RECURRENT BASAL-CELL CARCINOMA OF THE BACK INFILTRATING THE SPINE - RECURRENT BASAL-CELL CARCINOMA

BACKGROUND. Risk of basal cell carcinoma (BCC) recurrence appears to b e related to tumor location, tumor size, treatment modality, radicalne ss of excision, and histologic type. Recurrences of BCC on the trunk a nd extremities are rare, with 97% of all recurrent lesions being locat ed in the head and neck region. OBJECTIVE. This report concerns a man who had a BCC of the back removed with electrodesiccation and curettag e in 1980 at the age of 36. In the following 10 years the patient expe rienced five recurrences and finally developed infiltration of the tho racic spine that precluded further attempts at radical excision of the neoplasm. METHODS AND RESULTS. The pathology of the BCC in our patien t revealed a number of histologic features that have been associated w ith aggressive behaviour. These include an infiltrative growth pattern characterized by an irregular and acute tapered profile of the tumor cell groups and fibroblast-rich stroma, infiltrating invading tumour e dges, poorly peripheral palisading, nuclear pleomorphism, and perineur al invasion. CONCLUSION. Basal cell carcinomas that occur in sunlight- protected areas of the trunk of middle-aged individuals can occasional ly exhibit aggressive and highly invasive features as well as a marked tendency for local uncontrollable recurrences. The prognosis for pati entS with this variety of BCC is poor, especially when progressive inf iltration of deep tissues does not permit, as in our case, any possibl e further radical surgical procedure.