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Abstract

Introduction


Basosquamous cell carcinoma (BSCC) is a rare variant of basal cell carcinoma, which carries poor prognosis because of its metastatic potential. We present a case of BSCC of face, treated with radical surgical and adjuvant radiation. This case report stresses the need to critically differentiate BSCC from the close terminology of Basaloid squamous cell carcinoma which is an aggressive variant of squamous cell carcinoma occuring in the upper aerodigestive tract. Case ReportA 65 year old male reported to Ear, Nose and Throat (ENT) outpatient with painful ulcerative lesion of left lower two third of face. It started as a tiny lesion at left nasomaxillary groove one year back. This gradually increased in size. On clinical examination, it was an ulcerated lesion of 5 cm x 3 cm involving whole upper lip and left angle of mouth but sparing right angle mouth. The lesion extended to involve lower half of collumella and adjacent zygomaxillary region. The margins were irregular and the base was covered with purulent odouriferous secretion with numerous maggots crawling in it. Plain x-ray paranasal sinus (Water's view) did not depict any bony erosion. Presumptive diagnosis of basal cell carcinoma was made. After cleaning, debridement and parental antibiotics, the whole lesion was excised. On histopathological examination it was diagnosed as Baso-squamous cell carcinoma. The specimen revealed ulcerated surface squamous epithelium. Intact skin adnexae were however present. At low power, the tumor cells were predominantly arranged as cords (Figure 1). There were two types of cells. The peripheral cells were small and arranged in a pallisading pattern. Centrally, the cells showed squamoid differentiation with keratin formation, which were more obvious at high power (Fig ure 2). Brisk mitotic activity was also identified along with inflammatory infiltrate in the stroma. The surgical defect was secondarily covered with horizontal forehead flap. The patient was later sent for adjuvant radiotherapy.