Prediction of aggressive behavior in basal cell carcinoma.

In this study, a series of aggressively behaving basal cell carcinomas has been contrasted with a series of the nonaggressive type (metastasizing lesions were not considered in this study). Aggressive tumors were characteristically more likely to be ulcerative and infiltrative. They were composed of small groups of cells often displaying an irregular spiky appearance; infiltration of cells in cords, only one or two cells thick, could be seen. There was loss of peripheral palisading: the cells tended not to show differentiation. Hyalinization of the stroma was more common in the aggressive tumors. It is postulated that by utilizing these criteria, the pathologist can confidently diagnose the majority of cases and forewarn the clinician that a particular tumor is potentially aggressive. Adequate treatment and careful follow-up then become feasible.