BCC) associated with an aggressive clinical course helps the surgeon to anticipate the size of the postexcision defect and complexity of repair. During Mohs micrographic surgery (MMS), we have observed that BCC with adamantinoid histopathologic features tend to be clinically more aggressive.
To characterize the subtype of BCC with adamantinoid histopathologic features and determine whether it is clinically more aggressive than other BCCs.
A chart review was conducted of consecutive cases of MMS performed at Stanford University Medical Center for BCC from June 2002 through March 2004. Cases had been prospectively categorized as adamantinoid BCC if they met histopathologic criteria, including uniform clear areas around the individual tumor cells within tumor islands. We retrospectively compared adamantinoid and control cases in terms of patient age, sex, tumor location, number of Mohs stages required, area of post-Mohs defect, and type of repair.
Four hundred eighty-nine cases of MMS for BCC were reviewed. Forty-four (9%) were adamantinoid BCC. Patients with adamantinoid BCC did not differ statistically from the control group in terms of sex (23% vs 32% female, p = .20) but tended to be older (median age 73 vs 66, p = .04; mean age 70 vs 65 years, p = .05). The distribution of cases on the head and neck differed significantly between the adamantinoid and control groups (p = .02), with more adamantinoid cases located on the nose and ears. Adamantinoid BCC required more stages for clear histologic margins (median 3.00 vs 2.00, p < .001; mean 3.68 vs 2.34, p < .001) and had larger post-Mohs defects (median 3.00 vs 1.68 cm(2) , p < .001; mean 4.24 vs 2.78 cm(2) , p = .02). Only 4.5% of adamantinoid BCC cases were able to heal by second intention, with 20.4% requiring complex primary closure. Staged flaps were performed in 13.6% of individuals with adamantinoid BCC.
Adamantinoid BCC is an aggressive histopathologic subtype in terms of number of stages for clear margins and size of post-Mohs defect. It may also require more-complex repairs. Recognition of this aggressive variant may benefit future patients by facilitating prediction of the clinical extent of tumors.
识别与侵袭性临床病程相关的基底细胞癌（BCC）的组织病理学亚型有助于外科医生预测切除后的缺陷大小和修复的复杂性。在Mohs 显微外科手术（MMS）期间，我们观察到具有造釉细胞瘤样组织病理学特征的 BCC 往往具有更具侵袭性的临床特征。
描述具有造釉细胞瘤样组织病理学特征的 BCC 亚型，并确定其是否比其他 BCC 更具侵袭性。
对 2002 年 6 月至 2004 年 3 月期间斯坦福大学医疗中心连续进行的 MMS 治疗 BCC 的病例进行了图表回顾。如果病例符合组织病理学标准，包括肿瘤岛内单个肿瘤细胞周围有均匀的透明区域，则将其前瞻性地归类为造釉细胞瘤样 BCC。我们回顾性地比较了造釉细胞瘤样和对照组病例在患者年龄、性别、肿瘤位置、MMS 所需阶段数、Mohs 后缺陷面积和修复类型方面的差异。
对 489 例 MMS 治疗 BCC 的病例进行了回顾。44 例（9%）为造釉细胞瘤样 BCC。在性别方面，造釉细胞瘤样 BCC 组与对照组无统计学差异（23%与 32%女性，p=0.20），但年龄较大（中位年龄 73 岁与 66 岁，p=0.04；平均年龄 70 岁与 65 岁，p=0.05）。造釉细胞瘤样 BCC 组和对照组病例在头颈部的分布有显著差异（p=0.02），更多的造釉细胞瘤样 BCC 位于鼻子和耳朵上。造釉细胞瘤样 BCC 为获得明确的组织学边界需要更多的阶段（中位数 3.00 与 2.00，p<0.001；平均值 3.68 与 2.34，p<0.001），并且 Mohs 后缺陷更大（中位数 3.00 与 1.68cm2，p<0.001；平均值 4.24 与 2.78cm2，p=0.02）。只有 4.5%的造釉细胞瘤样 BCC 病例能够通过二期愈合，20.4%需要复杂的一期闭合。在 13.6%的造釉细胞瘤样 BCC 患者中进行了分期皮瓣。
在明确的边缘和 Mohs 后缺陷的大小方面，造釉细胞瘤样 BCC 是一种侵袭性的组织病理学亚型。它可能还需要更复杂的修复。识别这种侵袭性变体可能通过促进对肿瘤临床范围的预测，使未来的患者受益。
