Multimodal Considerations Concerning Basal Cell Carcinoma Clefting – Profile of Structural and Aggressive Traits – Perspectives

Elena Niculet1,2 *, Carmen Bobeica1 *, Mihaela Craescu,1,2 Alin Codrut Nicolescu3 *, George Tocu,4 Cristian Onisor1 *, Manuela Arbune5 *, Alin Laurentiu Tatu2,5,6 1Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania; 2Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, Romania; 3Roma Medical Center for Diagnosis and Treatment, Bucharest, Romania; 4Department of Pharmaceutical Sciences, “Dunărea de Jos” University, Galati, Romania; 5Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania; 6Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galați, Romania*These authors contributed equally to this workCorrespondence: Mihaela Craescu, Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 35 Alexandru Ioan Cuza Street, Galați, 800008, Romania, Tel +40751869864, Email dr.craescumihaela@yahoo.ro George Tocu, Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 35 Alexandru Ioan Cuza Street, Galați, 800008, Romania, Tel +40773819438, Email george_tocu@yahoo.comAbstract: Although basal cell carcinoma is a well-known tumor with confirmed clinical and histopathology traits, prognosis factors and treatment options, new facets of this tumor emerge as innovative approach methods develop. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) allow a basal cell carcinoma’s in vivo analysis of its depth of invasion, tumor margins prior to surgical approach and the tumor’s response to a non-invasive treatment, evaluating simultaneously the tumor’s vasculature. By RCM and OCT analysis, basal cell carcinoma has registered a groundbreaking discovery regarding a small (but with predictive factor potential) trait – the cleft, developing in between the tumor islands/nodules/chords and the surrounding tumor stroma; it was considered to date as a consequence of the tissue’s histopathology processing. RCM and OCT revealed that the “clefting artifact”, as it is frequently found in the medical literature, is not actually an artifact of laboratory processing, but a tumor trait found in vivo, with apparent mucin deposits. This review aims at merging the methods of evaluating basal cell carcinoma, both non-invasive (dermoscopy, RCM, OCT) and invasive ones (histopathology – with newly proposed classification), with special emphasis on the cleft issue – its assessment with the aforementioned techniques, with potential implications in the patient’s prognosis.Keywords: basal cell carcinoma, cleft, structural aggressive traits, reflectance confocal microscopy, optical coherence tomography, pathology