The Cutaneous Cancer of Ferdinando Orsini, 5th Duke of Gravina

The natural mummy of Ferdinando Orsini, Duke of Gravina in Apulia (southern Italy), dead in 1549 at about 50-55 years of age, showed the face completely covered by a veil and two small patches of cloth at the root of the nose and in the right orbit . After removal of the veil and the patches, surely a medical dressing, an extensive and destructive lesion of the right orbit and the root of the nose appeared (Fig. 6b). The lesion revealed, at macroscopic examination, complete destruction of the right and root of the left nasal bone, destruction of the medial wall of the right orbit with extensive erosion of the glabellar region and the upper third of the vomer. X-ray examination of the facial skull showed a large, irregular loss of bone, extending from the inner corner of the right orbit, near the root of the nose, towards the frontal bone, with total involvement of the right and partial of left sinuses and the ethmoid, without any sclerotic reaction. Total body X-ray did not reveal any other osteolithic lesion. Histology of eroded fragments of the vomer and left nasal bone showed largelacunae with clear borders, surrounded by other smaller round lacunae, destructing the normal lamellar bone, sometimes containing clusters of partially necrotic cells with solid epithelial-like aspects, well visible in particular inside one of the largest lacunae.The border between the bone and the underlying tissue in lacunae is clear and sharp and the brownish like-epithelial mass reveals a darker margin (looking like a palisade) and it is separated from the bone by clefting artifacts.The epithelial origin of the cells of the osteolytic lesion was confirmed by the strong positivity for pancytokeratin. The lesion of the facial skull of Ferdinando Orsini is macroscopically and microscopically suggestive of a diagnosis of destructive basal cell carcinoma in advanced stage of evolution. This tumor, histologically characterizedby a front of neoplastic invasion with cells arranged in a palisade and cleft-like retraction spaces of artefactual nature, has a strong local aggressiveness and cause skin ulceration and bone destruction (hence the Latin name of ‘ulcus rodens’), without remote metastases, is also at present one of the most common malignant skin neoplasms, caused by exposure to sunlight.