World Journal of Colorectal Surgery Volume 6, Issue 5 2016 Article 9 Basal Cell Cancer Carcinoma of the anus: Case Reports and Review of the Literature Christopher Dwyer MD Marc Brozovich MD, FACS, FASCRS Matthew Huk MD Rochelle Kline PA-C Shawna Bullard PA-C University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, The United States Of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, The United States Of, brozovichme@upmc.edu University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, The United States Of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, The United States Of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, The United States Of Copyright c 2017 The Berkeley Electronic Press. All rights reserved.
Basal Cell Cancer Carcinoma of the anus: Case Reports and Review of the Literature Christopher Dwyer MD; Marc Brozovich MD, FACS, FASCRS; Matthew Huk MD; Rochelle Kline PA-C; and Shawna Bullard PA-C Abstract Perianal basal cell carcinoma is an extremely rare version of the common non-melanoma skin cancer, likely due to the lack of ultraviolet light shining on the anus. A dearth of case reports of perianal basal cell carcinoma exists in colorectal literature. The following is a case report highlighting the key characteristics of perianal basal cell carcinoma and a brief literature review. KEYWORDS: anal, basal cell, cancer, skin cancer, anus
Dwyer et al.: Basal Cell Cancer Carcinoma of the anus: Case Reports and Review 1 Introduction Reports of perianal basal cell carcinoma in the colorectal literature are scant. A literature search for perianal basal cell carcinoma returned 71 results. Ten articles were from surgical journals while the rest came from dermatology or pathology literature. While common on the head and neck due to ultraviolet exposure, perianal basal cell carcinoma is quite rare and makes up approximately 0.1-0.4% of all anorectal neoplasms. (1) Most perianal basal cell carcinomas are treated with wide local excision, however reports describe treatments ranging from applying creams to abdominoperineal resection. In the few studies with adequate follow up, the overall crude 5-year survival rates range from 72% - 100%. (2, 3, 4) We present a patient with perianal basal cell carcinoma. Case Presentation A 77-year-old male presented to his primary care physician with a complaint of a perianal mass present for 6 months. He made the appointment to see his physician because of associated bleeding with the mass. His colonoscopy was up to date without pathology and his medical history was significant for multiple squamous cell carcinomas and basal cell carcinomas of the neck and trunk. After consultation with a gastroenterologist he underwent a punch biopsy of a 1.5cm perianal lesion. Biopsy results showed basal cell carcinoma and he was referred to our office. The patient endorsed occasional discomfort and bleeding at the site of the lesion, but no pain. He had no prior anorectal surgeries and was continent. Anal exam revealed an irregular, right-later perianal lesion that was raised and ulcerated. He also had external hemorrhoidal skin tags. With these findings the patient was offered wide local excision as definitive therapy of his perianal basal cell carcinoma. The lesion was completely excised in the operating room and pathologic exam revealed basal cell carcinoma, nodulo-ulcerative type with negative margins. Discussion Basal cell carcinoma can be broken into three main groups: Superficial, nodular, and infiltrative (sometimes referred to as morpheaphorm or micronodular). It is the most common non-melanoma skin cancer at 75%. More than 80% of these lesions are confined to the most sun-exposed areas of the body, especially the head and neck. (5) Produced by The Berkeley Electronic Press, 2016
2 World Journal of Colorectal Surgery Vol. 6, Iss. 5 [2016], Art. 9 Perianal basal cell carcinoma is an especially uncommon skin tumor, even in high referral colon and rectal practices. Presumably this is due to the lack of UV light in the region of interest. Of all cutaneous basal cell carcinomas, approximately 0.3% of these cancers have been localized to the anal margin and genital area. (6) Most patients are older men and most lesions are smaller than 2cm. (1) The most common type of perianal basal cell carcinoma is nodular, followed by the superficial type. (2) Treatment decisions should be made on a case-by-case basis. In general, basal cell carcinoma of the skin rarely metastasizes. However, perianal basal cell carcinoma can have an aggressive course and has been shown to have more frequent metastasis. (7) Depending on the type, treatments range from topical imiquimod cream for superficial basal cell to abdominoperineal resection for larger, ulcerated lesions within the anal canal. (1) The latter is extremely rare and an unusual finding. Since cosmesis of this area is not usually of concern, wide local excision is the treatment of choice and has good long term results. (2,3,4). Conclusion Our patient s six month history of a perianal lesion represents the tendency of perianal basal cell carcinoma cases to present later than other types of anal cancer. They can be mistaken for hemorrhoids or inappropriately treated as inflammatory or infections lesions. Early referral to a colorectal surgeon for wide local excision may benefit the patient, especially because the perianal basal cell type is more malignant than the usual head and neck type. References 1. Keighley MR, et al. Malignant Tumours of the Anal Canal and Anus. In: Surgery of the Anus Rectum and Colon., 16, 567-590. 2. Gibson GE, Ahmed I. Perianal and genital basal cell carcinoma: a clinicopathologic review of 51 cases. J Am Acad Dermatol 2001; 45(1): 68-71. 3. Paterson CA, et al. Basal cell carcinoma of the perianal region: 20-year experience. Dis Colon and Rectum 1999; 42(9): 1200-02. 4. Nielsen OV, Jensen SL. Basal cell carcinoma of the anus-a clinical study of 34 cases. Br J Surg 1981; 68: 856-57. 5. Bulur I, et al. Perianal basal cell carcinoma. Case Reports in Dermatology 2015; 7: 25-28. http://services.bepress.com/wjcs/vol6/iss5/art9
Dwyer et al.: Basal Cell Cancer Carcinoma of the anus: Case Reports and Review 3 6. Leonard D, et al. Neoplasms of Anal Canal and Perianal Skin. Clin Colon Rectal Surg 2011; 24: 54-63. 7. Damin DC, et al. Perianal basal cell carcinoma. J Cutan Med Surg 2002; 6: 26-28. Produced by The Berkeley Electronic Press, 2016