Basal Cell Carcinoma: A Retrospective Clinicopathological Analysis of 100 Cases Derived from the Histopathological Registry of the Institute of Pathology in Niš / Bazocelularni karcinom: retrospektivna kliničko-histološka analiza 100 slučajeva na osnovu Histopatološkog registra Instituta za patologiju u Nišu
Basal cell carcinoma (BCC) is the most common malignant tumor of the skin. This study was conducted to analyze patients with BCC, their age and sex distribution, occupation, site distribution of tumors, clinical types, and histopathological characteristics of lesions. Based on the data obtained from the Histopathological Registry, a clinical and histopathological analysis of the surgically excised BCCs was performed.
The study included 100 randomly selected patients out of 263 consecutive patients with histopathologically diagnosed BCC at the Institute of Pathology of the Clinical Center in Niš in the period of 15 months. The sex ratio was 1.4:1 in favor of men (p<0.05). Two thirds of patients were over the age of 60 (p<0.0001). The average age of patients was 66.6 ± 12.2 years (range 23 - 90). In agreement with the age distribution, 53 patients were retired (mostly retired farmers), 12 were workers, 14 farmers, 12 without permanent employment, 5 were housewives, and 4 clerks. A substantial majority of 61% of examinees lived in the country (p<0.001). The employment status was related to the age of examinees, but also with the altered demographic structure in the country: many workers lived in the country, or returned to the country after retirement.
BCC was commonly found on the face (77%), and rarely on the trunk (11%) and extremities (2%).
There were no data about exposition to X-rays or chemicals (except for pesticides and insecticides), scars resulting from burns or genodermatoses. In 87% of cases, BCC was significantly most often found at sites continually exposed to the sun (head including face and scalp, and neck). The most commonly diagnosed was the nodular type (57%), then the superficial (7%), ulcerative (5%), ulcero-sclerotic (4%), pigmented (1%), and morpheaform (1%). In 27% of cases, there were no data about the histopathological type of BCC in the Histopathological Registry, based on which accurate histological type of BCC could have been established. Based on histopathological analysis, apart from the nodular (40%), other types were rarely diagnosed, like the adenoid (12%) (p<0.0001), mixed types (nodular-adenoid, nodular-adenoid-fibroblastic and mixed) (9%), superficial (7%), fibroblastic (2%), infiltrative (1%), pigmented (1%), and morpheaform (1%). Surgical excision is the gold standard in the treatment of BCC: conventional, conducted in our patients, and Mohs micrographic surgery, which takes an important place in the treatment of high-risk BCCs. In 6% of cases, the tumor process was found in the margins of the excision.
In conclusion: Basal cell carcinoma was more common in males than in females. Significantly more patients with excised basal cell carcinoma lived in the country. An age-related increase in the number of patients with BCC has been established, and most patients with excised basal cell carcinomas belonged to the age group of 61 to 81 years of age. In most patients the tumor site was on the face, whereas clinically and histopathologically, nodular type was the most common.
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1. Quinn AG Perkins W. Non-melanoma skin cancer and other epidermal skin tumours. In: Burns T Breathnach S Cox N Griffiths C eds. Rook’s textbook of dermatology. 6th ed. Oxford: Blackwell Publishing Ltd; 2010. p. 52.1-48.
2. Ančevski A. Bazocelularni karcinom. In: Karadaglić Đ ed. Dermatologija. Beograd: Vojnoizdavački zavod Versalpres; 2000. p. 825-34. Serbian.
3. Murphy GM Moloney F. The pathogenesis of skin cancer in organ transplant recipients. In: Otley CC Stasko T Griffin MD Murphy GM Hirose R Chong AH. Skin disease in organ transplantation. Cambridge: Cambridge University Press; 2008. p. 137-41.
4. Owens DM Wat FM. Contribution of stem cells and differentiated cells to epidermal tumours. Nat Rev Cancer 2003;3:444-51.
5. Kleydman Y Manolidis S Ratner D. Basal cell carcinoma with intracranial invasion. J Am Acad Dermatol 2009;60(6):1045-9.
6. Robinson JK Dahiya M. Basal cell carcinoma with pulmonary and lymph node metastasis causing death. Arch Dermatol 2003;139:643.
7. James WD Berger TG Elston DM. Andrews’ diseases of the skin: clinical dermatology. Philadelphia: Elsevier Inc; 2006.
8. Chuang TY Popescu A Su WP Chute CG. Basal cell carcinoma: a population-based incidence study. J Am Acad Dermatol 1990;22:413-7.
9. Marks R Staples M Giles GG. Trends in non-melanocytic skin cancer treated in Australia: the second national survey. Int J Cancer 1993;53:585-90.
10. Reizner GT Chuang TY Elpern DJ Stone JL Farmer ER. Basal cell carcinoma in Kauai Hawaii: the highest documented incidence in the United States. J Am Acad Dermatol 1993;29:184-9.
11. Giles GG Marks R Folly P. Incidence of non- melanocytic skin cancer treated in Australia. Br Med J 1988;296:13-6.
12. Holme SA Malinovszky K Roberts DL. Changing trends in non-melanoma skin cancer in South Wales 1988-98. Br J Dermatol 2000;143:1224-9.
13. Dahl E Aberg M Rausing A Rausing EL. Basal cell carcinoma: an epidemiologic study in a defined population. Cancer 1992;70:104-8.
14. Mijušković ŽP Kandolf-Sekulović L Zečević RD. Kliničke karakteristike bazocelularnog karcinoma-analiza 83 pacijenta [Clinical characteristics of basal cell carcinoma - analysis of 83 patients). In: Zbornik rezimea XV Beogradski dermatološki dani [Book of abstracts of the 15th Belgrade days of Dermatology]; 2010 Nov 12-13; Beograd (Srbija). Beograd: Srpsko Lekarsko Društvo; 2010. p. 37-8. Serbian.
15. Segura S Puig S Carrera C Lecha M Borges V Malvehy J. Non- invasive management of non melanoma skin cancer in patients with cancer predisposition genodermatosis: a role for confocal microscopy and photodynamic therapy. J Eur Acad Dermatol Venereol 2011;25:819-27.
16. Abuzahra F Parren LJMT Frank J. Multiple familial and pigmented basal cell carcinomas in early childhood - Basex-Dupré-Christol Syndrome. J Eur Acad Dermatol Venereol 2012;27:117-21.
17. 15. Pauwels C Mazereeuw-Hautier J Basset-Seguin N Livideanu C Viraben R Paul C et al. Topical methyl aminolevulinate photodynamic therapy for management of basal cell nevus syndrome improves patient’s satisfaction and reduces the need for surgical procedure. J Eur Acad Dermatol Venereol 2011;25:861-4.
18. Bagazgoitia L Bea S Santiago JL Cuevas J Juarranz A Jaen P. Multiple basal cell carcinomas arising on a termal burn scar. Successful treatment with photodynamic therapy. J Eur Acad Dermatol Venereol 2002;23:459-61.
19. Harwood CA Proby CM Mc Gregor JM Sheaff MT Leigh IM Cerio R. Clinicopathologic features of skin cancer in organ transplant recipients: a retrospective case - control series. J Am Acad Dermatol 2006;54:290-300.
20. Escutia B Ledesma E Serra-Guillen C Gimeno C Vilata JJ Guillen C et al. Detection of human papilloma virus and nodular basal cell carcinomas in immunocompetent subjects. J Eur Acad Dermatol Venereol 2011;25:32-8.
21. Aguilar Bernier M Rivaz Ruiz F De Troya M Blazquez Sanchez N. Comparative epidemiological study of nonmelanoma skin cancer between Spanish and North and Central European residents on the Costa del Sol. J Eur Acad Dermatol Venereol 2012;26:41-7.
22. Roewert-Huber J Lange-Asschenfeldt B Stockfleth E Kerl H. Epidemiology and aetiology of basal cell carcinomas. Br J Dermatol 2007;157(Suppl 2):47-51.
23. Stern RS. The mysteries of geographic variability in nonmelanoma skin cancer incidence. (editoral). Arch Dermatol 1999:135:843-4.
24. Madan V Lear JT Szeimies RM. Non-melanoma skin cancer. Lancet 2010;375: 673-85.
25. Guillaume JC. Carcinomes basocellulaires. In: Saurat JH Grosshans E Laugier P eds. Dermatologie et infections sexuellment transmissibles. 4th ed. Paris: Masson; 2004. p. 640-7.
26. Stang A Ziegler S. Buchner S Ziegler B. Jockel KH Ziegler U. Malignant melanoma and nonmelanoma skin cancers in Northrhine-Westphalia Germany: a patient-vs diagnosis based incidence approach. Int J Dermatol 2007;46:564-70.
27. Raasch BA Buettner PG Garbe C. Basal cell carcinoma: histological classification and body-site distribution. Br J Dermatol 2006;155:401-7.
28. Paravina M. Epidemiologija epitelnih malignih tumora kože [Epidemiology of epithelial malignant tumors of the skin]. Proceedings of the 16th Congress of Yugoslav dermatovenerologists; 2000 Sep 20-23; Igalo. Beograd: Yugoslav Association of Dermatovenerologists; 2000. p. 25. Serbian.
29. Paravina M Spalević Lj Janković A Đokić S. Faktori rizika i neki epidemiološki pokazatelji malignih epitelnih tumora kože [Risk factors and some epidemiological characteristics of malignant epithelial tumors of the skin]. Zbornik rezimea XXXV Dani preventivne medicine [Book of abstracts 35th Days of Preventive Medicine]; 2001. Niš: Medicinski fakultet; 2001. p. 99-100. Serbian.
30. Pons M Quintanilla M. Molecular biology of malignant melanoma and other cutaneous tumours. Clin Transl Oncol 2006;8:466-74.
31. Trakatelli M Ulrich C del Marmol V Euvard S Stockfleth E Abeni D. Epidemiology of nonmelanoma skin cancer (NNSC) in Europe: accurate and comparable data are needed for effective public health monitoring and interventions. Br J Dermatol 2007;156(Suppl 3):1-7.
32. Mc Loone NM Tolland J Walsh M Dolan OM. Follow-up of basal cell carcinomas: an audit of current practice. J Eur Acad Dermatol Venereol 2006;20(6):698-701.
33. Dauden E. Effectivnes and satisfaction with imiquimod for the treatment of superficial basal cell carcinoma in daily dermatological practice. J Eur Acad Dermatol Venereol 2011;25:1304-10.
34. Fantini F Greco A Dell Giovane C Cesinaro AM Venturini M Zane C et al. Photodynamic therapy for basal cell carcinoma: Clinical and pathological determinants of response. J Eur Acad Dermatol Venereol 2011;25:896-901.
35. Tiftikcaglu JO Karaaslan D Aksoy HM. Aksoy B Koçer U. Basal cell carcinoma in Turkey. J Dermatol 2005;32:946-50.
36. Meneses N Guides R Moreira A Mota G Baptista A. Basal cell carcinoma: epidemiology from 269 cases. J Eur Acad Dermatol Venereol 2010;24:1359-60.
37. Paravina M Jovanović S Ranđelović J Stanojević M Spalević Lj Tiodorović J i dr. Karcinomi kože: analiza kliničkih i histoloških karakteristika [Skin carcinomas: analysis of clinical and histological characteristics]. Acta Dermatovenerol Iugosl 1990;17:157-61.
38. Arits AH Schlangen MH Nelemans PJ Kelleners-Smeets NW. Trends in the incidence of basal cell carcinoma by histopathological subtype. J Eur Acad Dermatol Venereol 2011;25:565-9.
39. Abeldano MA Pincay Cedeno L Neglia V Brea P Retamar R Kien M et al. Basal cell epithelioma of atypical localisation. J Eur Acad Dermatol Venereol 2001; 15(Suppl 2):167.
40. Gibson GE Ahmed I. Perianal and genital basal cell carcinoma: a clinicopathologic review of 51 cases. J Am Acad Dermatol 2001;45:68-71.
41. Mulayin N Silver DF Ocal JT Babalola E. Vulvar basal cell carcinoma: two unusual presentation and review of the literature. Gynecol Oncol 2001;85:531-7.
42. Pisani E Poggiali S La de Padova Andreassi A Bilenchi R. Basal cell carcinoma of the vulva. J Eur Acad Dermatol Venereol 2006;20:446-8.
43. Woo SH Kim IH Son SW. Axillary basal cell carcinoma. J Eur Acad Dermatol Venereol 2006;20:222-3.
44. Betti R Crosti C Moneghini L Crespi E Menni S. Axillary basal cell carcinoma: Additional 25 patients and consideration. J Eur Acad Dermatol Venereol 2011;25: 858-60.
45. Crowson AN. Basal cell carcinoma: biology morphology and clinical implications. Modern Pathol 2006;19:S127-47.
46. Rigell DS Cockerell CJ Caruci J Wharton J. Actinic keratosis basal cell carcinoma and squamous cell carcinoma. In: Bolognia JL Jarizzo JL Rapini RP. Dermatology. 2nd ed. St. Louis: Mosby Elsevier; 2008. p. 1641-60.
47. Wolff K Johnson KA Suurmond D. Fitzpatrick’s color atlas and synopsis of clinical dermatology. New York: McGraw-Hill; 2005. p. 282-9.
48. Stojanović S Poljački M. Klinička slika bazocelularnog karcinoma kože [Clinical picture of basal cell carcinoma of the skin]. In: Poljački M Ed. Bazocelularni i spinocelularni karcinom kože [Basal cell and spinocellular skin cancers]. Novi Sad: Medicinski fakultet; 1997. p. 43-7. Serbian.
49. Višnjić MM. Hirurgija tumora kože i mekih tkiva. [Surgery of skin tumors and soft tissues]. Niš: Prosveta; 1997. str. 16-25.
51. Vučković N Vučković D. Histogeneza i mikroskopske karakteristike [Histogenesis and microscopic characteristics]. U: Poljački M Ed. Bazocelularni i spinocelularni karcinom kože [Basal cell and spinocellular skin cancers]. Novi Sad: Medicinski fakultet; 1997. p. 35-42. Serbian.
52. Rubin AJ Chen EH Ratner D. Basal cell carcimoma. N Engl J Med 2005;353: 2262-9.
53. LeBoit PE Burg G Weedon D Sarasin A eds. World Health Organisation classification of tumors: pathology and genetics of skin tumors. Lyon: IARC Press; 2006. p. 10-33.
54. Popadić S Tanasilović S Živanović D Medenica Lj. Genital superficial basal cell carcinoma: a case report. Serb J Dermatol Venereol 2010;2(3):106-9.
55. Stang A Weichenthal M. Micrographic surgery of skin cancer in German hospitals 2005-2006. J Eur Acad Dermatol Venereol 2011:25:422-8.
56. Perrot JL Labelle B Cambazard F Godard W Gentil A Chanoz Poulard G et al. Assessment of microscopic surgical margins used in the exscision of basal cell carcinoma in the Loire and Haute-Loire regions from 2006 to 2008. Journées dermatologiques de Paris. The key moments of today’s dermatology. Paris: Société Francaise de dermatologie; 2009. p. 46-7.
57. Coulomb A Agence Nationale d’Accreditation et d`Evaluation (ANAES). Recommandations for basal cell carcinoma. Ann Dermatol Venereol 2004;131(6-7 Pt2):661-756.
58. Smeets NWJ Kuijpers DJM Nelemans P Verhaegh MEJM Kreckels GAM Neuman HAM. Mohs’ micrographic surgery for treatmant of basal cell carcinoma of the face: results of a reprospective study and review of the literature. Br J Dermatol 2004;151:141-7.
59. Dabrera G Wakeel R. Is the adequacy of excision of basal cell carcinoma related to operator experience? Clin Exp Dermatol 2006;32:103-4.
60. Santiago F Serra D Vieira R Figueiredo A. Incidence and factors associated wiht recurrence after incomplete excision of basal cell carcinomas: a study of 90 cases. J Eur Acad Dermatol Venereol 2010:24:1421-4.
61. Lalloo MT Sood S. Head and neck basal cell carcinoma: treatment using a 2mm clinical excision margin. Clin Otolaryngol Allied Sci 2000;25:370-3.
62. Dandurand M Petit T Martel P et al. Management of basal cell carcinoma in adults: clinical practice guidelines. Eur J Dermatol 2006;4:394-401.
63. Caresana G Giardini R Dermoscopy-guided surgery in basal cell carcinoma. J Eur Acad Dermatol Venereol 2010;24:1395-9.