Subsequent Basal Cell Carcinoma Research Articles

The Burden of Multiple Basal Cell Carcinomas: A Population-wide Study.

Basal cell carcinoma (BCC) is a common skin cancer type and affected individuals are known to be at risk of developing multiple consecutive tumours. Research into BCC multiplicity has, thus far, been challenging, due to a lack of national registration. This registry-based cohort study aimed to analyse the occurrence of multiple BCCs in Sweden, and risk factors for subsequent primary BCCs. Data regarding all histopathologically verified, primary BCC tumours in Sweden from 2004 to 2017 was extracted from the Swedish BCC Registry. Risk of developing a subsequent BCC in relation to person-related factors was estimated with Cox regression analysis. Cumulative risk of BCC development after 1 or 3 earlier BCCs was estimated. In total, 39.9% of individuals with a registered BCC had at least 2 registered tumours. The risk of developing a subsequent BCC increased significantly in males, older age, and with residence in southern Sweden. The cumulative 5-year risk of developing an additional BCC after first diagnosis was approximately 30% in males and 27% in females and increased after multiple previous BCCs. This study showed the cumulative risk of a subsequent BCC to increase with a history of multiple BCCs, indicating the need for clinical surveillance in these individuals.

An Epidemiology Study and Risk of Subsequent Basal Cell Carcinoma, A 5-year Retrospective Investigation

Background: This study aimed to investigate the epidemiology of basal cell carcinoma (BCC) and the probability of having another lesion in patients diagnosed with BCC. Methods: This descriptive-analytical study was conducted from 2015 to 2017, based on the data from patients with definitive diagnoses of BCC in two university hospitals in Birjand. In this study, 85 patients with BCC were selected based on pre-defined inclusion criteria and then divided into two groups, including single and subsequent asynchronous lesions in another anatomic area. In this study, the information was collected by census method from diagnosed patients two years after surgery. The subsequent lesions in other anatomical areas were investigated, then tumor risk factors were compared in the two groups. Results: The mean age of the patients was 67.83 ± 12.29, and the youngest and the oldest patients were 38 and 92 years old, respectively. Among the studied patients, 75.3% had a history of sun exposure. The most common occupations of the patients were farmer, rancher, and housekeeper. Head and neck regions were involved in 96.5%. The patients with subsequent asynchronous BCC in another facial skin region were 10.6% (CI95: 4.06 - 17.14). These patients have been subject to several simultaneous risk factors in their medical history; most of them were farmers older than 65 years. Two patients experienced three lesions in three different anatomical regions at different times. There was no statically significant difference between the two groups regarding mean age (P = 0.47), gender (P = 0.73), pathologic subtype (P = 0.06), and other risk factors (P > 0.05). Conclusions: This study confirms the likelihood of having a subsequent lesion in other anatomical regions in patients diagnosed with BCC. Patients with a history of BCC require prolonged follow-up because of the probability of new BCC developing.

Melanoma survivors are at increased risk for second primary keratinocyte carcinoma.

Recent large cohorts have reported that melanoma survivors are at risk of developing second keratinocyte carcinoma (KC). However, the detailed proportion and risk are still unknown. We aimed to comprehensively analyze the risk of developing keratinocyte carcinoma after primary melanoma. We conducted systematic literature research in PubMed, Embase, Web of Science, and Cochrane Library published prior to September 13, 2021. Proportion and standardized incidence ratios (SIR) with its corresponding 95% confidence interval (CI) were pooled for assessing the risk. A total of 15 studies encompassing 168,286 patients were included in our analysis. The pooled proportions of melanoma survivors that developed a subsequent basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and KC were 4.11% (95% CI, 1.32-6.90), 2.54% (95% CI, 1.78-3.31), and 5.45% (95% CI, 3.06-7.84), respectively. The risks of developing a second BCC, SCC, and KC in melanoma survivors were 5.3-fold (SIR 5.30; 95% CI, 4.87-5.77), 2.6-fold (SIR 2.58; 95% CI, 1.33-5.04), and 6.2-fold (SIR 6.17; 95% CI, 3.66-10.39) increased in comparison with the general population. Both fixed effects and random effects models were applied in conducting meta-analysis and reached a consistent conclusion. Our results indicated melanoma survivors are at elevated risk of experiencing second primary BCC and SCC, which suggested the significance of surveillance for second primary KC and efforts for prevention in patients with a history of melanoma.

Joint effects of general population polygenic risk scores (PRS) and radiation treatment on subsequent neoplasm risk among childhood cancer survivors: A report from the Childhood Cancer Survivor Study (CCSS).

10008 Background: We examined whether PRS from general population studies are associated with risk of subsequent neoplasms (SNs) in childhood cancer survivors and evaluated joint associations between PRS and radiation treatment (RT), an established SN risk factor. Methods: Common genetic variants associated with risk of basal cell carcinoma (BCC), breast cancer, thyroid cancer, squamous cell carcinoma (SCC) or melanoma in general population studies were used to calculate cancer specific PRS among 5,911 5 year cancer survivors diagnosed < 21 years of age and between 1970-1986 in the CCSS. We examined associations between each PRS and SN risk using conditional logistic regression in nested case control studies, with incidence density sampling and matching on childhood cancer type, age at diagnosis, sex, RT dose to the SN site, and chemotherapy exposure. Further analyses matching only on non-treatment factors assessed joint associations considering potential combinations of PRS and RT exposure. We calculated the relative excess risk due to interaction (RERI) to determine whether joint associations were consistent with additivity of the individual risk factors (RERI > 0 indicates a more-than-additive joint association). Results: Among survivors (median age at follow-up 40 years, range 3-67; 62% exposed to RT), cancer specific PRS were associated with risk of subsequent BCC (N = 626; quartile 4 versus 1, OR [95% CI] = 1.9 [1.5-2.4]), breast cancer (N = 277; 4.5 [2.8-7.1]), thyroid cancer (N = 149; 1.9 [1.2-3.1]), and melanoma (N = 76; 2.7 [1.3-5.6]). Both PRS and RT were independently associated with SN risk, but joint analyses using a common reference group (PRS < median, RT < 1 Gy) found that both risk factors together resulted in more-than-additive increases in risk of BCC (RERI [95% CI] = 6.9 [2.0-11.8], breast cancer (6.6 [2.2-10.1], and thyroid cancer (4.8 [0.5-9.2]). Specifically, BCC risk was increased 28.8-fold for both PRS ≥ median and RT ≥ 1 Gy together, but only 3.3-fold for PRS ≥ median alone and 19.7-fold for RT ≥ 1 Gy alone. Similarly, breast cancer risk was increased 14.1-fold for both risk factors together, 2.5-fold for PRS ≥ median alone, and 6.5-fold for RT ≥ 1 Gy alone, and thyroid cancer risk was increased 12.3-fold for both risk factors together, 2.4-fold for PRS ≥ median alone, and 6.0-fold for RT ≥ 1 Gy alone. In joint analyses using more detailed RT categories, we found more-than-additive joint associations at both low and high RT doses. Conclusions: General population PRS were associated with SN risks after childhood cancer. More-than-additive increased risks with the combination of PRS and RT suggest that established markers of genetic susceptibility remain important in the context of treatment-related risks and may be useful in further refining risk assessment and follow-up guidelines for survivors.

A nationwide study of the incidence and trends of first and multiple basal cell carcinomas in the Netherlands and prediction of future incidence.

Basal cell carcinoma (BCC) is the most frequently diagnosed malignancy worldwide and an ever increasing annual incidence is observed. However, nationwide registries of BCCs are very rare, and often extrapolation of the data has been necessary to estimate the absolute number of diagnoses. As of September 2016, all histopathologically confirmed BCCs are registered in the Netherlands, due to developments in automatic notification and import in the Netherlands Cancer Registry. This offers the unique possibility to assess the nationwide population-based incidence of first and multiple BCCs. To assess the nationwide incidence and trends of first and multiple BCCs in the Netherlands and to predict incidence rates up to 2029. All patients with histopathologically confirmed BCC between 2001 and 2019 were selected from the population-based Netherlands Cancer Registry. Age-standardized incidence rates were calculated and trends were analysed with use of the estimated annual percentage change. Prediction of BCC incidence rates up to 2029 was based on a regression model. In total, 601806 patients were diagnosed with a first BCC over the period 2001-2019. The age-standardized incidence rates for both men and women with a first BCC increased over these years, from 157 to 304 and from 124 to 274 per 100000 person-years, respectively. For male and female patients aged 30-39years, decreases in annual incidences of -3·6% and -3·0%, respectively, were found in recent years. For patients aged 50years or older an ever increasing trend was found. One-quarter of the patients with a first primary BCC developed one or more subsequent BCCs within 3years. Increases in incidence of 30·4% (male) and 25·3% (female) are expected in the next 10years. BCC incidence has doubled over the past two decades. Trends have seemed to stabilize in recent years for patients aged < 50years. This might be a first sign of a decreasing trend. The incidence continues to rise in patients aged 50years and older. In the next decade a further increase in BCC incidence is expected.

The VIDYA Study-designed to Determine if Patients With a History of Basal Cell Carcinoma Are More Inclined to Return for Follow-up if Their Risk of a Subsequent Basal Cell Carcinoma is Quantitated.

The VIDYA Study-designed to Determine if Patients With a History of Basal Cell Carcinoma Are More Inclined to Return for Follow-up if Their Risk of a Subsequent Basal Cell Carcinoma is Quantitated.

Factors influencing low‐value follow‐up care after BCC

Basal cell carcinoma (BCC) is the most common type of cancer worldwide and its incidence is still rising. It is a type of skin cancer, but it is generally slow‐growing and very rarely spreads elsewhere in the body. Currently, guidelines recommend to only provide follow‐up care (e.g. annual check‐ups) to BCC patients considered ‘high risk’ according to certain factors, such as the size of the tumour, its location, and if it was faster growing than normal. However, dermatologists still provide follow‐up care to patients with low‐risk BCCs as well. To understand why this so called ‘low‐value care’ is provided and to identify strategies to reduce this care, the Dutch authors (based in Rotterdam) interviewed 18 dermatologists and organised three focus groups with 17 low‐risk BCC patients. The interviews and focus groups were audio taped and then transcribed literally. These transcripts were then loaded into a software programme and analysed for themes. Two main reasons given by dermatologists for providing low‐value follow‐up care were: i) complying with patient preferences and ii) a lack of trust in general practitioners (GPs) to identify suspicious lesions (possible skin cancers). Financial incentives and force of habit were two further reasons. Patients also expressed a lack of trust in GPs, and whereas some of the BCC patients preferred receiving periodic follow‐up care, other patients felt it was unnecessary. Several strategies for reducing follow‐up care were suggested, of which educating patients was identified as potentially effective by dermatologists and patients. Results of this study have already been incorporated in a pilot study, in which BCC patients receive written information which includes information about their disease, treatment, recurrence chance and chance of subsequent BCC. This letter is tailored to their specific situation.

200 Risks and timing of future skin cancers in patients with actinic keratosis

Actinic keratoses (AKs) are commonly diagnosed during dermatology visits and used to guide follow up care, such as skin cancer screening exams. However, prior research on AKs has focused on individual lesions: their rates of regression, recurrence, and progression to skin cancer. On a patient level rather than a lesion level, the risks and timing of skin cancers after a patient has had an AK have not been well studied, however. To evaluate this, we performed a cohort study using the OptumInsights Electronic Health Record Database between July 1, 2007 and June 30, 2017 among patients with AKs. We included 14,490 patients with at least one year of dermatology follow-up prior to their first AK in the cohort and no known history of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), or melanoma. Mean follow-up was 2.0 years (SD 1.8 years). Using survival analysis, we calculated that the risk of a subsequent AK after an initial AK was 42% (95% CI 41%-43%) at 1 year and 65% (95% CI 65%-66%) at 2 years. The risk of either BCC or SCC after an initial AK was 8% (95% CI 8%-9%) at 1 year and 14% (95% CI 14%-15%) at 2 years. When we divided BCC and SCC outcomes, the risks of subsequent BCC and of subsequent SCC were similar. The risk of melanoma was 0.8% (95% CI 0.6%-1%) at 1 year and 1.6% (95% CI 1.4%-1.9%) at 2 years. Our findings suggest that patients with AK are highly likely to develop another AK and have sizeable and similar risks of both BCC and SCC, with more than one in ten patients developing BCC or SCC in the first two years after an AK. Risks of melanoma, while smaller, are still considerable. These results provide evidence of AKs as biomarkers of skin cancer risk overall, beyond the risk of an individual AK lesion transforming into a carcinoma.

Genome-Wide Association Study in Irradiated Childhood Cancer Survivors Identifies HTR2A for Subsequent Basal Cell Carcinoma

Genome-Wide Association Study in Irradiated Childhood Cancer Survivors Identifies HTR2A for Subsequent Basal Cell Carcinoma

Predicting the Risk of a Second Basal Cell Carcinoma

A third of basal cell carcinoma (BCC) patients will develop subsequent BCCs. We aimed to develop a simple model to predict the absolute risk of a second BCC. We observed 14,628 participants of Northern European ancestry from a prospective population-based cohort study. BCCs were identified using a linkage with the Dutch Pathology Registry (Pathological Anatomy National Automated Archive). Predictors for a second BCC included 13 phenotypic, lifestyle, and tumor-specific characteristics. The prediction model was based on the Fine and Gray regression model to account for the competing risk of death from other causes. Among 1,077 participants with at least one BCC, 293 developed a second BCC at a median of 3 years. Several well-known risk factors for a first BCC were not prognostic for a second BCC, whereas having more than one initial BCC was the strongest predictor. Discriminative ability at 3 years was reasonable (bootstrap validated c-index=0.65). Three groups were created, with 7, 12, and 28% risk of a second BCC within 3 years. We conclude that a combination of readily available clinical characteristics can reasonably identify patients at high risk of a second BCC. External validation and extension with stronger predictors is desirable to further improve risk prediction.

Timing of subsequent new tumors in patients who present with basal cell carcinoma or cutaneous squamous cell carcinoma.

Patients with basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) (often termed nonmelanoma skin cancer or keratinocyte carcinoma [KC]) often develop new KCs, but information is limited on the frequency and timing of these subsequent tumors. This information is crucial to guide follow-up care. To determine the timing of subsequent new KCs in patients who present with KC. We enrolled a consecutive cohort of 1426 patients diagnosed as having biopsy-proven KC from January 1, 1999, through December 31, 2000, in a university dermatology practice and its affiliated Department of Veterans Affairs dermatology service. After exclusion of patients with basal cell nevus syndrome and immunocompromise, 1284 patients (90.0%) were followed up prospectively for a mean of 5.7 (range, 0-12.3) years. We assessed the risks for subsequent KCs over time using single-failure and multiple-failure models. We separately assessed outcomes after first lifetime KCs and after nonfirst lifetime KCs. We also performed secondary analyses of the risk for a subsequent BCC after a prior BCC diagnosis and the risk for a subsequent SCC after a prior SCC diagnosis. The risk for a subsequent KC was substantially lower after the first lifetime KC diagnosis: 14.5% (95% CI, 11.9%-17.7%) at 1 year, 31.1% (95% CI, 27.3%-35.3%) at 3 years, and 40.7% (95% CI, 36.5%-45.2%) at 5 years, than after a nonfirst KC: 43.9% (95% CI, 42.0%-45.9%) at 1 year, 71.1% (95% CI, 69.1%-73.0%) at 3 years, and 82.0% (95% CI, 80.2%-83.7%) at 5 years. Secondary analyses of the risks for a subsequent BCC after a prior BCC diagnosis and of a subsequent SCC after a prior SCC diagnosis yielded results consistent with the analyses for the pooled KC sample. Although all patients with KC are assumed to be at high risk for subsequent tumors, a subset may not develop another KC after their first tumor. Whether these findings are related to biological or behavioral differences or to differences in health care services should be investigated further to inform and improve care. Ongoing routine screening for subsequent KC may not be indicated for all patients with KC. Skin cancer screening can be improved with a better understanding of the course and frequency of subsequent KC diagnoses.

Risk of subsequent cutaneous malignancy in patients with prior melanoma: a systematic review and meta-analysis.

Melanoma patients are known to be at risk of developing multiple cutaneous (pre-) malignancies, however, the exact dimensions of these risks are unknown. In this meta-analysis, risks of developing a melanoma, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) after a melanoma were investigated. An extensive systematic literature search was conducted (last performed on 18 January 2012). Studies reporting risks, i.e. proportions, standardized incidence ratios (SIR) and cumulative risks (CRs) were included. Fifty, of 233 fully read articles, met selection criteria. Two independent reviewers extracted data on study characteristics and risks measurements. Random-effects meta-analyses were used to pool the risk estimates for the three tumour combinations. In melanoma patients, pooled proportions for a subsequent melanoma, BCC or SCC were respectively 3.8% (n = 47), 2.8% (n = 5) and 1.0% (n = 6). The pooled SIRs for a subsequent melanoma, BCC or SCC in melanoma patients were respectively 10.4 (n = 12), 4.6 (n = 2) and 2.8 (n = 2). Mean 20-year CRs of a subsequent melanoma, BCC or SCC in melanoma patients were respectively 5.4% (n = 3), 14.0% (n = 1) and 4.0% (n = 1). Subgroup analyses showed substantial differences in reported risks between continents and study design. In conclusion, a history of a prior melanoma is a strong predictor for development of a subsequent melanoma (approximately 10-fold increased risk) and to a lesser extent BCC or SCC. This information could serve as information for health care systems. Further, secondary prevention seems pivotal in this patient group.

Effect of Imiquimod as Compared With Surgery on the Cancerization Field in Basal Cell carcinoma

BackgroundPatients with basal cell carcinoma (BCC) have an increased risk of subsequent BCCs. It is possible that imiquimod might reduce this risk by acting on the cancerization field. ObjectiveTo examine the ability of imiquimod to reduce subsequent BCCs. MethodsRetrospective cohort study of patients with BCC treated at our hospital between 2003 and 2011. The patients were divided into 2 groups depending on whether they had been treated with surgery or with imiquimod. Comparing the 2 groups, we analyzed the development of new BCCs, the time that elapsed between first and subsequent tumors, and the site of occurrence of the second BCC with respect to the first one (local, same lymphatic drainage basin or anatomic region, or other). Survival methods were used to analyze the data. ResultsWe reviewed the charts of 623 patients. Of these, 550 had been treated with surgery (88.3%) and 71 with imiquimod (11.4%). Overall, a second BCC occurred in 36.4% of patients (n=227). The rate of occurrence was 38.2% in the surgery group and 23.9% in the imiquimod group (P=.02). The hazard ratio for the occurrence of a subsequent BCC was 2.13 (95% CI, 1.28-3.53) for patients treated with surgery compared with those treated with imiquimod. Imiquimod reduced the risk of a second BCC locally, regionally, and in the lymphatic drainage area. Our findings are limited by the retrospective nature of our study and the small number of patients treated with imiquimod. ConclusionsImiquimod may reduce the risk of subsequent BCC in patients treated for BCC and its effect could last for up to 2 years in local, regional and lymphatic cancerization fields. We believe that the cancerization field concept should be expanded to include not only the local area, but also the pertinent anatomic region and the regional lymphatic drainage area.

Efecto del imiquimod comparado con la cirugía sobre el campo de cancerización en el carcinoma basocelular

BackgroundPatients with basal cell carcinoma (BCC) have an increased risk of subsequent BCCs. It is possible that imiquimod might reduce this risk by acting on the cancerization field. ObjectiveTo examine the ability of imiquimod to reduce subsequent BCCs. MethodsRetrospective cohort study of patients with BCC treated at our hospital between 2003 and 2011. The patients were divided into 2 groups depending on whether they had been treated with surgery or with imiquimod. Comparing the 2 groups, we analyzed the development of new BCCs, the time that elapsed between first and subsequent tumors, and the site of occurrence of the second BCC with respect to the first one (local, same lymphatic drainage basin or anatomic region, or other). Survival methods were used to analyze the data. ResultsWe reviewed the charts of 623 patients. Of these, 550 had been treated with surgery (88.3%) and 71 with imiquimod (11.4%). Overall, a second BCC occurred in 36.4% of patients (n=227). The rate of occurrence was 38.2% in the surgery group and 23.9% in the imiquimod group (P=.02). The hazard ratio for the occurrence of a subsequent BCC was 2.13 (95% CI, 1.28-3.53) for patients treated with surgery compared with those treated with imiquimod. Imiquimod reduced the risk of a second BCC locally, regionally, and in the lymphatic drainage area. Our findings are limited by the retrospective nature of our study and the small number of patients treated with imiquimod. ConclusionsImiquimod may reduce the risk of subsequent BCC in patients treated for BCC and its effect could last for up to 2 years in local, regional and lymphatic cancerization fields. We believe that the cancerization field concept should be expanded to include not only the local area, but also the pertinent anatomic region and the regional lymphatic drainage area.

Indoor Tanning and Tanning Dependence in Young People After a Diagnosis of Basal Cell Carcinoma

Individuals who have had basal cell carcinoma (BCC) are at high risk of subsequent BCCs and melanoma.1 Indoor tanning is an established risk factor for BCC, squamous cell carcinoma and melanoma.2 As such, continuing to tan indoors after a BCC diagnosis may elevate one’s risk for future skin cancers. Skin cancer survivors have sun protection behaviors that are similar to those of the general population,3 but little is known about their indoor tanning behavior. Notably, research suggests some individuals develop tanning dependence, analogous to substance dependence,4 which could be related to continued indoor tanning. To understand better the patterns of and reasons for indoor tanning after BCC diagnosis, we assessed indoor tanning and symptoms of tanning dependence in people who had at least one BCC before age 40.

Risk of subsequent cutaneous malignancy in patients with prior keratinocyte carcinoma: A systematic review and meta-analysis

In this systematic review and meta-analysis the risk of a subsequent basal cell carcinoma (BCC), squamous cell carcinoma (SCC) or melanoma in patients with a previous keratinocyte carcinoma (KC) was investigated. PubMed, Embase, Web of Science and the Cochrane library were searched for studies published before 1st January 2012 that reported risks (i.e. proportions, cumulative risks or standardised incidence ratios [SIR]) of developing a subsequent BCC, SCC or melanoma in patients with prior KC. 45 articles fulfilled the inclusion criteria. In BCC patients, the pooled proportion for a subsequent BCC, SCC or melanoma was respectively 29.2% (95% confidence interval (CI) 24.6–34.3%), 4.3% (1.7–10.1%) and 0.5% (0.4–0.8%). The pooled proportion of a subsequent SCC, BCC or melanoma in SCC patients was respectively 13.3% (95% CI 7.4–22.8%), 15.9% (5.6–37.6%) and 0.5% (0.3–0.6%). The pooled SIRs for a subsequent BCC, SCC or melanoma were respectively 17.4 (95% CI 0.0–37.4), 3.2 (0.0–6.5) and 2.4 (2.3–2.6) in BCC and 4.2 (95% CI 2.0–6.5), 15.0 (14.0–16.0) and 2.7 (2.3–3.2) in SCC patients. In the subgroup analyses, strongest differences in risks were found in the continent strata (risks Australia>North America>Europe).

Predictors of Basal Cell Carcinoma in High-Risk Patients in the VATTC (VA Topical Tretinoin Chemoprevention) Trial

Basal cell carcinoma (BCC) is the most common cancer in the United States today, and patients who have had one are likely to have multiple carcinomas over time. Predictors of new BCCs on the face and ears among those at very high risk have not been studied in detail. We sought to do so prospectively in the context of a 6-year trial. We found that the number of BCCs in the prior 5 years was the most important predictor. Age, sun sensitivity, occupational sun exposure before the age of 30 years (but not afterward), lower educational level, history of eczema, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and more sunscreen use in the week, but not the 6 months, before enrollment were also independent predictors, but sunburns, baseline sun exposure, and other sun-protective measures, other skin cancers, and actinic keratoses were not. None of the eczema patients had a history of topical calcineurin use. The cumulative risk of BCC was 55% at 5 years. These findings document the key risk factors in this very high-risk population, suggesting that the history of eczema may increase the risk in those at high risk and that early sun exposure is important even in this group, and underscoring the need for chemopreventive strategies.

Tumor Site Immune Markers Associated with Risk for Subsequent Basal Cell Carcinomas

BackgroundBasal cell carcinoma (BCC) tumors are the most common skin cancer and are highly immunogenic.ObjectiveThe goal of this study was to assess how immune-cell related gene expression in an initial BCC tumor biopsy was related to the appearance of subsequent BCC tumors.Materials and MethodsLevels of mRNA for CD3ε (a T-cell receptor marker), CD25 (the alpha chain of the interleukin (IL)-2 receptor expressed on activated T-cells and B-cells), CD68 (a marker for monocytes/macrophages), the cell surface glycoprotein intercellular adhesion molecule-1 (ICAM-1), the cytokine interferon-γ (IFN-γ) and the anti-inflammatory cytokine IL-10 were measured in BCC tumor biopsies from 138 patients using real-time PCR.ResultsThe median follow-up was 26.6 months, and 61% of subjects were free of new BCCs two years post-initial biopsy. Patients with low CD3ε CD25, CD68, and ICAM-1 mRNA levels had significantly shorter times before new tumors were detected (p = 0.03, p = 0.02, p = 0.003, and p = 0.08, respectively). Furthermore, older age diminished the association of mRNA levels with the appearance of subsequent tumors.ConclusionsOur results show that levels of CD3ε, CD25, CD68, and ICAM-1 mRNA in BCC biopsies may predict risk for new BCC tumors.

Cumulative risks and rates of subsequent basal cell carcinomas in the Netherlands

The incidence of multiple basal cell carcinomas (BCCs) is not well documented. To calculate the cumulative risks, rates and risk factors for the development of subsequent histologically confirmed BCCs. For this cohort study the Dutch nationwide network and registry of histopathology and cytopathology (PALGA) was used. The first 2483 patients diagnosed with a first histologically confirmed BCC in the year 2004 were followed for 5years. Multifailure survival models were used to study whether gender or age affected the risk of developing subsequent tumours. During our observational period, the 2483 patients developed a total of 3793 histologically confirmed BCCs. The 5-year cumulative risk of developing one or more subsequent BCCs was 29·2%. Incidence rates were 25,318 per 100,000person-years in the first 6months after first BCC diagnosis, decreasing to 6953 per 100,000person-years after 5years of follow-up. Males compared with females had a 30% [adjusted hazard ratio (HR) 1·30, 95% CI (confidence interval) 1·11-1·53] higher risk of developing multiple BCCs and those aged 65-79years had more than 80% (adjusted HR 1·81, 95% CI 1·37-2·41) higher risk of having subsequent tumours compared with patients younger than 50years. The high incidence rate of subsequent BCCs among patients with a first BCC is highest in the first months after diagnosis of the first BCC but persists long term, indicating that patients with BCC should undergo full-body skin examinations at first presentation and subsequent follow-up visits. Special attention should be paid to males and persons of older age at index lesion.

Use of nonsteroidal anti-inflammatory drugs and risk of basal cell carcinoma in the United States radiologic technologists study

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with reduced risk of colorectal and other cancers, but the association with basal cell carcinoma (BCC) is unclear. Previous epidemiological studies have been small in size, conducted in especially vulnerable populations, or have not accounted for solar ultraviolet exposure, a major risk factor for BCC. In the United States Radiologic Technologists cohort, we followed subjects to assess NSAID use on risk of first incident BCC. We included Caucasian participants who responded to both second and third questionnaires (administered from 1994 to 1998 and 2003 to 2005, respectively), and who reported no cancer at the time of the second questionnaire, N = 58,213. BCC, constituent risk factors (e.g., eye color, complexion, hair color) and sun exposure history were assessed through self-administered survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Of the 58,213 people in the study population, 2,291 went on to develop BCC. Any NSAID use was not associated with subsequent incidence of BCC (HR = 1.04, 95% CI: 0.92-1.16) after adjusting for age, sex and estimated lifetime summer sun exposure. Neither association was observed when stratified by NSAID type (aspirin and other NSAIDs), nor did dose-response patterns emerge by frequency of use (average days per month). Further analyses did not reveal interaction with sex, birth cohort, smoking, alcohol consumption, sun exposure, occupational radiation exposure or personal risk factors for BCC. In this large nationwide study, we observed no association between NSAID use and subsequent BCC risk.