not all basal cell carcinomas are created equal: a case of a fatal bcc

1
P6381 Mohs micrographic surgery is associated with a lower recurrence rate in patients with sebaceous carcinoma: An update of the Mayo Clinic expe- rience over the past 2 decades Jennifer Hou, Mayo Clinic College of Medicine, Rochester, MN, United States; Jerry Brewer, MD, Mayo Clinic Division of Dermatologic Surgery, Department of Dermatology, Rochester, MN, United States; Jill Killian, Mayo Clinic Division of Biostatistics, Rochester, MN, United States Background: Sebaceous carcinoma (SC) is a rare cutaneous neoplasm that arises from the adnexal epithelium of sebaceous glands. Early diagnosis and treatment are important because of aggressive local behavior and possible metastasis. Objective: To characterize the incidence and recurrence, metastatic, and mortality rates of sebaceous carcinoma and to examine treatment options and outcomes. Methods: A retrospective chart review was conducted of patients with sebaceous carcinoma treated at the Mayo Clinic (Rochester, MN) between the years of 1992- 2012. Results: A total of 46 patients with sebaceous carcinoma were identified. Of these patients, 34 (73.9%) were men and 12 (26.1%) were women. The mean age at diagnosis was 72.7 years (SD of 11.1 years). The mean age of diagnosis for women was slightly higher than that for men (73.2 compared to 72.5 years). The most common locations for sebaceous carcinoma were the back (19.6%), nose (15.2%), cheek (13.0%), eye (10.9%), and the scalp (8.7%) and forehead (8.7%). Mean length of Mayo follow-up was 2.5 years. Of the 44 patients whose treatment was known, 26 patients (59.1%) underwent Mohs micrographic surgery (MMS), 11 patients (25.0%) wide local excision (WLE), 6 patients (13.6%) biopsy only, and 1 patient (2.3%) no treatment. A total of 7 patients (16.3%) had one recurrence during the follow-up period, and 3 (7%) had two or more recurrences. Of the patients experiencing one recurrence, one also had a metastasis. Patients treated with MMS had better outcomes when compared to those treated with WLE with 1, 3, and 4 year recurrence-free survivals of 87.8% versus 67.3%, 87.8% versus 44.9%, and 58.6% versus 44.9%, respectively (P ¼.037). Conclusion: SC can occur on many locations including the eyelid. Mohs micro- graphic surgery demonstrates a higher cure rate with an associated higher recurrence-free survival when compared to WLE. The limitations of this study include its retrospective nature and small numbers of patients. In addition, a referral bias may play a role in studying only patients referred to a major academic center. Further research and prospective study of larger and more ethnically diverse cohorts of patients is needed to more fully understand the characteristics of SC. Commercial support: None identified. P6026 Not all basal cell carcinomas are created equal: A case of a fatal BCC Todd Mollet, MD, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Carlos Garcia, MD, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Marcus Smith, MD, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Rachel Clapper, MD, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Valerie Truong, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States Basal cell carcinoma is one of the most common malignancies in the world. It is usually a low-grade malignancy but may invade deeper structures and metastasize in \0.1% of cases. Giant basal cell carcinoma is a rare, much more aggressive subtype [5 cm in diameter. In this poster, the authors present a case of a neglected giant basal cell carcinoma that resulted in death, and provide a brief update on the literature. Commercial support: None identified. P6488 Phakomatosis pigmentokeratotica associated with multiple basal cell carcinomas Dong-Woo Suh, MD, Kyunghee University Hospital at Gangdong, Seoul, South Korea; Bark-Lynn Lew, MD, PhD, Kyunghee University hospital at Gangdong, Seoul, South Korea; Woo-Young Sim, MD, PhD, KyungHee University Hospital at Gangdong, Seoul, South Korea Phacomatosis pigmentokeratotica (PPK) is a recently identified disease character- ized by the coexistence of an organoid nevus with sebaceous differentiation arranged along the lines of Blaschko and a speckled lentiginous nevus showing a checkerboard pattern, mostly in association with various extracutaneous defects. A 52-year-old Korean man presented with asymptomatic ulcerative plaque on left cheek. Skin examination showed 2- 3 2-cm fleshy colored ulceration with light yellowish verrucous papules just beside the ulceration. Numerous various sized light brown colored and black maculopapules were also located on left side of chest wall, back and arm. Histopathologic examination of biopsy from ulceration on cheek revealed basal cell carcinoma with nevus sebaceous. Biopsy specimens from papules on trunk confirmed the diagnosis of basal cell carcinoma and melanocytic nevus with nevus sebaceous. Herein, we report a rare interesting case that multiple basal cell carcinomas developed from nevus sebaceous on PPK patient. Commercial support: None identified. P6969 Pharmacodynamics of ingenol mebutate 0.05% gel for the treatment of actinic keratosis assessed by histology Emmert Steffen, DMD, MD, Georg August University, Gottingen, Germany; Hans Peter Bertsch, DMD, MD, Georg August University, Gottingen, Germany; Holger A. Haenssle, PhD, MD, Georg August University, Gottingen, Germany; John R. Zibert, PhD, LEO Pharma A/S, Ballerup, Denmark; Margarete Schon, DDSc, Georg August University, Gottingen, Germany; Michael P. Schon, DMD, MD, Georg August University, Gottingen, Germany Ingenol mebutate gel (IngMeb) is a novel topical treatment for actinic keratosis (AK) with short treatment duration. In studies with tumor bearing mice, topical application of IngMeb resulted in cell death and an immune response characterized by infiltration of neutrophils and other immune cells. The aim of this study was to investigate the pharmacodynamics of IngMeb gel in paired 25 cm 2 areas with AK- containing or sun-protected normal skin (NS). Twenty-seven patients with 2 to 5 typical AK lesions within a 25 cm 2 area on the forearm, and a 25 cm 2 area of NS on the inner upper arm suitable for biopsy were included. IngMeb 0.05% gel was applied to the treatment areas once daily on 2 consecutive days. A total of 5 biopsies per patient were obtained from one AK lesion outside the forearm treatment area at day 0 (baseline), two AK lesions within this area at days 2 (during) and 3 (after treatment), and from NS outside the upper arm treatment area at day 0 (baseline) and day 3 (after treatment). The primary outcome measures were degree of leukocyte infiltration and necrosis in the biopsies. The secondary outcome measures were skin infiltration with erythrocytes, the RNA expression profile, and markers for inflammation, apoptosis, and endothelium activation. Data from the first 8 patients (all male, Fitzpatrick skin type II, mean age 72.9 years, mean duration of AK 4.1 years) showed that IngMeb gel induced epidermal cell death (necrosis and apoptosis) in both NS and AK. A strong inflammatory response was also observed in both NS and AK lesions, including heavy infiltration of T cells (in particular CD4 + T cells in the papillary dermis), neutrophils (abundant in intraepidermal pustules), and ICAM-1 expression on vascular endothelium of NS. Discrete extravasated erythrocytes were observed in the dermis of some of the normal skin samples and in all of the AK lesions after treatment. In addition, IngMeb gel had an effect on the expression of numerous genes, both in NS and in AK lesions. The functional annotation of the common differentially expressed genes revealed inflammatory responses and response to wounding. In treated AK lesions compared with baseline, genes involved in epidermal development were down-regulated. In conclusion, IngMeb 0.05% gel in AK lesions and NS induced epidermal cell death and an immune reaction. Supported 100% by LEO Pharma A/S. APRIL 2013 JAM ACAD DERMATOL AB163

Upload: vantuong

Post on 01-Jan-2017

216 views

Category:

Documents


2 download

TRANSCRIPT

Page 1: Not all basal cell carcinomas are created equal: A case of a fatal BCC

P6381Mohs micrographic surgery is associated with a lower recurrence rate inpatients with sebaceous carcinoma: An update of the Mayo Clinic expe-rience over the past 2 decades

Jennifer Hou, Mayo Clinic College of Medicine, Rochester, MN, United States;Jerry Brewer, MD, Mayo Clinic Division of Dermatologic Surgery, Department ofDermatology, Rochester, MN, United States; Jill Killian, Mayo Clinic Division ofBiostatistics, Rochester, MN, United States

Background: Sebaceous carcinoma (SC) is a rare cutaneous neoplasm that arisesfrom the adnexal epithelium of sebaceous glands. Early diagnosis and treatment areimportant because of aggressive local behavior and possible metastasis.

Objective: To characterize the incidence and recurrence, metastatic, and mortalityrates of sebaceous carcinoma and to examine treatment options and outcomes.

Methods: A retrospective chart review was conducted of patients with sebaceouscarcinoma treated at the Mayo Clinic (Rochester, MN) between the years of 1992-2012.

Results: A total of 46 patients with sebaceous carcinoma were identified. Of thesepatients, 34 (73.9%) were men and 12 (26.1%) were women. The mean age atdiagnosis was 72.7 years (SD of 11.1 years). The mean age of diagnosis for womenwas slightly higher than that for men (73.2 compared to 72.5 years). The mostcommon locations for sebaceous carcinoma were the back (19.6%), nose (15.2%),cheek (13.0%), eye (10.9%), and the scalp (8.7%) and forehead (8.7%). Mean lengthof Mayo follow-up was 2.5 years. Of the 44 patients whose treatment was known, 26patients (59.1%) underwent Mohs micrographic surgery (MMS), 11 patients (25.0%)wide local excision (WLE), 6 patients (13.6%) biopsy only, and 1 patient (2.3%) notreatment. A total of 7 patients (16.3%) had one recurrence during the follow-upperiod, and 3 (7%) had two or more recurrences. Of the patients experiencing onerecurrence, one also had a metastasis. Patients treated with MMS had betteroutcomes when compared to those treated with WLE with 1, 3, and 4 yearrecurrence-free survivals of 87.8% versus 67.3%, 87.8% versus 44.9%, and 58.6%versus 44.9%, respectively (P ¼ .037).

Conclusion: SC can occur on many locations including the eyelid. Mohs micro-graphic surgery demonstrates a higher cure rate with an associated higherrecurrence-free survival when compared to WLE. The limitations of this studyinclude its retrospective nature and small numbers of patients. In addition, a referralbias may play a role in studying only patients referred to a major academic center.Further research and prospective study of larger andmore ethnically diverse cohortsof patients is needed to more fully understand the characteristics of SC.

APRIL 20

cial support: None identified.

Commer

P6026Not all basal cell carcinomas are created equal: A case of a fatal BCC

Todd Mollet, MD, University of Oklahoma Health Sciences Center, OklahomaCity, OK, United States; Carlos Garcia, MD, University of Oklahoma HealthSciences Center, Oklahoma City, OK, United States; Marcus Smith, MD,University of Oklahoma Health Sciences Center, Oklahoma City, OK, UnitedStates; Rachel Clapper, MD, University of Oklahoma Health Sciences Center,Oklahoma City, OK, United States; Valerie Truong, University of OklahomaHealth Sciences Center, Oklahoma City, OK, United States

Basal cell carcinoma is one of the most common malignancies in the world. It isusually a low-grade malignancy but may invade deeper structures and metastasize in\0.1% of cases. Giant basal cell carcinoma is a rare, much more aggressive subtype[5 cm in diameter. In this poster, the authors present a case of a neglected giantbasal cell carcinoma that resulted in death, and provide a brief update on theliterature.

cial support: None identified.

Commer

13

P6488Phakomatosis pigmentokeratotica associated with multiple basal cellcarcinomas

Dong-Woo Suh, MD, Kyunghee University Hospital at Gangdong, Seoul, SouthKorea; Bark-Lynn Lew, MD, PhD, Kyunghee University hospital at Gangdong,Seoul, South Korea; Woo-Young Sim, MD, PhD, KyungHee University Hospital atGangdong, Seoul, South Korea

Phacomatosis pigmentokeratotica (PPK) is a recently identified disease character-ized by the coexistence of an organoid nevus with sebaceous differentiationarranged along the lines of Blaschko and a speckled lentiginous nevus showing acheckerboard pattern, mostly in association with various extracutaneous defects. A52-year-old Korean man presented with asymptomatic ulcerative plaque on leftcheek. Skin examination showed 2- 3 2-cm fleshy colored ulceration with lightyellowish verrucous papules just beside the ulceration. Numerous various sizedlight brown colored and black maculopapules were also located on left side of chestwall, back and arm. Histopathologic examination of biopsy from ulceration oncheek revealed basal cell carcinoma with nevus sebaceous. Biopsy specimens frompapules on trunk confirmed the diagnosis of basal cell carcinoma and melanocyticnevus with nevus sebaceous. Herein, we report a rare interesting case that multiplebasal cell carcinomas developed from nevus sebaceous on PPK patient.

cial support: None identified.

Commer

P6969Pharmacodynamics of ingenol mebutate 0.05% gel for the treatment ofactinic keratosis assessed by histology

Emmert Steffen, DMD, MD, Georg August University, G€ottingen, Germany; HansPeter Bertsch, DMD, MD, Georg August University, G€ottingen, Germany; HolgerA. Haenssle, PhD, MD, Georg August University, G€ottingen, Germany; John R.Zibert, PhD, LEO Pharma A/S, Ballerup, Denmark; Margarete Sch€on, DDSc, GeorgAugust University, G€ottingen, Germany; Michael P. Sch€on, DMD, MD, GeorgAugust University, G€ottingen, Germany

Ingenol mebutate gel (IngMeb) is a novel topical treatment for actinic keratosis (AK)with short treatment duration. In studies with tumor bearing mice, topicalapplication of IngMeb resulted in cell death and an immune response characterizedby infiltration of neutrophils and other immune cells. The aim of this study was toinvestigate the pharmacodynamics of IngMeb gel in paired 25 cm2 areas with AK-containing or sun-protected normal skin (NS). Twenty-seven patients with 2 to 5typical AK lesions within a 25 cm2 area on the forearm, and a 25 cm2 area of NS onthe inner upper arm suitable for biopsy were included. IngMeb 0.05% gel wasapplied to the treatment areas once daily on 2 consecutive days. A total of 5 biopsiesper patient were obtained from one AK lesion outside the forearm treatment area atday 0 (baseline), two AK lesions within this area at days 2 (during) and 3 (aftertreatment), and from NS outside the upper arm treatment area at day 0 (baseline)and day 3 (after treatment). The primary outcome measures were degree ofleukocyte infiltration and necrosis in the biopsies. The secondary outcomemeasureswere skin infiltrationwith erythrocytes, the RNA expression profile, andmarkers forinflammation, apoptosis, and endothelium activation. Data from the first 8 patients(all male, Fitzpatrick skin type II, mean age 72.9 years, mean duration of AK 4.1years) showed that IngMeb gel induced epidermal cell death (necrosis andapoptosis) in both NS and AK. A strong inflammatory response was also observedin both NS and AK lesions, including heavy infiltration of T cells (in particular CD4+

T cells in the papillary dermis), neutrophils (abundant in intraepidermal pustules),and ICAM-1 expression on vascular endothelium of NS. Discrete extravasatederythrocytes were observed in the dermis of some of the normal skin samples and inall of the AK lesions after treatment. In addition, IngMeb gel had an effect on theexpression of numerous genes, both in NS and in AK lesions. The functionalannotation of the common differentially expressed genes revealed inflammatoryresponses and response towounding. In treated AK lesions comparedwith baseline,genes involved in epidermal development were down-regulated. In conclusion,IngMeb 0.05% gel in AK lesions and NS induced epidermal cell death and an immunereaction.

d 100% by LEO Pharma A/S.

Supporte

J AM ACAD DERMATOL AB163