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      A Case Report of Basal Cell Carcinoma in a Non-Sun-Exposed Area: A Rare Presentation Mimicking Recurrent Perianal Abscess

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          Abstract

          Basal cell carcinoma (BCC), a common malignancy, arises most often in sun-exposed areas but does rarely occur in non-sun-exposed sites. Prior tissue injury, especially sharp trauma and chronic inflammation, increases the risk of BCC. We describe a 66-year-old male patient with recurrent perianal abscesses who was found to have a large pigmented basal cell carcinoma. The mass was excised without recurrence at two-year follow-up. Perianal BCC is commonly larger at the time of diagnosis than tumors in sun-exposed sites, likely related to delay in diagnosis. Increased size can lead to increased surgical complexity and more pronounced effects on nearby structures. Early detection is important for optimal patient outcomes. In selected patients presenting with a perianal mass, basal cell carcinoma should be included on the differential diagnosis.

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          Most cited references25

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          Burn scar neoplasms: a literature review and statistical analysis.

          Although squamous cell carcinoma (SCC) is the most common burn scar neoplasm, other neoplasms have also been reported. To compile the burn scar neoplasm cases in the literature and to analyze their frequency and demographic characteristics. Cases were obtained through literature searches. There were 412 cases gleaned from 146 articles between 1923 and 2004. Seventy-one percent (293) of the tumors were squamous cell carcinoma, 12% (48) were basal cell carcinoma (BCC), 6% (23) were melanoma, 5% (21) were sarcoma, 4% (16) were other neoplasms, 1% (6) were squamo-basal cell carcinoma, and 1% (5) squamous cell-melanoma. The mean age at tumor diagnosis was 50 years, the mean age at the time of burn injury was 20 years, the mean latency interval was 31 years. Only 5% of the reported cases were excised and grafted at the time of injury (p<0.001). BCC occurred at a significantly later age compared to SCC and sarcoma groups (p<0.02) and had a shorter latency period compared to SCC and sarcoma groups (p<0.004) and melanoma (p<0.008). Local recurrence was present in 16% of the cases, while regional lymph node involvement was seen in 22% of the cases and distant metastases was present in 14% of the patients. The mortality rate was 21%. Although the main burn scar neoplasm was SCC, other neoplasms contributed to the morbidity and mortality of burn patients. Excision and grafting of deep burns, and close follow-up of non-healing ulcerated burn scars is essential for the prevention and early detection of burn scar neoplasms.
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            HPV-associated diseases.

            Nearly 200 distinct human papilloma viruses (HPVs) have now been recognized, and each is associated with a specific set of clinical lesions. They are associated with a spectrum of diseases, from benign verrucae vulgares and condylomata acuminata to the malignancies of the cervix, vulva, anus, and penis. Disease associated with HPV can be divided into skin and mucosal lesion of the genital and extragenital regions. The relationship between HPV and nonmelanoma skin cancer (NMSC) is important clinically, because NMSC is the most common form of malignancy among fair-skinned populations. HPVs have also been detected in skin tags, lichen sclerosus, seborrheic keratoses, actinic keratoses, epidermal cysts, psoriatic plaques, and plucked hairs, but cutaneous HPV can be found on healthy skin.
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              Perianal and genital basal cell carcinoma: A clinicopathologic review of 51 cases.

              Basal cell carcinoma (BCC) occurring on non-sun-exposed sites, especially the perianal and genital regions, is very rare. We analyzed the incidence, clinical and pathologic features, and etiologic and prognostic factors of all non-nevoid perianal and genital BCCs diagnosed at our institution within a defined period (January 1985-September 1996). A retrospective review was performed with the use of patient clinical records and dermatopathologic slides. Cutaneous biopsy samples were tested for the presence of human papillomavirus (HPV) by in situ hybridization using biotinylated pan-HPV and serotype-specific (6, 11, 16, 18, 31, 33, 51) probes. Of all non-nevoid BCC syndrome cases, 51 BCCs (0.27%) were located within the perianal and genital regions. The average age of the patients was 73 years. Nine perianal BCCs occurred in men, 6 in women. Ten BCCs occurred in the pubic area, 18 on the vulva, 6 on the scrotum, and 2 on the penis. Three patients had 2 tumor sites. The average size of BCC was 1.95 cm; 29.4% were ulcerated. Seventeen patients (36%) had a history of skin cancer on sun-exposed sites and 10 (21%) had a possibly relevant associated condition. HPV was not detected in the specimens tested. Treatments included wide excision (n = 32), electrodesiccation and curettage (n = 10), Mohs micrographic surgery (n = 8), and carbon dioxide laser (n = 1). Of 30 patients with 5 years' follow-up or longer, 1 recurrence was noted 7 years after wide excision. There were no metastases. BCC of the perianal and genital skin is rare and exhibits clinical and histologic heterogeneity. Advancing age and local trauma may contribute to the pathogenesis of BCC at these sites.
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                Author and article information

                Contributors
                Journal
                Case Rep Surg
                Case Rep Surg
                CRIS
                Case Reports in Surgery
                Hindawi
                2090-6900
                2090-6919
                2018
                21 November 2018
                : 2018
                : 9021289
                Affiliations
                1Warren Alpert Medical School of Brown University, Providence, RI, USA
                2Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
                3Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
                Author notes

                Academic Editor: Yehuda Ullmann

                Author information
                http://orcid.org/0000-0003-1139-2559
                http://orcid.org/0000-0002-7763-9473
                Article
                10.1155/2018/9021289
                6280225
                30584488
                19d499f3-128e-478a-aca7-0c6885e02d1e
                Copyright © 2018 Audrey V. Carr et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 September 2018
                : 24 October 2018
                Categories
                Case Report

                Surgery
                Surgery

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