Cutaneous Basal Cell Carcinoma Arising in Odontogenic Cutaneous Fistula

Abstract

An odontogenic cutaneous fistula is a pathological communication between the outer skin surface of the face and the oral cavity. Facial cutaneous fistula is a complication of odontogenic infection that is often misdiagnosed with skin infection. We report a rare case, which was diagnosed as basal cell carcinoma based on the biopsy of skin lesions in the patient who had been diagnosed with odontogenic cutaneous fistula. A 64-year-old male patient presented with a cutaneous odontogenic fistula. The patient had undergone surgical extraction of fistula tract and loose tooth before dermatology or plastic surgery consultation. With the biopsy and computed tomography, it was confirmed that fistula and basal cell carcinoma. However, the connection between the fistula and skin cancer was not clear. Positron emission tomography-computed tomography scan was performed and was not detected as other local or distant metastasis. After that, wide excision of the skin lesion was performed. Although skin cancer is not commonly observed, it is necessary to rule out this disease entity by performing biopsy of skin lesions.

Neglected basal cell carcinoma presenting with diffuse skeletal metastases

“… 6 Various different types of trauma have been reported, including sharp or blunt injury, 7 surgical incisions, 8 vaccination sites, 9 piercings, 10 abscesses, 11 or fistulas. 12 Thermal or chemical burns are a common type of trauma associated with carcinoma. In fact, certain cultural practices of using thermal injury to the skin lead to burn scars with subsequent carcinomas that have been given eponyms such as Kangri and Kang cancers.…”

November’s 2020 Full Issue PDF

“…39 In a 64-year-old male patient with cutaneous basal cell carcinoma arising in odontogenic cutaneous fistula the sinus tract was also lined by inflamed granulation tissue. 32 Chang highlighted two case reports (23-year-old and 55-year-old males) with extraoral odontogenic sinus tracts which included its excision and in both patients the histologic report revealed chronic inflammation with fibrosis. 40 Other sources, which describe an odontogenic subcutaneous granuloma (as an OCST manifestations), reported the presence of granulation tissue in subcutaneous layer (in a place of cutaneous lesion), where it develops in the form of separate clusters -granulomas.…”

“…Moreover, Kim et al reported a unique case of cutaneous basal cell carcinoma arising in the area of odontogenic cutaneous fistula in a 64-year-old male patient. 32 Pseudofluctuation (feeling upon palpation for the false wavelike motion of the collected fluid [eg, pus]) is one of the core sings for the OCST manifested as a subcutaneous granuloma. 6 In fact, the symptom of pseudofluctuation is explained by the abundance of granulation tissue in the pathological focus.…”

“…Berman and Rotstein insisted that presence/absence of an epithelial lining does not seem to prevent closure of the tract as long as the source of the problem is properly diagnosed and adequately treated and the tooth-associated infection has eliminated. 25 Thus, although conservative treatment 22,29,36 nowadays is highly advocated, we strongly recommend (taking into account the experience from Korea) 32 to choose between two different management combinations for the group of elderly patients: 1) endodontic plus surgical treatment (apicoectomy + excision of the tract and cutaneous lesion) or 2) necrotic tooth extraction + excision of the tract and cutaneous lesion.…”

Odontogenic Fistula

“…1 Odontogenic cutaneous fistula is an uncommon disease and could be easily misdiagnosed, 2-4 and it can often mimic basal cell carcinomas, epidermoid cysts, or pyogenic granulomas. 2 The classic lesion is an erythematous, smooth, symmetrical nodule with or without drainage, which is associated with dental pain in up to 50% of patients. 1 When a dental infection is suspected, a radiography analysis can show bone loss in the apex of the infected tooth.…”