Metatypical basal cell or basosquamous cell carcinomas are a rare form of skin cancer. While the likelihood of developing this type of skin cancer increases on areas of the body that have had years of sun exposure, metatypical basal cell might also form on non-exposed regions. The disease process is also more aggressive, likely to recur and prone to metastases. Early detection and treatment is vitally important.
The growths most often appear on the neck and facial regions. Other areas of potential growth include the torso, the limbs and the scalp. The Department of Plastic Surgery from the University of Rome performed an extensive study of basosquamous cell malignancies. The research involved 240 men and women. Through the course of the study, scientists learned that the unusual malignancies affected men nearly twice as often as women. Metatypical basal cell growths were also more likely to develop on people over the age of 65. However, when the unique skin cancer developed on younger patients, females were most often affected.
Due to the combination of cells that form in the malignancy, lesions vary in size and appearance. The lesions found on the study participants ranged from 1/8 inch (0.4 centimeters) to nearly 2 inches (5 centimeters) in size. Some may appear as a raised, slightly reddened pimple-like growth. Others may develop into an irregularly-shaped flattened patch. In time, the rapid growth of the lesions leads to a greater degree of soft tissue and nerve tissue involvement and the potential to cause ulcerations.
The researchers from the University of Rome also found that the malignancies grow faster compared to either basal cell or squamous cell skin cancers. Soon, malignant cells break from the base tumor and migrate to the lungs and lymphatic system. Occasionally, they develop new tumors in bone or other organ tissues. As the lesions may resemble basal cell or squamous cell masses, the only way to accurately diagnose the condition requires a biopsy and microscopic evaluation.
Complete removal of the lesion is necessary. Mohs micrographic surgery performed by a board certified surgeon is one of the most effective means of ensuring complete tumor removal. The method was developed by and named for Dr. Frederick Mohs in the 1930s. The treatment involves removing the abnormal cells from the mass one layer at a time. Each layer is then immediately examined under a microscope.
A laboratory technician prepares the specimen by cutting, mapping and staining the cells. The layer then undergoes freezing and further shaving into extremely thin slices. The technique enables surgeons to more effectively identify the margins of the mass. Surgeons repeat the process until specimens no longer contain malignant cells.
The benefits of Mohs include knowing that the entire mass is successfully eliminated while not having to wait for a lab report outside of the treatment facility. Mohs surgery has also been shown to greatly decrease the return rate of metatypical basal cell carcinomas.
Mohs Procedure Explained
Physicians perform Mohs surgery as an outpatient procedure in the clinician's office. Initially, the area is thoroughly cleansed and numbed by injecting a local anesthetic using a very fine needle. After ensuring that the area is desensitized, the surgeon shaves across the top of the lesion. A minimal amount of healthy tissue bordering the mass is also removed. The surgeon then applies a temporary adhesive bandage to the site while the cells undergo examination. Once the entire malignancy has been successfully removed, the physician closes the wound. Under certain circumstances, if a surgeon suspects that metastasis has occurred, patients may also require chemotherapy and or radiation therapy.
The need for surgical reconstruction of the wound depends on the depth, size and location of the affected area. If the lesion developed on the face or other highly visible region, cosmetic correction provides a more aesthetically pleasing appearance. Reconstruction commonly occurs immediately following a Mohs procedure or up to one week later if a patient's medical condition requires a delay. Cosmetic procedures are performed using local or general anesthetic in an outpatient surgical facility.
For the convenience of Orange County, CA residents, the Skin Cancer and Reconstructive Surgery Center has a comprehensive, state-certified surgical center in the Fashion Island district of Newport Beach. Our state-of-the-art facility enables our physicians to diagnose and treat a wide variety of pre-cancerous and malignant lesions, which include metatypical basal cell carcinoma. We also perform on-site reconstructive surgery.