0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Case Report/Case Series |

Two Different Scenarios of Squamous Cell Carcinoma Within Advanced Basal Cell Carcinomas:  Cases Illustrating the Importance of Serial Biopsy During Vismodegib Usage

Gefei A. Zhu, BS1; Uma Sundram, MD, PhD1,2; Anne Lynn S. Chang, MD1
[+] Author Affiliations
1Department of Dermatology, Stanford University School of Medicine, Redwood City, California
2Department of Pathology, Stanford University School of Medicine, Stanford, California
JAMA Dermatol. 2014;150(9):970-973. doi:10.1001/jamadermatol.2014.583.
Text Size: A A A
Published online

Importance  Vismodegib is a Hedgehog signaling pathway inhibitor recently approved by the US Food and Drug Administration for advanced basal cell carcinoma. We present 2 cases of clinically significant squamous cell carcinoma within the tumor bed of locally advanced basal cell carcinoma found during vismodegib treatment.

Observations  The first case is that of a patient with locally advanced basal cell carcinoma responsive to vismodegib but with an enlarging papule within the tumor bed. On biopsy, this papule was an invasive acantholytic squamous cell carcinoma. The second case is that of a patient with Gorlin syndrome with a locally advanced basal cell carcinoma that was stable while the patient was receiving therapy with vismodegib for 2.5 years but subsequently increased in size. Biopsy specimens from this tumor showed invasive squamous cell carcinoma, spindle cell subtype. In both cases, the squamous cell carcinomas were surgically resected.

Conclusions and Relevance  These cases highlight the importance of repeated biopsy in locally advanced basal cell carcinomas in 2 clinical situations: (1) when an area within the tumor responds differentially to vismodegib, and (2) when a tumor stops being suppressed by vismodegib. Timely diagnosis of non–basal cell histologic characteristics is critical to institution of effective therapy.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
Clinical Photographs and Histopathologic Findings of Case 1

A, Locally advanced basal cell carcinoma (BCC) affecting the right medial canthus and surrounding structures. Arrowheads indicate the areas of the tumor that were biopsied. B, Histopathologic findings demonstrated dermal nests of basaloid keratinocytes with peripheral palisading and retraction artifact, consistent with nodular BCC. Hematoxylin-eosin, original magnification ×200. C, An enlarging hyperkeratotic papule within the regressing BCC tumor bed during vismodegib therapy was biopsied (arrowhead). D, Histopathologic findings demonstrated atypical keratinocytes with focal acantholysis invading the dermis, consistent with an invasive acantholytic squamous cell carcinoma. Hematoxylin-eosin, original magnification ×200.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Clinical Photographs and Histopathologic Findings of Case 2

A, Locally advanced basal cell carcinoma (BCC) on the scalp prior to treatment. B, Histopathologic findings demonstrated nests of basaloid keratinocytes with peripheral palisading, consistent with nodular BCC. Hematoxylin-eosin, original magnification ×200. C, Same tumor after 2.5 years of vismodegib exposure. D, Histopathologic findings demonstrated invasive squamous cell carcinoma, spindle cell subtype. Hematoxylin-eosin, original magnification ×200.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Immunohistochemical Analysis of Advanced Basal Cell Carcinoma/Spindle Cell SCC in Case 2

A, Strong positive cytokeratin (CK) 5/6 staining suggested a keratinocytic neoplasm. Tumor cells did not stain with antibodies to (B) CD10, (C) CD68, or (D) smooth muscle actin (SMA). B and D, Arrowheads indicate tumor cells that were nonstaining. The SMA antibody weakly stained epithelioid myofibroblasts in the same section. E, Histopathologic findings from the excision specimen showed positive CK AE1/AE3/CAM5.2 staining of tumor cells on the left side of the image. Areas of basaloid cells on the right side of the image did not stain with CK AE1/AE3/CAM5.2. A-E, Original magnification ×200.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();