Basosquamous Basal Cell Carcinoma with Bone Marrow Metastasis
Round 1
Reviewer 1 Report
This is a very interesting clinical scenario. However, with the immunohistochemical profile of the tumour perhaps a more extensive immuno panel should be cited to show that the metastasis is a BCC rather than a SCC with BCC differentiation.
A more detailed discussion on the immunohistochemical results would be appropriate
as Such the title should be' Basosquamous BCC..
A more detailed explanation on the immunohistochemical profile of both the primary and metastatic tumours to support the authors' assertion that this is truly a metastatic BCC without a squamous element.
Author Response
This is a very interesting clinical scenario. However, with the immunohistochemical profile of the tumour perhaps a more extensive immuno panel should be cited to show that the metastasis is a BCC rather than a SCC with BCC differentiation. A more detailed discussion on the immunohistochemical results would be appropriate
We are grateful for the mainly positive feedback from reviewer 1. In the revised version we have in more detail discussed the immunohistochemical features of the tumors.
as Such the title should be' Basosquamous BCC.
We thank you for this comment, and accordingly the title is changed.
A more detailed explanation on the immunohistochemical profile of both the primary and metastatic tumours to support the authors' assertion that this is truly a metastatic BCC without a squamous element.
We have also emphasized these features in more detail in the discount part of the revised manuscript.
Reviewer 2 Report
This is a nice case report article. More details on histological subtypes in Introduction could be useful to clarify risk factors in BCC clinical behavior.
Also in Discussion more data on basosquamous subtype and more details on HIC results could be useful
Author Response
This is a nice case report article. More details on histological subtypes in Introduction could be useful to clarify risk factors in BCC clinical behavior.
We are thankful for the nice feedback. We have made some alterations in the introduction to include the risk factor of different histological subtypes.
Also in Discussion more data on basosquamous subtype and more details on HIC results could be useful.
We have included some more information on basosquamous subtype and HIC in the discussion.
Reviewer 3 Report
- What is the main question addressed by the research?
The authors presented an interesting and a very rare case of bone and bone marrow metastatic BCC.
2. Do you consider the topic original or relevant in the field, and if
so, why?
It is estimated that only 0,4% of BCC metastasize. Metastatic BCC are rarely reported and such an unique case with a very fast spread and bone morrow involvement is rarely seen.
3. What does it add to the subject area compared with other published
material?
Despite surgical removal of the original lesion and a CT scan performed at the time of operation not showing any spread of the tumour, the patient developed widespread metastases within 3 months. Moreover, the patient psychiatric and general condition made the treatment decisions challenging.
- What specific improvements could the authors consider regarding the
methodology?
No methodology was involved, as it was a case report.
5. Are the conclusions consistent with the evidence and arguments
presented and do they address the main question posed?
It is a well written case with only minor clarifications/English improvements needed
Minor problems. Line 19 - I am not sure what you meant by differing growth pattern, please clarify. Line 42 I understand should be "with" instead of "which" Line 88 - "reduced" general condition should be replaced by a different word - poor?
Author Response
- What is the main question addressed by the research?
The authors presented an interesting and a very rare case of bone and bone marrow metastatic BCC.
- Do you consider the topic original or relevant in the field, and if
so, why?
It is estimated that only 0,4% of BCC metastasize. Metastatic BCC are rarely reported and such an unique case with a very fast spread and bone morrow involvement is rarely seen.
- What does it add to the subject area compared with other published
material?
Despite surgical removal of the original lesion and a CT scan performed at the time of operation not showing any spread of the tumour, the patient developed widespread metastases within 3 months. Moreover, the patient psychiatric and general condition made the treatment decisions challenging.
- What specific improvements could the authors consider regarding the
methodology?
No methodology was involved, as it was a case report.
- Are the conclusions consistent with the evidence and arguments
presented and do they address the main question posed?
It is a well written case with only minor clarifications/English improvements needed
Minor problems. Line 19 - I am not sure what you meant by differing growth pattern, please clarify. Line 42 I understand should be "with" instead of "which" Line 88 - "reduced" general condition should be replaced by a different word - poor?
We have made changes to line 19.
We have changed “reduced” with the word impaired.
English grammar has been improved.
Round 2
Reviewer 1 Report
This is now acceptable for publication.