Basal cell carcinoma and malignant melanoma cutaneous collision tumor.
A 67-year-old man presented to his primary care physician with an ill-defined, variegated plaque on the right dorsal forearm. A biopsy was performed and microscopic examination demonstrated a pigmented basal cell carcinoma. The patient underwent wide excision, yielding a 4.0 x 1.2 x 0.6 cm tissue sample with negative margins. Histologically, nests of basaloid tumor cells were seen with peripheral palisading and focal architectural clefting between the tumor cells and adjacent fibromyxoid stroma. In addition, colonizing the basal cell carcinoma, there was an in situ melanoma composed of large, variably sized nests and single melanocytes. There was also an associated invasive component of melanoma composed of similarly atypical melanocytes (Figures 1a--1c). Immunohistochemical stains for S-100 protein, MART-1, and SOX10 highlighted the melanoma (Figure 1d). Immunohistochemical stains for high-molecular-weight cytokeratin and Ber-EP4 highlighted the basal cell carcinoma. The patient had a negative sentinel lymph node biopsy and has remained free of recurrence for 18 months.
The etiology of the collision between basal cell carcinoma and melanoma remains unknown. Some authors believe that this is a coincidental event, whereas others suspect a field cancerization effect of sun-damaged skin. (1,5) Mancebo et al reported a case in which basal cell carcinoma was thought to be the conduit for the extension of the malignant melanoma cells. (6) These authors also theorized that the increase in cytokines and growth factors secreted from the basal cell carcinoma provides the ideal environment for unchecked melanocytic proliferation. (6) According to Burkhalter and White, the basal cell carcinoma provides the vessel for extension of atypical melanocytes, though this would not be considered true invasion. (7) There have, however, been reports of true invasive melanoma outside of the confines of the coexistent basal cell carcinoma. (8)
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(8.) Belisle A, Gautier M-S, Ghozali F, Plantier F, Wechsler J. A collision tumor involving basal cell carcinoma and lentigo maligna melanoma. Am J Dermatopathol. 2005; 27:319-321. doi:10.1097/01.dad.0000164603. 49026.6a. PMID: 16121053.
Reid Green, MD (a), Meghan Woody, MD, MPH (b), Anthony C. Soldano, MD (a), and Erin Madden, BS (c)
(a) Department of Dermatology, University of Texas at Austin, Austin, Texas; (b) Department of Dermatology, Oregon Health and Science University, Portland, Oregon; department of Nursing, University of San Francisco School of Nursing, San Francisco, California
Corresponding author: Meghan Woody, MD, MPH, Department of Dermatology, Oregon Health and Science University, 3303 SW Bond Avenue, Portland, OR 97239 (e-mail: firstname.lastname@example.org)
Received January 11,2018; Revised February 13,2018; Accepted February 20,2018.
Caption: Figure 1. (a) Low-power (x10) and (b, c) mid-power (x20) hematoxylin and eosin stains showing basal cell carcinoma (black arrows) and melanoma (blue arrow). (d) Positive MART-1 staining within melanoma and absence of staining in basal cell carcinoma.
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|Author:||Green, Reid; Woody, Meghan; Soldano, Anthony C.; Madden, Erin|
|Publication:||Baylor University Medical Center Proceedings|
|Article Type:||Clinical report|
|Date:||Jul 1, 2018|
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