Swetter S M, Yaghmai D, Egbert B M
Veterans Affairs Palo Alto Health Care System, Stanford, California, USA.
J Cutan Pathol. 1998 Sep;25(8):420-5. doi: 10.1111/j.1600-0560.1998.tb01768.x.
Over 200 basal cell carcinomas (BCCs) are biopsied and subsequently excised each year at the Veterans Affairs Palo Alto Health Care System (VAPAHCS). A focal infiltrative pattern developed in the region of the biopsy scar in the re-excision specimens of 20 cases out of approximately 400 BCCs (< 5%) examined histopathologically over a 2-year period. The patient population included predominantly male, elderly Caucasians (mean age 71), and all tumors fulfilled clinical and histologic criteria for nodular BCC at the time of initial punch or shave biopsy. No patient showed recurrence of tumor following simple re-excision with 2-3 mm surgical margins, with a mean follow up of 25.4 months after excisional surgery. These neoplasms had a more benign clinical course, possibly related to scar formation in healing sites of previously biopsied nodular BCC, rather than true aggressive-growth BCC. The authors conclude that a focal infiltrative pattern in a re-excision specimen may occur histologically as a scar-induced pattern which mimics an aggressive-growth BCC, but does not appear to have the same prognosis. We believe this is an important histologic observation, as recognition of biopsy scar changes in an excisional specimen of BCC may help to distinguish it from true aggressive-growth BCC.
每年在退伍军人事务部帕洛阿尔托医疗保健系统（VAPAHCS），有超过200例基底细胞癌（BCC）接受活检，随后被切除。在两年的时间里，对大约400例BCC（<5%）进行组织病理学检查，其中20例再次切除标本的活检瘢痕区域出现了局灶浸润性模式。患者群体主要为老年白人男性（平均年龄71岁），所有肿瘤在初次打孔或刮除活检时均符合结节性BCC的临床和组织学标准。在采用2 - 3毫米手术切缘进行简单再次切除后，没有患者出现肿瘤复发，切除术后平均随访25.4个月。这些肿瘤具有更良性的临床病程，可能与先前活检的结节性BCC愈合部位的瘢痕形成有关，而非真正的侵袭性生长BCC。作者得出结论，再次切除标本中的局灶浸润性模式在组织学上可能是一种瘢痕诱导模式，它模仿侵袭性生长的BCC，但似乎没有相同的预后。我们认为这是一项重要的组织学观察结果，因为在BCC切除标本中识别活检瘢痕变化可能有助于将其与真正的侵袭性生长BCC区分开来。
