Morpheaform facial basal cell carcinoma - a 16-year experience in an Asian center.

experience in an Asian center Dear Sir, Basal cell carcinoma (BCC) is the most common skin cancer in Singapore – an equatorial region with a multiethnic Asian population. Morpheaform/sclerosing BCC (mBCC) is the most aggressive subtype that often has a subtle presentation, occurring as an inconspicuous ‘‘scarlike’’ lesion. This poses challenges in surgical excision and clearance. Although often regarded as a subset of infiltrative BCC, the morphoeic subtype is distinguished by the presence of stromal fibrosis, a distinction that remains part of the minimum dataset for histopathological reporting of skin cancers. mBCCs are particularly rare in colored skin, with a lack of studies in Asian populations. We retrospectively reviewed our experience with surgical excision of facial mBCC from 1993 to 2009. There were 1573 histological diagnoses of BCC made over this 16-year period. Thirty-seven patients had a diagnosis of aggressive BCC (infiltrative, morpheaform and micronodular subtypes), of which seven were morpheaform (Table 1). mBCC subtypes included: pure morpheaform (five) and mixed morpheaform (two). Patient demographics were determined: mean age = 58.4 years; male:female ratio = 4:3. Five of the seven patients identified were Chinese, the remaining two were Caucasian, and none was from the Malay/Indian racial groups. All cases were found on the face, the most common anatomical location was the pinna of the ear (three), followed by the cheek (two), scalp (one) and periorbital (one). Four patients had a known diagnosis of BCC: infiltrative (two), morphoeic (one), and nodular (one). All presented with single tumors, tumor size 5–60 mm. Clinical presentation: ulceration (three), surface changes of existing scar (three), and enlarging nodule (one). The mean duration to presentation was 2.1 years. Three patients had locally invasive tumors. All patients were treated with wide excision. One patient had positive margins. Method of defect closure included: flap coverage (four), split skin graft (two), and secondary closure (one) (Table 2). Four of seven patients diagnosed with mBCC at our center presented with a local recurrence at a site of previous BCC excision, of which three were formerly diagnosed as the nonmorphoeic subtype (based on archived histopathological and patient records at our center). There was one case of recurrent mBCC diagnosed. 1 T a b le 1 Pa ti en t an d tu m or ch ar ac te ri st ic s