[Sclerodermiform basal cell carcinoma. Apropos of a study of 83 cases]

The authors present a study of 83 cases of sclerodermiform basal cell carcinoma. This series constitutes 2.3% of all skin cancers treated in the authors' unit from 1981 to 1996. The predominant site of these carcinomas is the centrofacial region with 46% of tumours involving the nose. In the majority of cases, treatment consisted of cover by a flap (52.6% of cases). Full-thickness skin grafts were used in 29% of cases and excision-suture was performed in 18.4% of cases. The authors emphasize the need to perform large resection with safety margins determined by the macroscopically visible tumour diameter. As frozen section pathological examination is not contributive, they prefer to defer reconstruction until the final pathology results are obtained. The only exception is the need to cover a vital region, such as the eye. These carcinomas must be followed in the long-term, as 20% of recurrences were detected in this series, comprising many orbitopalpebral sites, associated with difficult staging, and which always have a reserved prognosis. The authors therefore propose the use of epitheses in so-called high-risk sites. The three main guidelines in this disease, one of the most worrying forms of skin cancer, are surgical aggressiveness, modesty in terms of the cosmetic result and alertness in the follow-up.