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Area of Science:

  • Dermatopathology
  • Oncology

Background:

  • Intravascular tumor invasion is often linked to metastasis in cancers.
  • Basal cell carcinomas (BCCs) rarely metastasize, making the clinical impact of intravascularly invasive BCC (IVBCC) uncertain.
  • The existence and diagnostic criteria for IVBCC are debated due to its rarity and potential for artifactual findings.

Purpose of the Study:

  • To present cases of IVBCC.
  • To discuss challenges in studying IVBCC, including artifact and lack of clinical-pathological correlation.
  • To propose diagnostic criteria for IVBCC to reduce diagnostic ambiguity.

Main Methods:

  • Case series presentation.
  • Immunolabeling of blood vessels.
  • Review of diagnostic challenges and artifactual considerations.
  • Development of proposed diagnostic criteria.

Main Results:

  • Four cases of IVBCC were identified: one in advanced disease with clear vascular invasion, and three incidentally found during Mohs surgery.
  • Challenges in definitive diagnosis due to rarity, artifact, and lack of direct clinical correlation were discussed.
  • Proposed diagnostic criteria aim to standardize pathological identification.

Conclusions:

  • Standardized diagnostic criteria are needed to address the ambiguity surrounding IVBCC.
  • Further studies are required to elucidate the clinical significance of IVBCC.
  • Improved diagnostic accuracy may facilitate research into the metastatic potential and clinical outcomes of IVBCC.