PMC5946607_01
Clinical evolution of the giant morphea-form BCC after: (a) 1 day, (b) 30 days, (c) 60 days and (d) 120 days.
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A 54-year-old male patient presented a 14 cm x 10 cm large and 4.5 cm deep ulcerated wound with infiltrated nodular borders centered on the umbilicus (Figure 1(a)). Four months later, the lesion was significantly reduced in depth and extension and was not oozing or bleeding anymore (Figure 1(d)). This significant shrinkage both in size and depth (Figure 1(a)-(d)) finally allowed plastic surgery, respecting a 0.5 cm surgical margin.
(a) Histopathologic suspicion of squamous cell carcinoma on the initial 4-mm punch biopsy, (b) Deep infiltrating morphea-form BCC on the excisionnal biopsy.
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A 4-mm punch biopsy obtained under local anesthesia was suggestive for SCC (Figure 2(a)). Due to the clinical-pathological incoherence, a large excisional biopsy was performed revealing deep infiltrating morphea-form BCC (Figures 2(b) and 3(a)).
(a) H/E staining illustrating the sclerodermiform BCC, (b) faint CD56 immunostaining, and (c) strong immunohistochemical BerEp4 expression.
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Immunohistochemical studies revealed strong positive stainings for BerEp4 and chromogranin A, but CD56 expression was only marginal (Figure 3(b)).
MRI illustrating the tumoral invasion until the abdominal fascia, (a) transversal view, (b) sagittal view.
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Magnetic resonance imaging (MRI) revealed a deep tumor infiltration until the muscular fascia (Figure 4(a) and (b)).
Histologic aspect of the skin after 4 months of vismodegib therapy, showing cicatricial tissue without residual tumor tissue.
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Histology only revealed cicatricial scar tissue without any sign of residual BCC, particularly at the borders of the lesion (Figure 5).