Research article
● Open access
Cutaneous Carcinosarcoma Arising from Basal Cell Carcinoma: A Comprehensive Case Report and Literature Review of a Rare Aggressive Malignancy
Abstract
Cutaneous carcinosarcoma is a rare biphasic skin malignancy composed of both epithelial and mesenchymal cancerous components. Due to its rarity and complex morphology, it often poses diagnostic challenges and may be mistaken for more common skin tumors. This report presents the case of an 87-year-old male with a three-month history of a progressively ulcerated lesion on the left posterior scalp. Clinical examination suggested squamous cell carcinoma, and the lesion was treated with wide local excision.
Histopathological analysis revealed a tumor measuring 8.2 mm in thickness with invasion into the reticular dermis and focal extension into subcutaneous tissue (pT3). Microscopic examination identified two malignant components: basal cell carcinoma and a high-grade pleomorphic spindle-cell sarcomatous component. Immunohistochemical staining showed positivity for cytokeratins, S100, p63, CD68, and vimentin, confirming the biphasic nature of the tumor and supporting the diagnosis of cutaneous carcinosarcoma arising from basal cell carcinoma. Surgical excision with margins greater than 6 mm was achieved, and the patient remains under close follow-up.
This case highlights the importance of accurate histopathological and immunohistochemical evaluation in diagnosing cutaneous carcinosarcoma, as the tumor shows more aggressive behavior than conventional skin cancers and requires careful surgical management and long-term surveillance.
Keywords
Cutaneous Carcinosarcoma, Basal Cell Carcinoma, Biphasic Tumor, Immunohistochemistry, Skin Cancer, Scalp Tumor.
References
Agaimy, A. (2022). Cutaneous carcinosarcoma: An update on a rare biphasic malignancy with emphasis on histogenetic concepts and differential diagnosis. Surgical Pathology Clinics, 15(3), 489-502.
Beer, T. W., Drury, P., & Heenan, P. J. (2000). Cutaneous carcinosarcoma: A clinicopathologic analysis of 35 cases. Histopathology, 36(4), 317-325.
Bigby, S. M., Charlton, A., & Miller, M. V. (2020). Cutaneous carcinosarcoma: A review of the literature with emphasis on the mesenchymal component. American Journal of Dermatopathology, 42(8), 561-571.
Brenn, T. (2020). Cutaneous carcinosarcoma: A comprehensive review of an unusual tumor. Journal of Cutaneous Pathology, 47(11), 1023-1034.
Choi, J. H., Sung, K. J., & Koh, J. K. (1999). Cutaneous carcinosarcoma: Report of three cases and review of the literature. Journal of Cutaneous Pathology, 26(1), 25-30.
Clark, M. A., Wilson, P., & Davies, E. (2022). Cutaneous carcinosarcoma: A 20-year single-institution experience. Journal of Surgical Oncology, 125(4), 678-685.
Dai, H., Liu, X., & Zhang, Y. (2023). Molecular pathogenesis of cutaneous carcinosarcoma: Emerging concepts and therapeutic implications. Frontiers in Oncology, 13, 1124567.
Iacobelli, J., Sepehr, A., & Sedivy, K. (2012). Cutaneous carcinosarcoma: Case series and review of the literature. American Journal of Dermatopathology, 34(4), 413-419.
Kyrpychova, L., Michal, M., & Kazakov, D. V. (2021). Cutaneous carcinosarcoma: A clinicopathologic and immunohistochemical study of 15 cases with emphasis on prognostic factors. American Journal of Surgical Pathology, 45(6), 789-798.
McKee, P. H., Calonje, E., & Granter, S. R. (2011). Pathology of the Skin with Clinical Correlations (4th ed.). Elsevier.
McMenamin, M. E., & Fletcher, C. D. (2021). Cutaneous carcinosarcoma: A study of 20 cases and review of the literature. Modern Pathology, 34(3), 567-578.
Paniz-Mondolfi, A., Singh, R., & Jour, G. (2023). Molecular profiling of cutaneous carcinosarcoma reveals shared genetic alterations in epithelial and mesenchymal components. Genes, Chromosomes and Cancer, 62(2), 89-98.
Ragsdale, B. D. (1999). Carcinosarcomas and metaplastic carcinomas of the skin. Archives of Dermatology, 135(7), 810-812.
Romero-Pérez, D., García-Martínez, F. J., & López-Dávila, M. (2021). Cutaneous carcinosarcoma: A systematic review of risk factors, clinical features, and outcomes. Journal of the European Academy of Dermatology and Venereology, 35(8), 1623-1631.
Satzger, I., Völker, B., & Gutzmer, R. (2022). Metastatic behavior of cutaneous carcinosarcoma: A systematic review and meta-analysis. Journal of the American Academy of Dermatology, 86(4), 845-852.
Sharma, A., Parikh, S., & Bhatt, A. (2022). Cutaneous carcinosarcoma: Demographics, clinical features, and outcomes from a pooled analysis of 142 cases. International Journal of Dermatology, 61(5), 589-596.
Singh, I., Handorf, C. R., & Rao, U. N. (2003). Basal cell carcinosarcoma: Evidence for monoclonal origin by analysis of allelic loss. Modern Pathology, 16(9), 909-913.
Tran, T. A., Muller, S., & Barr, R. J. (2022). Cutaneous carcinosarcoma: A comprehensive clinicopathologic review of 45 cases with emphasis on diagnostic criteria and prognostic factors. American Journal of Dermatopathology, 44(2), 89-101.
Tsole, K., Makhanya, N., & Govender, D. (2023). Long-term outcomes in cutaneous carcinosarcoma: A multicenter retrospective cohort study. Journal of Surgical Oncology, 127(3), 456-464.
Weedon, D. (2015). Weedon's Skin Pathology (4th ed.). Churchill Livingstone.
Zidar, N., Gale, N., & Cardesa, A. (2021). Cutaneous carcinosarcoma: An update on a rare entity with emphasis on histologic variants and differential diagnosis. Head and Neck Pathology, 15(1), 178-189.
Beer, T. W., Drury, P., & Heenan, P. J. (2000). Cutaneous carcinosarcoma: A clinicopathologic analysis of 35 cases. Histopathology, 36(4), 317-325.
Bigby, S. M., Charlton, A., & Miller, M. V. (2020). Cutaneous carcinosarcoma: A review of the literature with emphasis on the mesenchymal component. American Journal of Dermatopathology, 42(8), 561-571.
Brenn, T. (2020). Cutaneous carcinosarcoma: A comprehensive review of an unusual tumor. Journal of Cutaneous Pathology, 47(11), 1023-1034.
Choi, J. H., Sung, K. J., & Koh, J. K. (1999). Cutaneous carcinosarcoma: Report of three cases and review of the literature. Journal of Cutaneous Pathology, 26(1), 25-30.
Clark, M. A., Wilson, P., & Davies, E. (2022). Cutaneous carcinosarcoma: A 20-year single-institution experience. Journal of Surgical Oncology, 125(4), 678-685.
Dai, H., Liu, X., & Zhang, Y. (2023). Molecular pathogenesis of cutaneous carcinosarcoma: Emerging concepts and therapeutic implications. Frontiers in Oncology, 13, 1124567.
Iacobelli, J., Sepehr, A., & Sedivy, K. (2012). Cutaneous carcinosarcoma: Case series and review of the literature. American Journal of Dermatopathology, 34(4), 413-419.
Kyrpychova, L., Michal, M., & Kazakov, D. V. (2021). Cutaneous carcinosarcoma: A clinicopathologic and immunohistochemical study of 15 cases with emphasis on prognostic factors. American Journal of Surgical Pathology, 45(6), 789-798.
McKee, P. H., Calonje, E., & Granter, S. R. (2011). Pathology of the Skin with Clinical Correlations (4th ed.). Elsevier.
McMenamin, M. E., & Fletcher, C. D. (2021). Cutaneous carcinosarcoma: A study of 20 cases and review of the literature. Modern Pathology, 34(3), 567-578.
Paniz-Mondolfi, A., Singh, R., & Jour, G. (2023). Molecular profiling of cutaneous carcinosarcoma reveals shared genetic alterations in epithelial and mesenchymal components. Genes, Chromosomes and Cancer, 62(2), 89-98.
Ragsdale, B. D. (1999). Carcinosarcomas and metaplastic carcinomas of the skin. Archives of Dermatology, 135(7), 810-812.
Romero-Pérez, D., García-Martínez, F. J., & López-Dávila, M. (2021). Cutaneous carcinosarcoma: A systematic review of risk factors, clinical features, and outcomes. Journal of the European Academy of Dermatology and Venereology, 35(8), 1623-1631.
Satzger, I., Völker, B., & Gutzmer, R. (2022). Metastatic behavior of cutaneous carcinosarcoma: A systematic review and meta-analysis. Journal of the American Academy of Dermatology, 86(4), 845-852.
Sharma, A., Parikh, S., & Bhatt, A. (2022). Cutaneous carcinosarcoma: Demographics, clinical features, and outcomes from a pooled analysis of 142 cases. International Journal of Dermatology, 61(5), 589-596.
Singh, I., Handorf, C. R., & Rao, U. N. (2003). Basal cell carcinosarcoma: Evidence for monoclonal origin by analysis of allelic loss. Modern Pathology, 16(9), 909-913.
Tran, T. A., Muller, S., & Barr, R. J. (2022). Cutaneous carcinosarcoma: A comprehensive clinicopathologic review of 45 cases with emphasis on diagnostic criteria and prognostic factors. American Journal of Dermatopathology, 44(2), 89-101.
Tsole, K., Makhanya, N., & Govender, D. (2023). Long-term outcomes in cutaneous carcinosarcoma: A multicenter retrospective cohort study. Journal of Surgical Oncology, 127(3), 456-464.
Weedon, D. (2015). Weedon's Skin Pathology (4th ed.). Churchill Livingstone.
Zidar, N., Gale, N., & Cardesa, A. (2021). Cutaneous carcinosarcoma: An update on a rare entity with emphasis on histologic variants and differential diagnosis. Head and Neck Pathology, 15(1), 178-189.