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. 2023 Jan-Mar;64(1):15-23.
doi: 10.47162/RJME.64.1.02.

Morphological aspects of basal cell carcinoma vascularization

Raluca Maria Bungărdean  1 , Mirela Anca Stoia, Bogdan Pop, Maria Crişan
Affiliations

Morphological aspects of basal cell carcinoma vascularization

Raluca Maria Bungărdean et al. Rom J Morphol Embryol. 2023 Jan-Mar.

Abstract

Basal cell carcinoma (BCC) is a malignant skin cancer which commonly exhibits aberrant blood flow because of angiogenesis. Its invasiveness and lack of metastatic potential may be explained by the typical pattern of vascularization seen in BCCs, where blood vessels are absent in the tumor islands and prominent in the tumor's periphery. From clinical point of view, high-frequency ultrasound (HFUS) is a useful tool for the evaluation of the lateral and depth extension of these tumors; furthermore, by employing color Doppler, important data regarding the vascularization degree of BCCs is provided. Knowingly, the sonographic vascular pattern of cutaneous tumors can aid in improving diagnosis and treatment by differentiating between benign and malignant lesions, between various types of cutaneous malignancies and also between various types of BCC (e.g., low risk versus high risk). Our aim was to perform a review integrating all currently known vascular properties of BCC as a tumor entity.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

Figure 1
Figure 1
Basal cell carcinoma specific vascularization pattern: one to two vascular pedicles. Blood circulation is concentrated at the tumor’s base.
Figure 2
Figure 2
Low-risk and high-risk BCC vascularization pattern (100×): (a and b) Low-risk BCC (nodular variant) – (a) Characteristic histological aspect of nodular variant in HE staining; (b) CD31 IHC staining shows increased microvessel distribution in the stroma surrounding BCC islands; (c and d) High-risk BCC (infiltrative variant) – (c) HE staining shows fibrotic stroma with narrow and variably sized basaloid epithelial islands, a characteristic appearance of the infiltrative variant; (d) CD31 IHC staining shows an abundant MVD in the fibrotic stroma. BCC: Basal cell carcinoma; CD31: Cluster of differentiation 31; HE: Hematoxylin–Eosin; IHC: Immunohistochemical; MVD: Microvessel density.
Figure 3
Figure 3
Comparison between different skin malignancies: (a–c) Color Doppler – (a) BCC, increased blood flow at tumor’s base with arborising pattern; (b) Cutaneous melanoma, hypervascularized tumor with parallel central pattern, with more than two vascular pedicles; (c) SCC, hypervascularized tumor with two vascular pedicles; (d–f) CD31 immunohistochemistry (200×) – (d) BCC, nodular variant, blood vessels surrounding tumor islands with no vessels present inside the islands; (e) Cutaneous nodular melanoma, increased intratumoral vascularization that spreads into nests; (f) SCC, increased intratumoral vascularization that spreads in tumor islands. BCC: Basal cell carcinoma; CD31: Cluster of differentiation 31; SCC: Squamous cell carcinoma.
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