ARTICLE
Diagnosis
The following laboratory parameters came up with pathological findings:
Hb 3.9 mg/dl, Fe 13 (mug/dl, BKS 87 mm. Following the transfusion of
four erythrocyte concentrates the Hb increased to 8.5 mg/dl with marked
improvement of skin coloring. Moreover, the quick disappearance of dyspnoe
was noted due to exertion.
Resection of the tumor included thoracic and abdominal wall as well
as partial diaphragm resection. Plastic reconstruction of soft tissue
and bone destruction was done with omental transposition. Following wound
granulation the defect was covered with meshgraft (Fig.
4).
The histological work up of the specimen revealed an infiltrative metatypical
basal cell carcinoma with morphea-like portions. Both lateral portions
of the sagittal section showed no evidence of tumor, however, the bottom
portion of the section still revealed tumor tissue. Therefore, following
healing of the wound, radiotherapy with 6 MeV- Photons was scheduled.
A total dose of 56 Gy with fractions of 2 Gy was delivered. Twelve months
after therapy there was no evidence of metastases.
Comments
The case presented shows the infiltrative and destructive growth potential
of a metatypical basal cell carcinoma in its most extreme form. The nosological
classification of a metatypical basal cell carcinoma marking the borders
to a squamous cell carcinoma often poses difficulties. Mostly depending
on the emphasis put on one or the other direction of classification skin
biopsies may lead to faulty diagnoses. In our particular case after the
histology it was the biological behaviour of the tumor which led to the
conclusion of a metatypical basal cell carcinoma which appropriated a
typical ulcus terebrans.
The patient did at no point show any evidence of metastases over a 15
year time period.
Following this diagnosis a curative therapy can still be considered.
This also justified the surgical risks following the procedure of two
body cavity surgery. The case presented also shows successful interdisciplinary
cooperation.
Article accepted on 20/1/00.
REFERENCES
1. Drake LA, Ceilley RI, Cornelison RL. Guidelines of care for
basal cell carcinoma. J Am Acad Dermatol 1992; 26: 117-20.
2. Jacobs GH, Rippey JJ, Altini M. Prediction on aggressive behavior
in basal cell carcinomas. Cancer 1982; 49: 533-7.
3. Schütte B, Schirren C. Basaliom mit lymphogener und hämatogener
Metastasierung (u. a. auch ins Myokard). Arch Dermatol Res 1981;
270: 299-312.
4. Wehner-Caroli J, Breuninger H, Eckhardt-Keller M, Rassner
G. Augedehntes Ulcus terebrans (Typ: solides Basalzellkarzinom). Hautarzt
1997; 48: 926-8.
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