Tchernev Georgi, Patterson James W, Lotti Torello, Gianfaldoni Serena, Lotti Jacopo, França Katlein, Batashki Atanas, Wollina Uwe
Medical Institute of Ministry of Interior (MVR), Department of Dermatology and Dermatologic Surgery, General Skobelev 79, 1606 Sofia, Bulgaria; Onkoderma - Policlinic for Dermatology, Venereology and Dermatologic Surgery, 26 General Skobelev blvd., Sofia, Bulgaria.
Department of Pathology, University of Virginia Health System, 1215 Lee Street, Box 800214, Charlottesville, VA 22908, USA.
Open Access Maced J Med Sci. 2017 Jul 25;5(4):564-565. doi: 10.3889/oamjms.2017.145.
We present a 68-year-old patient with multiple primary infiltrative BCCs in the scalp area, initially treated 14 years ago with superficial contact X-ray therapy, end dose 60 greys, followed by electrocautery (x2) several years later. He presented in the dermatologic policlinic for diagnosis and therapy of two additional, newly-formed pigmented lesions, and because of an uncomfortable, itchy, burning sensation in the area where lesions had been treated years before. Screening cranial computer-tomography (CT) examination revealed two deformities in the form of tumor-mediated osteolysis, affecting the diploe of the tabula externa on the left parietal and parasagittal areas. Complete excision with removal of periosteum and partial removal of the tabula externa was planned with neurosurgeons at a later stage. BCC is one of the most common malignant skin tumours of the head and neck region (about 90% of cases) and is characterised by a significant potential for local infiltration and destructive growth. Recurrent, invasive BCC of the scalp and calvarium is a difficult problem for which universally accepted treatment protocols had not been established. The primary treatment of aggressive BCCs is surgical, with a thorough examination of excision margins to ensure complete resection. Procedural-based options include standard excision, curettage, curettage with electrodessication, and Mohs micrographic surgery (MMS), with MMS being the gold standard for the definitive treatment of BCC. Improper removal or electrocautery (as in our case) of the several aggressive forms of BCC seems to be a particular problem, and not only for dermatologic surgeons. The risk of subsequent invasion and destruction of the cranium, underlying dura, and cranial nerves by basal cell carcinoma (BCC) is extremely low, with an estimated incidence of 0.03%, but is a potential complication over time. Computed tomography is the modality of choice for detecting tumour invasion into bone, which commonly appears as irregular demineralization or osteolysis.
我们报告一名68岁患者，头皮区域有多个原发性浸润性基底细胞癌（BCC），14年前最初接受浅表接触X线治疗，最终剂量为60格雷，几年后又进行了两次电灼治疗。他因另外两个新出现的色素沉着病变到皮肤科门诊进行诊断和治疗，同时也因为多年前治疗病变的区域出现了不适、瘙痒和烧灼感。头颅计算机断层扫描（CT）检查发现有两个呈肿瘤介导性骨质溶解形式的畸形，累及左顶叶和矢状旁区域的外板板障。随后计划由神经外科医生进行完整切除，包括去除骨膜和部分切除外板。BCC是头颈部最常见的恶性皮肤肿瘤之一（约90%的病例），其特点是具有显著的局部浸润和破坏性生长潜力。头皮和颅骨复发性浸润性BCC是一个难题，尚未建立普遍接受的治疗方案。侵袭性BCC的主要治疗方法是手术，要彻底检查切除边缘以确保完全切除。基于手术步骤的选择包括标准切除、刮除术、刮除术联合电干燥法以及莫氏显微外科手术（MMS），其中MMS是BCC确定性治疗的金标准。几种侵袭性BCC的切除不当或电灼治疗（如我们的病例）似乎是一个特殊问题，不仅对皮肤科外科医生而言。基底细胞癌（BCC）随后侵犯和破坏颅骨、硬脑膜和颅神经的风险极低，估计发生率为0.03%，但随着时间推移是一种潜在并发症。计算机断层扫描是检测肿瘤侵犯骨骼的首选方式，骨骼侵犯通常表现为不规则脱矿或骨质溶解。
