Basal Cell Carcinoma in African-Americans: Two Case Reports

Abstract

Introduction: Basal Cell Carcinoma (BCC) is the less aggressive type of skin tumor. It consists of cells which resemble epidermis basal cells, and metastases are described as exceptions. However, it can invade and destroy adjacent tissues, including bones. It is the most common cutaneous malignancy, with 65% of the total. It usually occurs after 40 years old, with sun exposure and fair skin as related factors, being rare in African-Americans. BCC is generally located on sun-exposed areas, like face (nose, ears and neck) and less commonly in trunk and extremities. The most frequent skin cancer in blacks is Squamous Cell Carcinoma, followed by BCC. There are different histologic patterns in BCC and the main characteristic is the presence of palisade basaloid cells masses arranged peripherally. The diagnosis is clinical and must be confirmed histologically. The choice for therapeutic procedures depends on the location, size and depth of the lesion. Case Reports: Case 1: A 53-years-old male, black, husbandman, presenting plaque lesion with pearly and pigmented edges on the nasal dorsum. Wide resection was made with safety margin, followed by reconstruction with a graft of frontal region. Case 2: A 57-years-old male, black, husbandman, presenting nodular-ulcerated lesion with pearly and pigmented edges on the right nasal ala. The resection with a wide safety margin was made, followed by reconstruction with graft of right genian region, bent at its end to reconstructing the inner portion of the nostril after two weeks. The diagnosis was confirmed through histopathology, which showed clear surgical margins. Discussion: Skin cancer affects mainly Caucasian people. It is rare in blacks, because the higher melanin content and dispersion pattern of melanosomes protect against the carcinogenic effects of sunlight. These cases are rare, but confirmed that ultraviolet radiation is an important risk factor for skin cancer, especially BCC. These two patients were over 40 years old; group most affected by skin cancer, and was submitted to prolonged sun exposure. Surgical resection was curative in both cases, since it was accomplished with good safety margin.