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- Presentation
Clinicopathologic Self-assessment
Description
Dr. Michelle Tarbox, a professor and program director in dermatology at Texas Tech University, presented cases examining the complexities of tumor diagnosis in dermatopathology. Her first case involved a 63-year-old man with a lesion on his chest, initially suspected to be a cyst, exhibiting characteristics resembling basal cell carcinoma (BCC). Through immunohistochemical analysis, she suggested the lesion was a BCC altered by treatment with vismodegib, highlighting how such treatments can change tumor profiles, including loss of typical markers and increased squamous differentiation. Her second case involved a 62-year-old woman with a history of breast cancer presenting with two vascular nodules, which were clinically reminiscent of BCC but ultimately diagnosed as metastatic breast cancer upon biopsy. These cases emphasized the significance of considering a broad differential diagnosis in dermatopathology and understanding how treatments can modify tumor presentations.
Conclusions
- Patients receiving vismodegib for basal cell carcinoma (BCC) may exhibit altered histological features, including significant squamous differentiation and central necrosis.
- Loss of BerEP4 expression in BCC can occur with vismodegib treatment, indicating a change in immunoprofile.
- Surgical debulking may enhance the efficacy of vismodegib by modifying Notch signaling pathways in BCC patients.
- Diagnosis of BCC may be complicated in patients with a history of other cancers, as metastatic lesions can mimic BCC histologically.
- Clinical vigilance is required in differentiating between BCC and other malignancies like metastatic breast cancer, especially in patients with cancer history.
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