Perianal Basal Cell Carcinoma: A Comparative Histologic, Immunohistochemical, and Flow Cytometric Study with Basaloid Carcinoma of the Anus

Perianal basal cell carcinoma is a very rare tumor accounting for only 0.2% of the anorectal tumors. It must be distinguished from basaloid carcinoma of the anus, which resembles it histologically but shows a much more aggressive behavior, metastasizes early, and often proves fatal, thus requiring different therapy. Differential diagnosis of both entities by light microscopy may be difficult. Five cases of perianal basal cell carcinoma and five cases of basaloid carcinoma were studied by means of immunohistochemistry and flow cytometry. Some immunohistochemical markers, such as epithelial membrane antigen, carcinoembrionic antigen, and keratins, as well as the lectin Ulex europaeus agglutinin I stained basaloid carcinoma and were negative for basal cell carcinoma. In contrast, the monoclonal antibody Ber-EP4 seems to be a good marker for perianal basal cell carcinoma and useful in differentiating it from basaloid carcinoma of the anus. Basaloid carcinomas are associated with a significantly higher S-phase fraction than are perianal basal cell carcinomas (p < 0.01).