fibroepithelial basal cell carcinoma

Fibroepithelial basal cell carcinoma (BCC) is a variant of basal cell carcinoma characterized by the presence of delicate, interanastomosing strands of basaloid cells surrounded by abundant fibroblastic stroma [14]. This type of BCC is also known as Fibroepithelioma of Pinkus or Pinkus tumour.

Microscopically, fibroepithelial BCC is distinguished by its unique histological features, including:

• Interconnected, branching strands of basaloid cells
• Abundant fibrous stroma surrounding the tumor cells
• Presence of cords of basaloid cells extending from the epidermis into the dermis [9]

Fibroepithelial BCC typically follows an indolent course and is often found on sun-damaged skin, although it can also occur on other areas of the body. It is essential to note that while fibroepithelial BCC is a variant of basal cell carcinoma, its distinct histological features set it apart from other types of this cancer.

References:

[14] Definition of Fibroepithelial Basal Cell Carcinoma [9] Description of Fibroepithelioma of Pinkus (NCI)

Fibroepithelioma of Pinkus (FeP) vs Basal Cell Carcinoma (BCC)

While both Fibroepithelioma of Pinkus (FeP) and Basal Cell Carcinoma (BCC) are types of skin cancers, they have distinct signs and symptoms.

Fibroepithelioma of Pinkus (FeP)

• Typically presents as a single, erythematous or flesh-colored, dome-shaped papule or plaque [1]
• Can be large, pedunculated, ulcerated, cystic, or nodular in appearance
• May be mistaken for seborrheic keratosis due to its nodular appearance

Basal Cell Carcinoma (BCC)

• Usually appears as a flat, firm, pale area that is small, raised, pink or red, translucent, shiny, and waxy [2]
• May bleed when traumatized
• Can be mistaken for a harmless pimple, scar, or sore due to its varied presentation
• Warning signs include:
  • An open sore that does not heal, and may bleed, ooze or crust [9]
  • A basal cell carcinoma may be pigmented, like this one, on skin of color [9]
  • A slowly growing skin-colored wound that does not heal [7]

Key differences

• FeP is typically a single lesion, while BCC can present as multiple lesions
• FeP is often mistaken for seborrheic keratosis due to its nodular appearance, whereas BCC can be mistaken for a variety of benign skin conditions

It's essential to consult a dermatologist for an accurate diagnosis and treatment plan. Early detection and treatment are crucial in preventing the spread of these cancers.

References:

[1] - [15] (citations provided within the response)

Diagnostic Tests for Fibroepithelioma of Pinkus (FEP) and Basal Cell Carcinoma

The diagnosis of fibroepithelioma of Pinkus (FEP), a variant of basal cell carcinoma, can be challenging due to its similarity in appearance to other skin tumors. However, several diagnostic tests can help confirm the diagnosis.

• Skin Biopsy: A skin biopsy is considered the gold standard diagnostic test for FEP and basal cell carcinoma. It involves taking a small tissue sample from the affected area for histopathological examination [2].
• Dermoscopy: Dermoscopy has been found to be helpful in diagnosing FEP and differentiating it from other benign skin tumors [4]. It can also aid in preoperative prediction of the BCC subtype.
• Non-invasive Imaging Techniques: Non-invasive imaging techniques such as optical coherence tomography, Raman spectroscopy, and confocal microscopy are becoming increasingly utilized for the diagnosis of basal cell carcinoma [5, 6].
• High-Resolution Ultrasonography: High-resolution ultrasonography can also be used in the diagnosis of BCC, particularly in cases where a skin biopsy is not feasible.
• Raman Spectroscopy and Terahertz Pulse Imaging: Raman spectroscopy and terahertz pulse imaging are other non-invasive techniques that can aid in diagnosing BCC [8, 9].

It's essential to note that the diagnosis of basal cell carcinoma should be confirmed by histological examination of the excised specimen following a biopsy and/or therapeutic excision [7]. The goal of treatment for basal cell carcinoma is to remove the cancer completely, and the best treatment option depends on the type, location, and size of the cancer, as well as individual preferences and follow-up visit requirements [10].

References: [2] - A skin biopsy is considered the gold standard diagnostic test for FEP and basal cell carcinoma. [4] - Dermoscopy has been found to be helpful in diagnosing FEP and differentiating it from other benign skin tumors. [5] - Non-invasive imaging techniques such as optical coherence tomography, Raman spectroscopy, and confocal microscopy are becoming increasingly utilized for the diagnosis of basal cell carcinoma. [7] - The diagnosis of BCC should be confirmed by histological examination of the excised specimen following a biopsy and/or therapeutic excision. [8] - High-resolution ultrasonography can also be used in the diagnosis of BCC, particularly in cases where a skin biopsy is not feasible. [9] - Raman spectroscopy and terahertz pulse imaging are other non-invasive techniques that can aid in diagnosing BCC.

Treatment Options for Fibroepithelial Basal Cell Carcinoma

Fibroepithelial basal cell carcinoma (BCC) is a rare subtype of BCC that can be challenging to treat. While surgical excision with 4-mm margins is the definitive treatment, there are other options available, particularly in cases where surgery may not be feasible or desired.

• Cemiplimab: This is an immunotherapy drug approved for the treatment of advanced basal cell carcinoma (BCC), including fibroepithelial BCC. It works by generating an immune system reaction to the tumor cells [12][13].
• 5-Fluorouracil ointment: This topical treatment has been used in some cases to treat fibroepithelial BCC, although its effectiveness is not well established [14].

It's essential to note that these alternative treatments may not be suitable for everyone and should only be considered under the guidance of a qualified healthcare professional. The decision on which treatment option to pursue will depend on various factors, including the size, location, and aggressiveness of the tumor, as well as the patient's overall health.

References:

• [12] Cemiplimab is used to treat patients with advanced basal cell carcinoma (BCC) previously treated with a hedgehog pathway inhibitor (HHI) or for whom an HHI is not appropriate.
• [13] Cemiplimab is a drug designed to generate an immune system reaction to the tumor cells. This drug is approved in other types of skin cancer and non-small cell lung cancer.
• [14] Reymann F. Treatment of basal cell carcinoma of the skin with 5-fluorouracil ointment...

The differential diagnosis for fibroepithelial basal cell carcinoma (BCC) includes several conditions that can mimic its appearance and characteristics.

• Follicular induction: Also known as follicular basal cell hyperplasia, this condition is a benign growth of the skin's hair follicles that can be mistaken for BCC [1].
• Actinic Keratosis: A precancerous lesion caused by sun exposure that can appear similar to BCC [2].
• Bowen Disease: A type of squamous cell carcinoma in situ that can have a similar appearance to BCC, especially when viewed under dermoscopy [6].
• Cutaneous T-Cell Lymphoma: A rare type of skin cancer that can present with lesions that resemble BCC [3].
• Skin tags: Benign growths on the skin's surface that can be mistaken for BCC due to their similar appearance [4].
• Intradermal melanocytic nevus: A benign mole that can appear similar to BCC, especially when viewed under dermoscopy [7].
• Neurofibroma: A type of nerve tumor that can present with lesions that resemble BCC [5].

To differentiate fibroepithelial basal cell carcinoma from these conditions, various diagnostic tools and techniques are used, including:

• Dermoscopy: A non-invasive technique that uses a specialized microscope to examine the skin's surface and underlying structures [6].
• Immunohistochemical stains: Specialized tests that can help identify specific proteins in tissue samples, aiding in diagnosis [8].

It is essential for dermatologists and pathologists to consider these differential diagnoses when evaluating patients with suspected fibroepithelial basal cell carcinoma.