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Sites of Basal Cell Carcinomas and Head and Neck Congenital Clefts: Topographic Correlation

Nicoletti, Giovanni MD, FEBoPRAS*†‡; Brenta, Federica MD*‡; Malovini, Alberto PhD§¶; Jaber, Omar MD*‡; Faga, Angela MD, FICS*†‡

Plastic and Reconstructive Surgery – Global Open: June 2014 - Volume 2 - Issue 6 - p e164
doi: 10.1097/GOX.0000000000000119
Original Articles

Background: The embryologic fusion planes might be related with the sites of onset of basal cell carcinoma (BCC), thus supporting an embryologic role for its pathogenesis.

Methods: A study involving 495 patients with 627 BCCs of the head and neck was carried out over a period of 5 years by correlating the distribution of all BCCs with the sites of congenital clefts of the head and neck using (1) the original anatomic diagram of the Tessier classification of craniofacial clefts, (2) the anatomic diagram by Moore et al featuring the paths of the “hairline indicators” of craniofacial clefts that represent the cranial extensions of the Tessier classification, and (3) an anatomical diagram featuring the sites of congenital clefts of the neck.

Results: The proportion of BCCs localized within a cleft site was significantly higher than those in the noncleft sites. The age of patients with BCCs localized within the Tessier cleft number 3 was the lowest among all cleft regions.

Conclusions: A topographic correspondence between the sites of BCCs and the sites of congenital clefts was demonstrated in the head and neck. This evidence would support the hypothesis of an embryologic role for the pathogenesis of BCC. The existence of clusters of embryological stem cells in the sites of fusion and/or merging of embryonic processes might therefore be proposed. There may be special biology/physiology along these cleft lines that predispose BCC formation.

From the *Plastic and Reconstructive Surgery, Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy; Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Centre, University of Pavia, Pavia, Italy; Plastic and Reconstructive Surgery Unit, Salvatore Maugeri Research and Care Institute, Pavia, Italy; §Department of Computer Engineering and Systems Science, University of Pavia, Pavia, Italy; and Laboratory of Informatics and Systems Engineering for Clinical Research, Salvatore Maugeri Research and Care Institute, Pavia, Italy.

Received for publication November 14, 2013; accepted April 15, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Giovanni Nicoletti, MD, FEBoPRAS, Plastic, Reconstructive and Aesthetic Surgery Unit, University of Pavia, Salvatore Maugeri Research and Care Institute, Via Salvatore Maugeri, 10, 27100 Pavia, Italy, E-mail:

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© 2014 American Society of Plastic Surgeons