Giant, Neglected Basal Cell Carcinomas and Neuropeptides: Could Alteration of Nociception and/or Mood Produce Neglect?
Jennifer Garbaini, Peter Engel, Song Lu, Ang Lee, Bruce Ragsdale, Andrzej Slominski, John A Carlson. Albany Medical College, NY; VA Hospital, Boston, MA; Stratton VA Medical Center, Albany, NY; Western Dermatopathology, San Luis Obispo, CA; University of TN Medical Center, Memphis, TN
Background: Infection and pain rarely complicate giant, neglected basal cell carcinomas (BCC). Notably, both normal and malignant epidermal tissues, including BCC, produce neuropeptides with opioid, antibacterial, and other effects. These peptides could potentially induce local analgesia and systemic effects such as mood alteration. Our objective was to document the clinicopathologic findings of a series of giant neglected BCC and compare the expression of neuropeptides to controls of conventional BCC.
Design: Clinicopathologic data was collected for 7 cases of giant (>5cm), neglected (>5years duration) BCC. The expression of serotonin (Abcam, MA), ACTH (Harbor-UCLA, Torrance, CA), ß-endorphin (Harbor-UCLA), met-enkephalin (Abcam) and neurofilament (Dako) was done by automated methods (Ventana Medical Systems Inc., Tucson, AZ). Clinicopathologic and immunohistochemistry findings were compared with 11 conventional BCC, matched for histologic pattern.
Results: Giant BCC occurred in 4 males/3 females with a mean age of 78yrs (range 62-90). All tumors had been hidden and neglected for greater than a mean 11yrs (range 5.1-20); were ulcerated; had a mean largest dimension of 17cm (range 5.5-30cm); affected the face and scalp (6) or forearm (1); and exhibited nodular and infiltrative patterns with bone invasion in 5 and destruction of orbit and eye in 2 patients. Compared to conventional BCC controls, giant BCC had a higher mean labeling index (LI) of expression of serotonin (2% vs. 0) and ACTH (8% vs. 4%), but a lower mean LI for ß-endorphin (40% vs. 78%) and met-enkephalin (30% vs. 76%). Neither controls nor giant BCC had intratumoral nerves, where as 46% and 17%, respectively had peritumoral nerve filaments.
Conclusions: BCC, conventional and giant, express proopiomelanocortin (POMC)-derived ß-endorphin and proenkephalin derived met-enkephalin with opioid activity at significantly higher levels than of POMC-derived ACTH or unrelated serotonin neuropeptides. Their dosage, possibly related to BCC size, could impact on the patients' pain perception and/or mood leading to neglect. Further investigates could include measurement of neuropeptides levels in the general circulation; examination for activated opioid receptors on sensory nerves in perilesional skin; and/or whether opiate antagonists affect the patient's perception of their tumors.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 114, Wednesday Afternoon