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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
Atypical Recurrent Presentation of Histologically Aggressive Type of Basal Cell Carcinoma with a Challenging Management- A Rare Case Report
Correspondence Address :
Dr. Kamala Balakrishnan,
Old Malaysian Girls Hostel, VMKV Hospital, Attayampatti Seeragapadi, Salem-636308, Tamil Nadu, India.
E-mail: balakrishnankamala54@gmail.com
Basal Cell Carcinoma (BCC) is the most common type of eyelid malignancy among white race individuals but is rare among blacks and Indians. The BCC predominantly affects the sun exposed parts like the neck, back and face (88-90%). These tumours are mostly located on the lower eyelid margin and the medial canthus as upper eyelids are protected from the Ultraviolet (UV) sunrays by the eyebrows and superior orbital margin. Although BCC seldom metastasizes, it is nonetheless considered malignant, since it can infiltrate adjacent tissues and cause substantial deformity and destruction. Here, authors have reported a rare case of 55-year-old female patient with recurrence of surgically treated BCC of upper eyelid involving eyebrow. Surgical excision is the most common employed treatment of choice in extensive tumours. Patient had extensive recurrent spread of BCC in left upper eyelid with multiple small ulcers in and around the left eye with pain and no Perception of Light (PL) vision. Exenteration of left eye was done followed by split skin autografting at the site. The BCC is usually not fatal, but early diagnosis and appropriate treatment promises better functionality and aesthetic outcome.
Malignancy, Metastasis, Tumour
A 55-year-old female patient, field worker by occupation, resident of South India, presented to the Ophthalmology Outpatient Department in January 2020 with an ulcerative lesion on the left upper eyelid. Patient first noticed a small ulcerative lesion near the left lateral canthus two years back which was diagnosed as BCC, following which wide local excision with a flap cover was done in 2018. Patient noticed a similar ulcerative lesion and complained of pain two months following the surgery at the same site which had gradually progressed to the present size measuring 3×0.5 cm in the upper eyelid in almost a year; associated with pain and had difficulty in opening the left eye. Patient also had history of severe itching and profuse foul smelling discharge. No history of any other systemic illness and family history of skin carcinoma or any other malignancy.
Ocular examination findings of left eye showed no PL. Left eyebrow and eyelid showed ulcerative lesion with rolled, beaded edges. Lid oedema and loss of upper lid eyelashes and sparse lower lid nasal eyelashes with profuse foul smelling purulent discharge was present. Multiple irregular shaped ulcers were noted on upper eyelid, Lower eyelid, below lateral canthus and eye measuring 3×0.5 cm, 0.5×0.5 cm, 3×1 cm and 4×1.5 cm, respectively with rolled, raised and beaded pigmented edge with ulceration in the floor (Table/Fig 1). Tenderness was present. Bleeding was absent. Slit lamp examination of anterior segment was not possible to assess due to extensive spread of ulcerative lesion over left cornea and conjunctiva. Preoperative Contrast Enhanced Computed Tomography of Paranasal Sinuses (CECT-PNS) showed variable enhancing soft tissue thickening of size 2.1×2.0 cm at lateral canthus of eye involving the lateral rectus muscle and left eyelid with optic nerve thickening (Table/Fig 2). The provisional diagnosis of recurrence of BCC of left upper eyelid was made based on the preoperative findings and investigations.
Since the patient had a history of BCC of left lateral canthus and presented now with similar ulcerative lesion of left upper eyelid and since the vision of the patient was completely compromised, no conservative management was planned, and we opted for surgical exenteration of left eye with Split Skin Grafting (SSG) (Table/Fig 3). Periosteum along with entire orbital contents including the anterior part of optic nerves, orbital fat, extra ocular muscles, eyelids and entire globe was removed. Patient’s left eye was prepared for harvesting graft and a partial thickness SSG was placed over the recipient area of the eye socket. Exenterated specimen measured (Table/Fig 4)a 6×3.5×3.5 cm along with 1 cm long optic nerve. Cut section showed ulceroinfiltrative grey, white growth in the upper eyelid measuring 2.5×0.9×0.5 cm (Table/Fig 4)b. Another satellite lesion in the lateral canthus measuring 0.8×0.5×0.5 cm was also marked.
Histopathological report of intraoperative excised tissue showed features suggestive of metatypical (basosquamous) BCC admixed with areas of adenoid and pigmented BCC of left upper eyelid and lateral canthus (Table/Fig 5)a-d with tumour invasion in resected margin.
Diagnosis was confirmed with histopathology report showing infiltrating malignant epithelial neoplasm in nests, cords, sheets and lace like pattern. Tumour nests with peripheral palisading, retraction artefact and peritumoural mucoid material deposition was observed with extensive areas of keratinisation, squamoid differentiation, pigmentation and necrosis.
Surgery went uneventful and the treatment was well tolerated. Patient was reviewed at postoperative day 14 (Table/Fig 6) and graft site was found healthy. Patient was kept for regular follow-up and prosthetic eye will be planned in the future.
Basal cell carcinoma is the most common eyelid malignancy amongst the Caucasian population however, in India it is the second most common eyelid malignancy, first being squamous cell carcinoma (1),(2),(3). The site distribution in this case is in concordance with the literature. The highest percentage (47%) of all BCC cases were marked to be located on the face, followed by the trunk, lower and upper limb, neck and hair free skin (4). The trend observed in this case was confirmed in other studies (5). Nodular BCCs were found to be the most frequent subtype of BCC for both males and females (69.74%) (4). In a study conducted by Ghartimagar D et al., at Pokhara found that, the histological subtype predominant was nodular with 41 (53.94%) cases, followed by the 14 (18.42%) cases of pigmented and 10 (13.15%) cases of basosquamous subtype (6). Few other studies conducted among South Asian population by Ullah O et al., Asif M et al., Laishram RS et al., Malhotra P et al., Chow VLY et al., Janjua OS and Qureshi SM, Chang JM and Gao XM had come to the similar conclusion of nodular variety being the most common type of BCC presentation (7),(8),(9),(10),(11),(12),(13). The BCC being a rare presentation among South Asian population only few studies were conducted and details of studies done are mentioned (Table/Fig 7) (7),(8),(9),(10),(11),(12),(13).
The most frequent site of origin is lower eyelid and medial canthus. However, in the present case the lesion appeared in a much rarer site (left upper eyelid and lateral canthus). About 90% of BCC occurs among the age group of 55 to 70 years (14),(15). However, in this case the lesion had first appeared at the age of 50 years. After two months from the surgery the patient had a recurrence at the same site. The recurrent lesion gradually progressed in size in two years. The patient was an agricultural worker for almost 30 years, native of a hot weather village in South India, owing to prolonged high exposure to sunlight. The UV radiation, most specifically UV-B is currently believed to be the most crucial etiological factor for BCC. In a study conducted by Malhotra P et al., among BCC patients in North India, 91% patients had history of prolonged sunlight exposure (10).
The present case patient hails from a subtropical district in southern India a place with very high temperature. Patient is an agricultural field worker who previously used to work outdoors during morning hours regularly. In this case, environmental and occupational parameters would have played the key roles in the development of BCC.
According to National Comprehensive Cancer Network (NCCN) guidelines 2019 for high risk BCC, Mohs micrographic surgery or an excision with 1 cm circumferential clearance is suggested (16). According to study done by Ro KW et al., pigmented BCCs show lesser subclinical infiltration than non pigmented BCCs (17). Since the patient presented with recurrence of BCC of left upper eyelid and since the vision of the patient was completely compromised, authors opted for exenteration of left eye with SSG with 1 cm circumferential clearance.
Basal cell carcinoma is an extremely complex disease, with many aetiological factors influencing its development. In this case report, the aetiological factors related to the development of this rare BCC presentation were older age and exposure to prolonged UV rays both environmental and in occupational form, with a clear impact on the patients’ quality of life. This causes a significant burden to the health system, especially in such cases of invasive behaviour and recurrence after treatment. Educating the patients regarding all the risk factors and special attention to the diagnosis of minor lesions through self examination are crucial in prevention and improved prognosis, and faster diagnosis particularly in susceptible population.
DOI: 10.7860/JCDR/2022/52952.16052
Date of Submission: Oct 22, 2021
Date of Peer Review: Dec 09, 2021
Date of Acceptance: Dec 23, 2021
Date of Publishing: Mar 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 23, 2021
• Manual Googling: Dec 08, 2021
• iThenticate Software: Jan 11, 2022 (20%)
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