PubMed · 10522675
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T W McGovern, D J Leffell. 1999. Mohs surgery: the informed view.. https://doi.org/10.1001/archderm.135.10.1255
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Basal cell carcinoma (BCC) is one of the most common skin neoplasms in humans and is usually characterized by local aggressiveness with little metastatic potential, although deep invasion, recurrence, and regional and distant metastases may occur. Here, we studied the mechanism of BCC invasion. We found that human BCC tissues and a BCC cell line had significant expression of CXCR4, which was higher in invasive than non-invasive BCC types. Further, of 19 recurrent tumors among 390 BCCs diagnosed during the past 12 years, 17/19 (89.5%) had high CXCR4 expression. We found that the CXCR4 ligand, stromal-cell-derived factor 1alpha (SDF-1alpha), directed BCC invasion and that this was mediated by time-dependent upregulation of mRNA expression and gelatinase activity of matrix metalloproteinase-13 (MMP-13). The transcriptional regulation of MMP-13 by SDF-1alpha was mediated by phosphorylation of extracellular signal-related kinase 1/2 and activation of the AP-1 component c-Jun. Finally, CXCR4-transfected BCC cells injected into nude mice induced aggressive BCCs that co-expressed CXCR4 and MMP-13. The identification of SDF-1alpha/CXCR4 as an important factor in BCC invasiveness may contribute insight into mechanisms involved in the aggressive potential of human BCC and may improve therapy for invasive BCCs.
Traditional lining techniques such as prefabricated flaps, hinge-over flaps, or second local flaps for lining are thick, stiff, or poorly vascularized. Support grafts have traditionally been placed incompletely or secondarily. Intranasal lining flaps have revolutionized reconstruction but are complex, tedious, and destructive to the residual nose. More recently, the forehead skin has been transferred for cover as a full thickness flap in three stages. It has allowed the modification of the traditional folded flap technique for lining to permit a simple, efficient, and widely useful method of lining replacement for common defects. Thin, supple, vascular lining is combined with delayed primary cartilage grafts to provide excellent functional and cosmetic results.