Facial basal cell carcinoma:A retrospective study of 67 cases

BACKGROUND Basal cell carcinoma(BCC)is a slow-growing malignant tumor characterized by local invasiveness but an exceptionally rare metastatic potential.It ideally affects sun-exposed skin of older patients with more propensity for the facial region.AIM To evaluate the different clinicopathological characteristics of the facial BCC and the efficacy and safety of diode laser for the treatment of these lesions.METHODS We retrospectively reviewed facial BCC lesions of<1.5 cm in diameter and subjected them to diode laser ablation during the period from September 2016 to August 2021 at Al-Ramadi Teaching Hospital,Ramadi City,Iraq.Data matching the age,gender,duration,site,and clinical and histological types were registered for every subject.The functional and aesthetic outcomes and complications following diode laser ablation for each patient were also recorded.RESULTS Of 67 patients with facial BCC,there was 65.67%from the age group≥60 years and 58.21%males.The mean duration of the lesions was 5.15±1.836 mo.The most involved location was the nose(29.85%).About half of the cases belong to the noduloulcerative type.Solid histological type comprises 40.3%of the cases,while the least was keratotic(13.4%).Moreover,65.2%of the solid cases were from the age group≤60 years and 38.6%of the adenoid type from the age group>60 years(P value=0.007).Excellent aesthetic and functional outcomes were reported in all cases after 6 mo of follow-up.Few complications were reported after diode laser ablation.CONCLUSION Facial BCC was mostly seen in the elderly and men.The mean duration was 5.15 mo.The nose was the commonest involved site.Noduloulcerative lesions were seen in approximately half of the lesions.The age of the patients determined the histological type of the lesion(solid type was mostly seen in the age group≤60 years,while,adenoid in the age group>60 years).Diode laser ablation showed excellent functional and aesthetic outcomes following a 6-mo follow-up.

Establishment of basal cell carcinoma animal model in Chinese tree shrew (Tupaia belangeri chinensis)

Basal cell carcinoma （BCC） is the most common skin cancer worldwide, with incidence rates continuing to increase. Ultraviolet radiation is the major environmental risk factor and dysregulation of the Hedgehog （Hh） signaling pathway has been identified in most BCCs. The treatment of locally advanced and metastatic BBCs is still a challenge and requires a better animal model than the widely used rodents for drug development and testing. Chinese tree shrews （Tupaia belangeri chinensis） are closely related to primates, bearing many physiological and biochemical advantages over rodents for characterizing human diseases. Here, we successfully established a Chinese tree shrew BCC model by infecting tail skins with lentiviral SmoA1, an active form of Smoothened （Smo） used to constitutively activate the Hh signaling pathway. The pathological characteristics were verified by immunohistochemical analysis. Interestingly, BCC progress was greatly enhanced by the combined usage of lenUviral SmoA1 and shRNA targeting Chinese tree shrew p53. This work provides a useful animal model for further BCC studies and future

THE EXPRESSION OF C－erbB－1 AND C－erbB－2ONCOGENES IN BASAL CELL CARCINOMA ANDSQUAMOUS CELL CARCINOMA OF SKIN

The expression of c-erbB-1 and c-erbB-2 oncogenes were investigated by immunohistochemistry using monoclonal antibodies to c-erbB-2 and c-erbB-2 protein in 43 cases of basal cell carcinoma (BCC) and 26 cases of squamous cell carcinoma (SCC). We found that the expression of c-erbB-1 oncogene in all BCC increased by different degrees and the expression of c-erbB-2 oncogene in BCC was significantly reduced or lost when compared to that in normal epidermal cells. Furthermore, apparent negative and positive rela-tionships were observed respectively between the tumor differentiation and the expression of cerbB-1 and c-erbB-2 oncogenes in SCC. It is suggested that the abnormal expression of c-erbB-1 and c-erbB-2 oncogenes in BCC and SCC may play a role in the development of skin tumors. The pattern of the c-erbB-1 and c-erbB-2 oncogenes expression in SCC may assist in distinguishing the biological behavior and prognosis of SCC.

Correlation and Expression of COX-2 and P53 Protein in Basal Cell Carcinoma of Eyelid

The correlation between the expression of COX-2 and p53 protein in basal cell carcinoma （BCC） of eyelid and apoptosis was investigated. Specimens of BCC were collected from 40 cases （aged 28-68 y） at the Department of Pathology, Renmin Hospital of Wuhan University, and Department of Pathology, Zhongnan Hospital of Wuhan University during from 1999 to 2006. Five specimens of paracancerous tissues served as control group. Immunohistochemical staining was performed to detect the expression of COX-2 and p53 in the tissues. The average absorbance （A） and the average positive area rate of COX-2 and p53 protein were measured by image analysis. The positive area rate of COX-2 and p53 protein was analyzed by linear correlation analysis. It was found that COX-2 and p53 proteins were highly expressed in BCC of eyelid, and weakly expressed in paracancerous tissues. Image analysis revealed that the expression of COX-2 and p53 proteins in BCC of eyelid was sig- nificantly higher than that in paracancerous tissues （P〈0.01）. Spearman rank correlation analysis demonstrated a positive correlation between the expression of COX-2 and p53 （r=0.113, P=0.421）. It was concluded that COX-2 can increase the expression of p53 protein, therefore suppressing apoptosis.

Curaderm, the Long-Awaited Breakthrough for Basal Cell Carcinoma

Background: Basal cells form a continuous cell layer at the bottom of the epidermis, which is the outermost layer of the skin. Basal cell carcinoma occurs when a mutation occurs in the DNA of a basal cell. The mutation inhibits apoptosis—the programmed cell death mechanism. The cell continues to multiply but does not die, resulting in a change in the skin, such as a growth or sore that will not heal. Basal cell carcinoma is the most common form of skin cancer and the most frequently occurring form of all cancers. Key words searched for the database of this communication were: Curaderm, BEC 5, cancer, skin cancer, basal cell carcinoma, nonmelanoma skin cancer, solamargine, solasonine and solasodine glycosides. Treatments: Several types of treatments are available to remove or destroy basal cell carcinoma. All currently used treatments are indiscriminate and also remove or destroy normal skin cells resulting in compromised cosmetic outcomes. Development of Curaderm Pharmacotherapy: Curaderm pharmacotherapy discriminates and specifically activates apoptosis at the molecular level in cancer cells but not in normal cells. Accordingly, Curaderm pharmacotherapy for basal cell carcinoma effectively and safely treats virtually all types, sizes and lesion locations. This review describes studies from the inception of Curaderm pharmacotherapy and covers the discovery of the anti-cancer effects, mode of action, preclinical, clinical and field applications with emphasis on efficacy, safety, compliance, tolerance, cost effectiveness and especially cosmetic outcome. In 2018 Curaderm was approved by the European Health Authorities as a Medical Device Class 1 for the indication “Topical Treatment with Keratolytic Action, and Antineoplastic Activity in the Treatment and Healing of Localized Basal Cell Carcinoma of the Skin”.

The Role of Bcl-2, CD10 and CD34 Expression in Differentiation between Basal Cell Carcinoma and Trichoepithelioma

Background: Basal cell carcinoma (BCC) and trichoepithelioma (TE) have some similarities clinically and histologically. The aim of this work is to evaluate the role of Bcl-2, CD10 and CD34 in differentiation between BCC and TE. Methods: The immunohistochemical expression of Bcl-2, CD10 and CD34 was evaluated in 20 BCCs and 12 TEs in a retrospective study. The localization of these markers in tumor and stromal cells was determined and comparison between BCC and TE was done. Immunohistochemistry for Bcl-2, CD10 and CD34 was performed on sections obtained from formalin-fixed, paraffin-embedded blocks. Bcl-2, CD10 and CD34 immunoreactivity in the stromal and/or tumor cells was determined as follows: negative (0);1+ (10% - 50% positive cells);and 2+ (>50% positive cells). Results: In BCC (20 cases), the expression of Bcl-2 in stromal cells showed (0) immunoreactivity in 8 cases (40%), (1+) immunoreactivity in 7 cases (35%), and (2+) immunoreactivity in 5 cases (25%). Tumoral cells showed diffuse positivity in 20 out of 20 cases (100%), (1+) immunoreactivity in 5 cases (25%) and (2+) immunoreactivity in 15 cases (75%). On the other hand, the expression of Bcl2 in TE, 4 cases showed positive stromal cells out of 12 (33.33%), (1+) immunoreactivity in 2 cases (16.6%) and (2+) immunoreactivity in 2 cases (16.6%), and 8 cases showed no immunoreactivity. Tumoral cells showed positivity in 12 out of 12 cases (100%), (1+) immunoreactivity in 5 cases (41.6%), (2+) immunoreactivity in 7 cases (58.3%). In BCC cases, the expression of CD10 was noted in stromal cells in 8 out of 20 cases (40%), 5 cases showed positivity in stromal and basaloid cells and 3 cases showed positivity in stromal cells only, and 12 cases showed no immunoreactivity (60%). Tumor cells showed positivity in 11 cases out of 20 (55%), (1+) immunoreactivity in 6 cases (30%), (2+) in 5 cases (25%), and 9 cases showed no immunoreactivity (45%). On the other hand, the expression of CD10 in TE 7 cases showed positive stromal cells out of 12 (58.33%), (1+) immunoreactivity in 5 cases (41.6%) and (2+) in 2 cases (16.6%), and 5 cases showed no immunoreactivity (41.66%). Tumor cells showed positivity in 5 cases out of 12 (41.66%), (1+) immunoreactivity in 4 cases (33.33%) and (2+) in 1 case (8.3%), and 7 cases showed no immunoreactivity (58.33%). In BCC cases, the expression of CD34 was noted in stromal cells in14 cases out of 20 cases (70%), (1+) immunoreactivity in 10 cases (50%) and (2+) in 4 cases (20%), and 6 cases showed no immunoreactivity (30%). On the other hand, the expression of CD34 in TE, 10 cases showed positive stromal cells out of 12 (83.33%), (1+) immunoreactivity in 6 cases (50%) and (2+) in 4 cases (33.33%), and 2 cases showed no immunoreactivity (16.6%). Tumor cells showed no immunoreactivity for CD 34 in both BCC and trichoepithelioma, (100%) negative tumor cells. Significant difference of tumor\stromal cells immunoreactivity for Bcl-2 and CD34 in both BCC and TE but it was insignificant for CD10. Conclusion: We conclude that Bcl-2 CD10, CD34 are useful markers in the differential diagnosis of BCC versus TE.

Basal Cell Carcinoma at Pediatric Age Gorlin-Goltz Syndrome Clinic Experience

The nevoid basal cell carcinoma syndrome is an autosomal dominant inherited disease, associated with PTCH gene mutation. Its presentation is polymorphous, being frequent to appear the clinical triad carcinomas basal cell, odontogenic cysts and skeletal abnormalities. Skin lesions are a very frequent reason for consultation in the paediatric age, being evaluated in most cases in primary care. Sometimes, patients need the intervention of other specialists to deep in a given area. The medical literature shows a fragmented view of the disease, possibly related to the low frequency of appearance of this syndrome, and by the need for intervention of not transversal knowledge specialist, which is why we feel interesting to evaluate the role of specialist who is developing the activity at primary care, with patients who require a multidisciplinary intervention.

Gold Standard for Skin Cancer Treatment: Surgery (Mohs) or Microscopic Molecular-Cellular Therapy (Curaderm)?

Non-melanoma skin cancers or keratinocyte cancers such as basal cell carcinoma and squamous cell carcinoma make up approximately 80% and 20% respectively, of skin cancers with the 6 million people that are treated annually in the United States. 1 in 5 Americans and 2 in 3 Australians develop skin cancer by the age of 70 years and in Australia it is the most expensive, amassing $1.5 billion, to treat cancers. Non-melanoma skin cancers are often self-detected and are usually removed by various means in doctors’ surgeries. Mohs micrographic surgery is acclaimed to be the gold standard for the treatment of skin cancer. However, a novel microscopic molecular-cellular non-invasive topical therapy described in this article, challenges the status of Mohs procedure for being the acclaimed gold standard.

A Rare Case of a Large Basal Cell Carcinoma of the Vulva

We present an interesting and unusual case of a 5 cm well-demarcated erosive plaque on the labia minora, extending to the vagina in an 85-year-old woman, causing pain and discomfort for 2 years. The patient was treated several times with topical and systemic anti-fungals without benefit. Histopathology revealed a typical superficial spreading basal cell carcinoma (BCC) and the patient was referred to a gynecologist for surgical excision. Our case is an alert of BCCs arising on the genital area because they are rare and patients usually present with large lesions, as they do not seek medical attention for what they consider simple irritation. Physicians easily misdiagnose these cancers as inflammatory or infectious dermatoses.

Recurrent basal cell carcinoma of lower lid invading the orbit and whole hemiface reconstructed by rectus abdominis free flap

Dear Sir, I am Dong Hyun Ji, from the Department of Ophthalmology of St. Vincent’s Hospital, Suwon, Korea. I write to present a very severely recurrent basal cell carcinoma (BCC) in lower lid invading left orbit and whole hemiface,

Basal cell carcinoma stem cells exhibit osteogenic and chondrogenic differentiation potential

Specific cell subpopulations identified as cancer stem cells(CSCs)can be found in basal cell carcinoma(BCC).Generally,CSCs have a marked trans-differentiation potential that could potentially be used in differentiation therapies.However,there are no studies regarding BCC CSCs multipotency.The aim of the study was to analyze the characteristic of CSCs of BCC with emphasis on their differentiation potential upon specific induction.Specific staining and cell morphology were used for differentiation confirmation,along with the expression analysis of osteogenic(ALP,BSP,Runx2,OCN,BMP2),chondrogenic(COL1 and COL2A1),adipogenic(PPAR-γ)and neurogenic(Nestin and MAP2)markers.BCC CSCs differentiated into osteogenic and chondrogenic lineages,as judged by staining and high expression of specific markers(from 2-to 92-fold higher upon induction).Concomitantly with differentiation,the levels of cancer stem cell markers decreased in the cultures.Adipo-differentiation and neuro-differentiation were unsuccessful.In conclusion,BCC CSCs exhibit the capacity to trans-differentiate,a characteristic that may potentially be useful in the development of new strategies for the treatment of aggressive BCCs.

Peroxidative Activity in Patients with Skin Basal Cell Carcinoma

Oxidative status assessment is an initial step in tumor related studies. To the best of our knowledge, this is the first study considering oxidative activity of both serum and tissue specimens in human basal cell carcinoma (BCC), which is the most common tumor in the world. Concentration of Malondialdehide (MDA) in human basal cell carcinoma (BCC) and individually matched normal skin tissue were examined with spectrophotometery method. Fresh normal and cancerous skin paired tissue was obtained from 60 patients who underwent curative BCC resection at one center in Tehran (Razi hospital). Serum Concentration of Malondialdehide (MDA) in these patients and 55 normal subjects were also measured. MDA level in cancerous tissue of patients with skin BCC (1.0 ± 0.14 ng/g) was significantly (p = 0.001) higher than normal neighboring skin tissue (0.3 ± 0.07 ng/g). A remarkable (Not significant, P = 0.18) increase was found in the serum MDA level in patients with skin BCC (8.0 ± 2.3 ng/ml) in comparison with the control subjects (7.3 ± 2.9 ng/ml). A significant positive correlation (r = 0.276, p = 0.03) was found between Serum MDA and skin tissue MDA for non-affected skin tissue (normal neighboring skin), whereas no significant correlation (p > 0.05) was found for cancerous tissue. Cut-point of 5.2 ng/ml of serum MDA concentration showed a screening sensitivity of 95%. There is an active oxidative process in BCC lesions. Serum MDA concentration can be used either as a screening test or a predictor for tissue MDA concentration.

Basal Cell Carcinoma: Experience in a Teaching Hospital, Calabar-South Nigeria

Background: Basal cell carcinoma (BCC) is the commonest malignancy among Caucasians in Europe, North America, and Australia. This study attempted to identify the prevalence, risk factors, and outcome of management of this problem in our region. Methods: All the patients with histologic diagnosis of BCC presenting to the University of Calabar Teaching Hospital, Calabar during the study period January 2000 to December 2009 were evaluated. Results: One hundred and fifty two patients (136 blacks, 16 albinos) were afflicted with skin malignancy, squamous cell carcinoma and BCC totaled 70 [SCC – 62, BCC – 8], and malignant melanoma (MM) – 16. Of the 8 patients, (3 males and 5 females, mean age 43 years, range 21-65 years) observed with BCC lesions, 2 (25%) were darkly pigmented and 6 (75%) were albinos. Most of the albinos who presented 3 decades before the darkly pigmented ranged in age from 21-60 years (mean 35.7 years). The lesions afflicted the head and neck region, 9 (82%), while 2 (18%) were observed on the upper limb. All the patients had excision with satisfactory results during the period of follow up that ranged from 6 months to 3 years (mean 13 months). Conclusion: BCC is an uncommon lesion in our region. Albinism and solar radiation were identified risk factors. Most of the albinos presented 3 decades earlier than the darkly pigmented. Early institution of preventive measures, early diagnosis, and treatment would result in better outcome.

Vulvar basal cell carcinoma: A retrospective study of 29 cases from Queensland

Objective: Review the clinical features, diagnosis, management and outcomes for 29 cases of Basal Cell Carcinoma (BCC) of the Vulva referred to Queensland Centre for Gynaecological Cancer (QCGC) between 1986 and 2010. Methods: Vulvar BCC cases from QCGC were reviewed and analysed using the computer software Statistical Package for the Social Sciences (SPSS) 11.0. Results: BCC of the vulva is uncommon with an incidence from the QCGC vulvar cancer registry of 3.2%. Of the 29 patients one died of their BCC and seven died of unrelated causes. The mean age at diagnosis was 69.5 years (range 40 to 91). All cases were Caucasian. Time from onset of symptoms to diagnosis averaged 22.6 months (range 0 - 120 months). Not until a biopsy was performed was the diagnosis made. The most common presenting complaints were pruritis and a lump. Initial treatment was surgical. Conclusions: The prognosis for vulvar BCC is excellent. Histological diagnosis and long term follow-up are important management issues. The status of disease at the margins of surgical specimens does not reliably equate to patient long term outcomes. Follow up should be supervised via a gynecological oncology register to reduce the risk of patient loss to follow up.

Vismodegib Provides a Novel Treatment for Advanced Basal Cell Carcinoma

Objective: To review and evaluate vismodegib, the first US Food and Drug Administration (FDA) approved treatment for locally advanced (laBCC) or metastatic basal cell carcinoma (mBCC) that has recurred after surgery or for patients in which surgery or radiation is not an option. Data Sources: A literature search using PubMed was conducted through January 2013, using the terms vismodegib, GDC-0449, and Erivedge. Additional literature was found through the reference citations of identified articles. Study Selection and Data Extraction: Potential sources were limited to human studies published in English with a priority placed on those focused on laBCC or mBCC. Data Synthesis: Vismodegib is a selective inhibitor of the hedgehog (Hh) pathway approved for the treatment of laBCC or mBCC that has recurred after surgery, or for patients for whom surgery or radiation is contraindicated. Vismodegib inhibits cancer cell growth and survival by binding Smoothened, a transmembrane protein involved in the Hedgehog signal transduction. Vismodegib is administered orally at a dose of 150 mg daily. It is primarily eliminated through the feces unchanged but does have some oxidative metabolites produced from the recombinant cytochrome P450 (CYP) 2C9 and CYP3A4/5. Despite CYP450 involvement, it appears to have very few drug interactions. The most common adverse events reported with vismodegib include muscle spasms, dysgeusia, alopecia, weight loss, fatigue, nausea, anorexia, and diarrhea. FDA approval was based on a single arm phase II study that demonstrated an objective response rate of 30% in mBCC patients and 45% in laBCC patients. Vismodegib was approved by the FDA on January 30, 2012 for use in patients with advanced basal cell carcinoma, and continues to be studied in other patient populations for additional potential uses. Conclusions: Based on a review of current evidence, vismodegib provides an effective and well-tolerated treatment for otherwise untreatable basal cell carcinoma.

Treatment Patterns and Clinical Characteristics of Patients with Advanced Basal Cell Carcinoma in the Community Oncology Setting

Advanced basal cell carcinoma (aBCC) includes metastatic and locally advanced BCC that is inoperable (or with surgery contraindicated). We describe patient characteristics and treatment history for aBCC cases from community oncology. Nine cases of aBCC were found within the ACORN Data Warehouse, a community oncology database of >180,000 cancer patients. Data were summarized descriptively. Three illustrative case histories are presented. Patients were predominantly Caucasian (8/9), male (6/9), and over 60 (6/9). Four had metastatic disease;five had aBCC without metastasis. Five had a history of treatment for early stage BCC, including surgery (5/5), radiation (1/5), and none had chemotherapy. Those with history of early stage BCC had periods of apparent lack of follow-up and treatment. One had chemotherapy for aBCC (platinum based with radiation) and eight had radiation without chemotherapy. Patients had multiple comorbid serious medical conditions. Six were deceased, but only one was documented to have aBCC as cause of death. Advanced BCC is rare in community oncology settings. There appear to be gaps in the care and follow-up of patients with initial early stage BCC. More data and larger samples are needed from multi-specialty databases such as dermatology and head and neck surgery.

Research progress in the cell origin of basal cell carcinoma

Identification of the cell origin of human neoplasms remains a challenging but important task in cancer research.The outcomes in this area of study may allow us to design novel strategies for early cancer detection and targeted cancer therapeutics.Skin is a great organ to study cancer stem cells because stem cells in skin have been well investigated and approaches of genetic manipulation in specific cell compartments are available to mimic clinical skin cancer in a mouse model.Recently,by using different genetic engineered mouse models,several groups have tried to discover which cell type in skin was responsible for the initiation of basal cell carcinoma,the most common type of skin cancer.These studies raised more questions but also showed more ways for future investigation.

Prognostic factors correlation between the cell cycle phases and apoptosis in basal cell carcinoma

Basal cell carcinoma (BCC) is the most common skin malignancy, are found in various forms depending on their clinical and biological behavior. The objective of study was analyzed the phases of the cell cycle and correlations between BCC of low and high risk of recurrence and correlation prognostic factors. The quantity of content DNA in tissues of normal skin, showed small amount of cells in apoptosis and mostly in phase quiescent and rare aneuploidy cells. In BCC, apoptosis was higher in the BCC at high risk than low risk, probably due to their high rates of cell proliferation, and present of aneuploidy cells, when compared to the average percentage of aneuploidy. The DNA content from cells of normal skin shows that the majority is in the quiescent phase;compatible with tissues that are is refreshing. There is presence of apoptosis in the epidermis by probable normal process of differentiation. The aneuploidy in BCC showed a direct correlation with the degree of tumor aggressiveness.

Clinicopathological Pattern of Basal Cell Carcinoma among Sudanese Patients

Background: Basal cell carcinoma (BCC) is a frequently diagnosed skin cancer with variable histopathological types. BCC was not widely studied in Sudan as it is in the Caucasian population. Objectives: To appraise the clinical and histopathological aspects of BCC of the skin in Sudan. Materials and methods: A retrospective descriptive analysis of 84 histologically diagnosed BCC specimens seen at three hospitals in four-year duration were reviewed and classified into histological variants according to the WHO classification 2006. Data were analyzed using Statistical Package for the Social Sciences, version 23.0. Results: The mean age (±SD) of the study participants was 56 (±1.75) years, ranging from 20 to 92 years and 63.1% were females (Female to male ratio 1.7:1). The most common incidence was among the age group 51 - 60 years. The face was the primary tumor site in 89.3% with a predilection for the nasal area (31% of those in the face), followed by the trunk (6%). Out of the total, 54.8% were histologically categorized as nodular/solid, while infiltrative accounts for 11.9% followed by the superficial type (8.3%). Surgical margins were involved in 34.5% of cases and peri-neural invasion was seen in 3.6% of cases, mostly were of the infiltrative variant. Conclusion: BCC in Sudan is commonly present in the head as solid nodular histopathological variant which is correlated with worldwide distribution but has slightly younger age and female predominance;thus further studies are needed to assess risk factors in Sudanese patients and improve approaches for earlier diagnosis and better management.

Cholesterol Crystal Deposition in Basal Cell Carcinoma: An Investigation of 4 Cases

Cholesterol crystals are a primary cause of cholesterol embolism if they appear in vessels. Various papers have reported the involvement of cholesterol crystal deposition in cutaneous diseases such as xanthoma. However, no cases of cholesterol crystal involvement in cutaneous cancer have been reported. We report four cases of basal cell carcinoma with cholesterol crystal deposition, and discuss the mechanism(s) of the condition. Disease duration, anatomical site, histopathological features, and serum lipid profiles were investigated. The median disease duration was 3.5 years, and the sites of the lesions were the scrotum (one patient) and the nose (three patients). Histopathologically, there was necrotized tissue around the clefts. In addition, we detected frequent apoptotic cells around the cholesterol clefts in two of the patients by using the terminal deoxynucleotidyl transferase dUTP nick-end labeling method. Serum lipid levels were slightly elevated in two of the patients. In conclusion, cholesterol crystal deposition in basal cell carcinoma was considered to relate to a long disease duration with a tumor in a region that was subject to external irritation. Histopathologically, apoptotic cells around the cholesterol clefts indicated that lipids from the tumor cell membranes were one of the causes of cholesterol crystal deposition.