rodent ulcer

蚕食性角膜潰瘍

WordNet

1. relatively small placental mammals having a single pair of constantly growing incisor teeth specialized for gnawing (同)gnawer
2. a circumscribed inflammatory and often suppurating lesion on the skin or an internal mucous surface resulting in necrosis of tissue (同)ulceration

PrepTutorEJDIC

1. 齧歯(げっし)類の動物(ネズミ・ウサギ・リス・ビーバーの類) / 齧歯類の / かじる;かじるのに適した
2. 潰瘍
3. rideの過去形

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/12/14 11:43:23」(JST)

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"Rodent ulcer" redirects here. For the feline skin condition, see Eosinophilic granuloma.

Basal cell carcinoma
Ulcerated basal cell carcinoma affecting the skin of the nose in an elderly individual
Classification and external resources
Specialty	Oncology
ICD-10	C44 (ILDS C44.L21)
ICD-9-CM	173
ICD-O	M8090/3-8093/3
OMIM	605462
DiseasesDB	1264
MedlinePlus	000824
eMedicine	med/214
Patient UK	Basal-cell carcinoma
MeSH	D002280

Basal cell carcinoma (BCC) (also known as basalioma or basal cell cancer), is the most common skin cancer, and one of the most common cancers in the United States. While BCC has a very low metastatic risk, this tumor can cause significant disfigurement by invading surrounding tissues.

Signs and symptoms

Individuals with a basal-cell carcinoma typically present with a shiny, pearly skin nodule. However, superficial basal-cell cancer can present as a red patch similar to eczema. Infiltrative or morpheaform basal-cell cancers can present as a skin thickening or scar tissue – making diagnosis difficult without using tactile sensation and a skin biopsy. It is often difficult to visually distinguish basal-cell cancer from acne scar, actinic elastosis, and recent cryodestruction inflammation.

• Basal-cell carcinoma, nodular type

• Basal cell carcinoma in a sun-exposed area

Cause

About two thirds of basal-cell carcinomas occur on sun-exposed areas of the body. One-third occur on areas of the body that are not exposed to sunlight, emphasizing the genetic susceptibility of basal-cell cancer.

Diagnosis

To diagnose basal cell carcinomas, a skin biopsy is performed for histopathologic analyses. The most common method is a shave biopsy under local anesthesia. Most nodular basal cell cancers can be diagnosed clinically; however, other variants can be very difficult to distinguish from benign lesions such as intradermal naevus, sebaceomas, fibrous papules, early acne scars, and hypertrophic scarring.

Classification

Basal cell carcinoma can be divided into three groups, based on the growth patterns.

1. Superficial basal cell carcinoma, formerly referred to in-situ basal cell carcinoma, is characterized by a superficial proliferation of neoplastic basal cells. This tumor is generally responsive to topic chemotherapy, such as Aldara (Imiquimod), or Fluorouracil.
2. Infiltrative basal cell carcinoma, that also encompasses morpheaform and micronodular basal cell cancer, is more difficult to treat with conservative methods, given its tendency to penetrate into deeper layers of the skin.
3. Nodular basal cell carcinoma includes most of the remaining categories of basal-cell cancer. It is not unusual to encounter heterogeneous morphologic features within the same tumor.

Histopathologic classification

The histopathologic classification includes:

• Nodular basal cell carcinoma (also known as "classic basal-cell carcinoma") most commonly occurs on the sun-exposed areas of the head and neck.
• Cystic basal cell carcinoma is morphologically characterized by dome-shaped, blue-gray cystic nodules.
• Cicatricial basal cell carcinoma (also known as "morpheaform basal cell carcinoma," and "morphoeic basal cell carcinoma") is an aggressive variant with a distinct clinical and histologic appearance.
• Infiltrative basal cell carcinoma is an aggressive type characterized by deep infiltration.
• Micronodular basal cell carcinoma is characterized by a micronodular growth pattern.
• Superficial basal cell carcinoma (also known as "superficial multicentric basal-cell carcinoma") occurs most commonly on the trunk and appears as an erythematous patch.
• Pigmented basal cell carcinoma exhibits increased melanization. About 80% of all basal-cell carcinoma in Chinese are pigmented while this subtype is uncommon in white people.
• Rodent ulcer (also known as a "Jacob's ulcer") is a large skin lesion of nodular basal-cell carcinoma with central necrosis. Almost all cancers can metastasize except glioma (maligancy of the central nervous system) and the rodent ulcer.
• Fibroepithelioma of Pinkus most commonly occurs on the lower back.
• Polypoid basal cell carcinoma is characterized by exophytic nodules (polyp-like structures) on the head and neck.
• Pore-like basal cell carcinoma resembles an enlarged pore or stellate pit.
• Aberrant basal cell carcinoma is characterized by the formation of basal-cell carcinoma in the absence of any apparent carcinogenic factor, occurring in odd sites such as the scrotum, vulva, perineum, nipple, and axilla.

See also:

• Nevoid basal-cell carcinoma syndrome

• Cystic basal cell carcinoma

• Micronodular basal cell carcinoma

• Superficial basal cell carcinoma

• Micrograph of a fibroepithelioma of Pinkus

Pathophysiology

See also: List of cutaneous conditions associated with increased risk of nonmelanoma skin cancer

Micrograph of a basal-cell carcinoma, showing the characteristic histomorphologic features (peripheral palisading, myxoid stroma, artefactual clefting). H&E stain

Basal cell carcinomas are currently considered to have origin from the folliculo-sebaceous-apocrine germ, also known as trichoblast. The differential diagnosis with trichoblastic carcinoma, a rare malignant form of trichoblastoma, can be challenging. Alternatively, one argument is that basal call carcinoma is trichoblastic carcinoma. Overexposure to sun leads to the formation of thymine dimers, a form of DNA damage. While DNA repair removes most UV-induced damage, not all crosslinks are excised. There is, therefore, cumulative DNA damage leading to mutations. Apart from the mutagenesis, overexposure to sunlight depresses the local immune system, possibly decreasing immune surveillance for new tumor cells.

Basal cell carcinomas can often come in association with other lesions of the skin, such as actinic keratosis, seborrheic keratosis, squamous cell carcinoma. In a small proportion of cases, basal cell carcinoma also develops as a result of basal cell nevus syndrome, or Gorlin Syndrome, which is also characterized by keratocystic odontogenic tumors of the jaw, palmar or plantar (sole of the foot) pits, calcification of the falx cerebri (in the center line of the brain) and rib abnormalities. The cause of this syndrome is a mutation in the PTCH1 tumor suppressor gene located in chromosome 9q22.3, which inhibits the hedgehog signaling pathway. A mutation in the SMO gene, which is also on the hedgehog pathway, also causes basal-cell carcinoma.

Prevention

Basal-cell carcinoma is a common skin cancer and occurs mainly in fair-skinned patients with a family history of this cancer. Sunlight is a factor in about two-thirds of these cancers; therefore, doctors recommend sunscreens with at least SPF 30. One-third occur in non-sun-exposed areas; thus, the pathogenesis is more complex than UV exposure as the cause.

The use of a chemotherapeutic agent such as 5-Fluorouracil or Aldara (Imiquimod), can prevent development of skin cancer. It is usually recommended to individuals with extensive sun damage, history of multiple skin cancers, or rudimentary forms of cancer (i.e., solar keratosis). It is often repeated every 2 to 3 years to further decrease the risk of skin cancer.

Treatment

The following methods are employed in the treatment of basal-cell carcinoma (BCC):

Surgery

Standard surgical excision

This can be with either frozen section histology, or paraffin-embedded fixed-tissue pathology. It is the preferred method for removal of most BCCs. A dermatoscope can help an experienced surgeon accurately identify the visible tumour that the naked eye can not see.

The cure rate for this method, whether performed by a General Surgeon, Otolaryngologist, Head & Neck Surgeon, Plastic Surgeon, Maxillofacial Surgeon or dermatologist is totally dependent on the surgical margin. The narrower the free surgical margin (skin removed that is free of visible tumor) the higher the recurrence rate. If a 4 mm free surgical margin is obtained around a small tumor (less than 6mm), or a wider 6 mm free surgical margin is obtained around a larger tumor (greater than 6mm), the cure rate is very high—95% or better. However, for cosmetic reasons, many doctors take only very small surgical margins 1–2 mm, especially when operating on the face. In such a case, a pathology report indicating the margins are free of residual tumour is often inaccurate, and recurrence rates are much higher (up to 38%).

A weakness with standard surgical excision is the high recurrence rate of basal-cell cancers of the face, especially around eyelids, nose, and facial structures. A diagram on page 38 of the National Comprehensive Cancer Network publication demonstrate the area of high risk of recurrence as most the face with the exception of the central cheek and upper forehead. On the face, or on recurrent basal-cell cancer after previous surgery, special surgical margin controlled processing (CCPDMA—complete circumferential peripheral and deep margin assessment) using frozen section histology (Mohs surgery is one of the methods) is required.

With surgical margin controlled frozen section histology, a surgeon can achieve a high cure rate and low recurrence rate on the same day of the excision. However, most standard excisions done in a plastic surgeon or dermatologist's office are sent to an outside laboratory for standard bread loafing method of processing. With this method, it is likely that less than 5% of the surgical margin is examined, as each slice of tissue is only 6 micrometres thick, about 3 to 4 serial slices are obtained per section, and only about 3 to 4 sections are obtained per specimen (see figure 2 of reference).

When in doubt, a patient should demand that either Mohs surgery or frozen section histology with either margin control (ccpdma) or thin serial bread-loafing is utilized when dealing with a tumour on the face. The pathologist processing the frozen section specimen should cut multiple sections through the block to minimize the false negative error rate. Or one should simply process the tissue utilizing a method approximating the Mohs method (described in most basic histopathology text books or described in this reference ) during frozen section processing. Unfortunately, these methods are difficult when applied to frozen sections; and they are very tedious to process. When not utilizing frozen section, the surgeon might have to wait a week or more before informing the patient if more tumour is left, or if the surgical margin is too narrow. And a second surgery must be performed to remove the residual or potential residual tumour once the surgeon informs the patient of the positive or narrow surgical margin on the surgical pathology report.

A 2008 meta-study of the literature around management of BCCs suggested that excision is a good treatment for primary tumors.

Mohs surgery

Mohs surgery (or Mohs micrographic surgery) is an outpatient procedure, which was developed by Frederic E. Mohs in the 1940s, in which the tumor is surgically excised and then immediately examined under a microscope. It is a form of pathology processing called CCPDMA. The base and edges are microscopically examined to verify sufficient margins before the surgical repair of the site. If the margins are insufficient, more is removed from the patient until the margins are sufficient. It is also used for squamous-cell carcinoma; however, the cure rate is not as high as Mohs surgery for basal-cell carcinoma. The 2008 study found MMS to be a good option for both primary and high-risk recurrent BCCs.

Cryosurgery

Cryosurgery is an old modality for the treatment of many skin cancers. When accurately utilized with a temperature probe and cryotherapy instruments, it can result in very good cure rate. Disadvantages include lack of margin control, tissue necrosis, over or under treatment of the tumor, and long recovery time. Overall, there are sufficient data to consider cryosurgery as a reasonable treatment for BCC. There are no good studies, however, comparing cryosurgery with other modalities, particularly with Mohs surgery, excision, or electrodesiccation and curettage so that no conclusion can be made whether cryosurgery is as efficacious as other methods. Also, there is no evidence on whether curetting the lesions before cryosurgery affects the efficacy of treatment. Several textbooks are published on the therapy, and a few physicians still apply the treatment to selected patients.

Electrodesiccation and curettage

Electrodesiccation and curettage (EDC, also known as curettage and cautery, simply curettage) is accomplished by using a round knife, or curette, to scrape away the soft cancer. The skin is then burned with an electric current. This further softens the skin, allowing for the knife to cut more deeply with the next layer of curettage. The cycle is repeated, with a safety margin of curettage of normal skin around the visible tumor. This cycle is repeated 3 to 5 times, and the free skin margin treated is usually 4 to 6 mm. Cure rate is very much user-dependent and depends also on the size and type of tumor. Infiltrative or morpheaform BCCs can be difficult to eradicate with EDC. Generally, this method is used on cosmetically unimportant areas like the trunk (torso). Some physicians believe that it is acceptable to utilize EDC on the face of elderly patients over the age of 70. However, with increasing life expectancy, such an objective criterion cannot be supported. The cure rate can vary, depending on the aggressiveness of the EDC and the free margin treated. Some advocate curettage alone without electrodesiccation, and with the same cure rate.

Chemotherapy

Some superficial cancers respond to local therapy with 5-fluorouracil, a chemotherapy agent. Topical treatment with 5% Imiquimod cream, with five applications per week for six weeks has a reported 70–90% success rate at reducing, even removing, the BCC [basal-cell carcinoma]. Both Imiquimod and 5-fluorouracil have received FDA approval, and topical IMQ is approved by the European Medicines Agency for treatment of small superficial basal-cell carcinoma. Off label use of imiquimod on invasive basal-cell carcinoma has been reported. Imiquimod may be used prior to surgery in order to reduce the size of the carcinoma. One can expect a great deal of inflammation with this treatment. Chemotherapy often follows Mohs surgery to eliminate the residual superficial basal-cell carcinoma after the invasive portion is removed. Some advocate the use of imiquimod prior to Mohs surgery to remove the superficial component of the cancer. Removing the residual superficial tumor with surgery alone can result in large and difficult to repair surgical defects. One often waits a month or more after surgery before starting the Imiquimod or 5-fluorouracil to make sure the surgical wound has adequately healed. Some people advocate the use of curettage (see EDC below) first, followed by chemotherapy. These experimental procedures are not standard care. The 2008 study reported that topical IMQ appears effective in the treatment of primary small superficial BCCs, but only 'may possibly' have a role in the treatment of primary nodular BCC.

Approved in 2012, vismodegib is used to treat an advanced form of basal-cell carcinoma.

Immunotherapy

Immunotherapy research suggests that treatment using Euphorbia peplus, a common garden weed, may be effective. Australian biopharmaceutical company Peplin is developing this as topical treatment for BCC. Imiquimod is an immunotherapy but is listed here under chemotherapy.

Radiation

Radiation therapy can be delivered either as external beam radiotherapy or as brachytherapy (internal radiotherapy). Although radiotherapy is generally used in older patients who are not candidates for surgery, it is also used in cases where surgical excision will be disfiguring or difficult to reconstruct (especially on the tip of the nose, and the nostril rims). Radiation treatment often takes as few as 5 visits to as many as 25 visits. Usually, the more visits scheduled for therapy, the less complication or damage is done to the normal tissue supporting the tumor. Radiotherapy can also be useful if surgical excision has been done incompletely or if the pathology report following surgery suggests a high risk of recurrence, for example if nerve involvement has been demonstrated. Cure rate can be as high as 95% for small tumor, or as low as 80% for large tumors. Usually, recurrent tumors after radiation are treated with surgery, and not with radiation. Further radiation treatment will further damage normal tissue, and the tumor might be resistant to further radiation. Radiation therapy may be contraindicated for treatment of nevoid basal-cell carcinoma syndrome. The 2008 study reported that radiation therapy is a good treatment for primary BCCs and recurrent BCCs, but not for BCCs that have recurred following previous radiation treatment.

Photodynamic therapy

Photodynamic therapy (PDT) is a new modality for treatment of basal-cell carcinoma, which is administrated by application of photosensitizers to the target area. When these molecules are activated by light, they become toxic, therefore destroy the target cells. Methyl aminolevulinate is approved by EU as a photosensitizer since 2001. This therapy is also used in other skin cancer types. The 2008 study reported that PDT was a good treatment option for primary superficial BCCs, reasonable for primary low-risk nodular BCCs, but a 'relatively poor' option for high-risk lesions.

Prognosis

Prognosis is excellent if the appropriate method of treatment is used in early primary basal-cell cancers. Recurrent cancers are much harder to cure, with a higher recurrent rate with any methods of treatment. Although basal-cell carcinoma rarely metastasizes, it grows locally with invasion and destruction of local tissues. The cancer can impinge on vital structures like nerves and result in loss of sensation or loss of function or rarely death. The vast majority of cases can be successfully treated before serious complications occur. The recurrence rate for the above treatment options ranges from 50 percent to 1 percent or less.

Epidemiology

Basal-cell cancer is a very common skin cancer. It is much more common in fair-skinned individuals with a family history of basal-cell cancer and increases in incidence closer to the equator or at higher altitude. There are approximately 800,000 new cases yearly in the United States alone. Up to 30% of Caucasians develop basal-cell carcinomas in their lifetime. In Canada, the most common skin cancer is basal cell carcinoma (as much as one third of all cancer diagnoses), affecting 1 in 7 individuals over a lifetime.

In the United States approximately 3 out of 10 caucasians develop a basal cell carcinoma during their lifetime. This tumor accounts for approximately 70% of non-melanoma skin cancers. In 80 percent of all cases, basal cell carcinoma affects the skin of head and neck. Furthermore, there appears to be an increase in the incidence of basal-cell cancer of the trunk in recent years.

Most sporadic BCC arises in small numbers on sun-exposed skin of people over age 50, although younger people may also be affected. The development of multiple basal-cell cancer at an early age could be indicative of nevoid basal-cell carcinoma syndrome, also known as Gorlin's Syndrome.

References

External links

• The Skin Cancer Foundation

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 難治性または再発性の消化性潰瘍に対するアプローチ approach to refractory or recurrent peptic ulcer disease
• 2. 消化性潰瘍の合併症の概要 overview of the complications of peptic ulcer disease
• 3. 消化性潰瘍：臨床症状および診断 peptic ulcer disease clinical manifestations and diagnosis
• 4. 消化性潰瘍：マネージメント peptic ulcer disease management
• 5. 消化性潰瘍の外科的マネージメント surgical management of peptic ulcer disease

English Journal

• Expanding the Morphologic Spectrum of Differentiated VIN (dVIN) Through Detailed Mapping of Cases With p53 Loss.

• Singh N1, Leen SL, Han G, Faruqi A, Kokka F, Rosenthal A, Jiang XR, Kim R, McAlpine JN, Gilks CB.
• The American journal of surgical pathology.Am J Surg Pathol.2015 Jan;39(1):52-60. doi: 10.1097/PAS.0000000000000291.
• The pathogenesis of vulvar squamous cell carcinoma follows 1 of 2 distinct pathways. A precursor lesion in the human papilloma virus-independent pathway, differentiated vulvar intraepithelial neoplasia (dVIN), was only recently characterized in detail and is infrequently diagnosed without an associa
• PMID 25025443

• Life expectancy following orbital exenteration.

• Wong JC1, Thampy R2, Cook A2.
• The British journal of ophthalmology.Br J Ophthalmol.2015 Jan;99(1):1-4. doi: 10.1136/bjophthalmol-2013-304436. Epub 2014 May 30.
• Orbital exenteration is a physically debilitating procedure that may be a necessity in the management of orbital malignancy. It requires a sensitive multidisciplinary approach, both preoperatively and postoperatively. Providing life expectancy information for patients during preoperative counselling
• PMID 24879806

• The cytoskeletal inhibitors latrunculin A and blebbistatin exert antitumorigenic properties in human hepatocellular carcinoma cells by interfering with intracellular HuR trafficking.

• Doller A1, Badawi A1, Schmid T2, Brauß T2, Pleli T3, Zu Heringdorf DM1, Piiper A3, Pfeilschifter J1, Eberhardt W4.
• Experimental cell research.Exp Cell Res.2015 Jan 1;330(1):66-80. doi: 10.1016/j.yexcr.2014.09.010. Epub 2014 Sep 21.
• The impact of the RNA-binding protein HuR for the post-transcriptional deregulation of tumor-relevant genes is well established. Despite of elevations in HuR expression levels, an increase in cytoplasmic HuR abundance in many cases correlates with a high grade of malignancy. Here, we demonstrated th
• PMID 25240929

Japanese Journal

• 巨大な Rodent Ulcer を呈した基底細胞癌の1例

• 吉井 典子,谷 暁子,武田 浩一郎,下舞 浩二,島田 英彦,瀬戸山 充,神崎 保,川原 元司,井畔 能文,森山 由紀則,平 明
• 西日本皮膚科 = The Nishinihon journal of dermatology 61(6), 744-747, 1999-12-01
• 症例は67歳の男性。約8年前に気づいた黒色の左鼠径部の皮疹が徐々に拡大, 潰瘍化してきたため, 1998年鹿児島大学病院皮膚科外来を受診した。潰瘍は24cm×9.5cmと下腹部ほぼ全体を占め, 潰瘍底には鼠径動脈が露出していた。また陰茎皮膚は象皮症を呈し, 排尿困難があった。潰瘍辺縁より行った皮膚生検で基底細胞癌の診断を得た。入院後に行った全身検索では他臓器への転移は見られなかった。露出動脈からの …
• NAID 10019140967

• 尿崩症を合併した臨床的にＷｅｇｅｎｅｒ肉芽腫症が示唆された１例

• 山田 祥之,村手 孝直,下方 薫
• 日本胸部疾患学会雑誌 25(6), 668-674, 1987
• 鼻症状が初発で眼, 皮膚病変も出現, さらに約2ヵ月半後より発熱と口渇, 多尿などの尿崩症の徴候を急速に呈してきた臨床的に Wegener 肉芽腫症が示唆された1例を報告した. 症例は43歳女性, 初診時, 右蚕食性角膜潰瘍, 右眼瞼下垂, 鞍鼻, 皮膚結節潰瘍病変などを認め, 胸部X線で空洞を有する結節状陰影を認めた. 鼻, 肺生検組織は壊死性肉芽組織しか得られなかったが臨床症状もあわせて We …
• NAID 130003676149

• 肛門およびその周辺癌

• 高野 正博,隅越 幸男,佐藤 昭二,平塚 襄,岡田 光生,有輪 六朗
• 日本大腸肛門病学会雑誌 26(3), 291-298,367, 1973
• 過去11年において経験した肛門癌は16例で大腸肛門癌合計症例185例中8.6%を占める.比較的まれな疾患であるにかかわらず,病理学的には非常にvarietyに富んでいる.これには肛門部の上皮を形成する肛門上皮,cloacogenic zone等の構成細胞の特異性,複雑さによるものである.<BR>1.Adenocarcinoma tubulare(1例)直腸に比してその頻度はごく少ない. …
• NAID 130000782117

Related Links

• Types of skin cancer | Cancer Research UK

There are other less common types of skin cancer. Added together, these types make up only about 1 out of every 100 (1%) skin cancers diagnosed in the UK. They are Merkel cell carcinoma Kaposi’s sarcoma T cell lymphoma of ...

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Rodent ulcer information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. ... Shiny papule Bleeding papule Scabbing papule Facial ulcer more symptoms...» ...

Related Pictures

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★リンクテーブル★

リンク元	「蚕食性角膜潰瘍」「蚕食性潰瘍」「pigmented basal cell carcinoma」
関連記事	「rodent」

「蚕食性角膜潰瘍」

　　[★]

英

rodent ulcer

ラ

ulcus corneae rodeus

同

モーレン潰瘍 Mooren's ulcer

関

角膜潰瘍

「蚕食性潰瘍」

　　[★]

英

rodent ulcer

関

基底細胞がん、色素沈着型基底細胞癌、基底細胞上皮腫

「pigmented basal cell carcinoma」

　　[★]

色素沈着型基底細胞癌

関

basal cell carcinoma、basal cell epithelioma、rodent ulcer

「rodent」

　　[★]

げっ歯類、齧歯類、齧歯目、齧歯動物

関

Rodentia

同

rodents, plague