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

Background The incidence of multiple basal cell carcinomas (BCCs) is not well documented. Objectives To calculate the cumulative risks, rates and risk factors for the development of subsequent histologically confirmed BCCs. Methods 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 5 years. Multifailure survival models were used to study whether gender or age affected the risk of developing subsequent tumours. Results 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 100 000 person‐years in the first 6 months after first BCC diagnosis, decreasing to 6953 per 100 000 person‐years after 5 years 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 65–79 years 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 50 years. Conclusions 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.     

Characteristics of multiple basal cell carcinomas: The first study on Japanese patients

Basal cell carcinoma (BCC), the most frequent skin cancer, has been increasing in incidence. However, the characteristics of multiple BCC have not been clarified in Japan. Therefore, we conducted a retrospective study to elucidate the features of multiple BCC compared with solitary BCC. The study population consisted of 327 patients with histopathologically proven BCC who were referred to the Department of Dermatology in Tottori University Hospital between November 2006 and April 2016. Of the 327 patients, 304 (93.0%) had solitary BCC and 23 (7.0%) had multiple BCC. The mean age of the patients with solitary BCC was 74.7 years (range, 31–102) and that of patients with multiple BCC was 79.3 years (range, 63–91). There was a significant difference in mean age between the two groups (P = 0.01). Approximately four‐fifths of the BCC were located on the head or neck in the total study population. In the group of patients with multiple BCC, the incidence of lesions on the head and neck was lower and that on the trunk was higher than those in patients with solitary BCC. There was a significant difference in the tumor site between the two groups (P < 0.0001). With respect to tumor histopathology, the ratio of superficial BCC was significantly higher in the group of patients with multiple BCC than in the group of patients with solitary BCC (P < 0.0001). In conclusion, we demonstrated that older age, truncal location and superficial histopathological type of tumor are features of multiple BCC in Japanese subjects.     

Population‐based incidence of basal cell carcinoma in a Spanish Mediterranean area

Background Considering the latitude of Spain, the reported age‐adjusted incidence rates of basal cell carcinoma (BCC) in this country, similar to those of Northern Europe, are lower than expected. Objectives To estimate the actual incidence of BCC in a Mediterranean population from the eastern coast of Spain. Methods A registry of BCC cases newly diagnosed between 16 January 2006 and 16 January 2007 was established for the population of residents in the Barcelonès Nord county (369 622 inhabitants). All dermatologists of this area agreed to register their patients. All tumours were registered as ‘definite’ or ‘probable’ BCC cases according the existence or not of a proven microscopic diagnosis. If a patient had more than one tumour at different sites, each was counted and registered separately. Sex‐specific, age‐specific and age‐standardized incidence rates were calculated by direct standardization to the World and European Standard Population. Results Among the 936 cases registered, 81·2% were classified as ‘definite’ BCC and 18·8% as ‘probable’ BCC. The overall crude incidence rate was 253·2 per 100 000 person‐years, and was 128 per 100 000 person‐years and 195·5 per 100 000 person‐years after standardizing for the World and European population, respectively. After the age of 65 years, the BCC age‐adjusted incidence rates showed a significantly higher increase in men than in women (P = 0·01). Conclusions The incidence rates found in our study are higher than those previously reported in Spain. Age‐adjusted incidence rates revealed that BCC increases with age in both sexes, this increase being particularly evident in men older than 65 years.     

Increase in basal cell carcinoma incidence steepest in individuals with high socioeconomic status: results of a cancer registry study in the Netherlands

Background  Development of both basal cell carcinoma (BCC) and cutaneous malignant melanoma (MM) is associated with acute and intermittent sun exposure. In contrast to MM, the association between socioeconomic status (SES) and BCC is not well documented.
Objectives  To investigate the incidence of BCC according to SES, stratifying by age and tumour localization in a large population-based cohort. To assess changes over time in the distribution of the patients with BCC across the SES categories.
Methods  All patients with a histologically confirmed first primary BCC ( n  = 27 027) diagnosed between 1988 and 2005 in the Southeast of the Netherlands were stratified by sex, age (25–44, 45–64 and ≥ 65 years), period of diagnosis, SES category (based on income and value of housing) and localization of the BCC. Age-standardized BCC incidence rates were calculated for the year 2004 by SES category and localization. Ordinal regression was used to assess changes over time in the proportion of patients with BCC by sex, age and SES.
Results  For men in all age groups higher BCC incidence in the highest SES category was observed, which remained significant after stratification for tumour localization. For women a consistent relationship was found only in younger women (< 65 years) for truncal BCCs, which occurred more frequently in high SES groups. Between 1990 and 2004, the proportion of BCC patients with high SES increased (+6%) and the proportion with low SES decreased (−7%).
Conclusions  High SES is associated with increased incidence of BCC among men. Our data suggest that BCC is changing from a disease of the poor to a disease of the rich.     

Clinical Features of Cutaneous Premalignant Lesions in Busan City and the Eastern Gyeongnam Province,Korea: A Retrospective Review of 1,292 Cases over 19 Years (1995~2013)

BackgroundThe global prevalence of premalignant lesions has been continuously increasing in recent years, but there has been little research regarding the distribution and incidence of cutaneous premalignant lesions in Korean populations.ObjectiveWe conducted this retrospective study to analyze recent trends in the incidence and clinical patterns of cutaneous premalignant lesions in the Korean population.MethodsWe reviewed 1,292 cases (3,651 lesions) of patients with cutaneous premalignant lesions, including actinic keratosis (AK) and Bowen''s disease (BD), from the Department of Dermatology at Dong-A University Hospital (January 1995 to December 2013).ResultsThe average cutaneous premalignant lesion annual incidence was 1.82%, and the incidence continuously increased from 0.70% to 4.25% over the study period. The most common cutaneous premalignant lesion was AK (75.85%), followed by BD (24.15%). The mean age of onset was 68.76 years (men, 70.89 years; women, 65.56 years), and the male:female ratio of patients was 1:1.52. Major skin cancers, including squamous cell carcinoma (SCC, 8.90%), basal cell carcinoma (BCC, 6.42%), and malignant melanoma (MM, 0.70%), were detected in 15.79% of patients with cutaneous premalignant lesions. Three patients (0.23%) were previously diagnosed with both SCC and BCC. In addition, 59.13% of patients had a single lesion, while 40.87% had multiple lesions. Patient age, history of previous skin cancers, and occupation-related exposure to ultraviolet radiation were more common in patients with multiple lesions.ConclusionCutaneous premalignant lesion incidence has gradually increased in the Korean population.     

Epidemiologic risk factors of basal cell carcinoma development and age at onset in a Southern European population from Greece

Background: Basal cell carcinoma (BCC) is the most common form of skin cancer with increasing incidence rates worldwide. Methods: To assess the association of BCC with epidemiologic risk factors in a Southern European population from Greece, we conducted a hospital‐based case–control study of 199 patients with BCC and 200 controls. Results: In the multivariate analysis, fair skin colour was associated with increased risk of BCC (OR: 4.9, 95% CI: 2.4–10.0). However, darker skin phototypes III/IV (patient’s reported sun sensitivity/tanning ability) showed a higher BCC risk (OR: 3.9, 95% CI: 1.8–8.5). Persons with occupational UV exposure of 5 years or more had a 2.7‐fold increased risk (95% CI:1.4–5.3). There was an increased risk of BCC related to the number of sunburns after the age of 20 years (OR: 3.2, 95% CI: 1.4–7.3) and solar lentigines (OR: 6.8, 95% CI: 3.6–12.8). Subgroup analysis showed that different risk factors are associated with early onset BCC including the presence of dysplastic nevi (OR: 6.4, 95% CI: 1.5–27.2), the number of weeks per year spent at the beach during childhood (OR: 8.9, 95% CI: 3.3–24.1) and the history of sunburns during childhood (OR:5.0, 95% CI: 1.3–19.1). Conclusions: Fair skin colour was significantly associated with BCC risk. The relation of sunburns during adulthood with BCC underlies the importance of sunburn prevention throughout life time. Early onset BCCs seem to have a different pathogenetic background and were associated with dysplastic nevi as well as intermittent sun exposure and sunburns during the early years of life.     

Trends in the incidence of non-melanoma skin cancer in the SE Netherlands 1975–1988: a registry-based study

The trends in the incidence and the sites of primary basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin were examined in a defined population of 650,000 persons in the SE Netherlands during the period 1975-88. The data was obtained from the Cancer Registry in Eindhoven and was from the dermatological and surgical clinics of 12 community hospitals. The incidence rates for BCC during this period rose from 42 to 53/100,000 person years for males and 24 to 38/100,000 person years for females. The rate of incidence for SCC varied with an increase mainly among males. In about 80% of the cases BCC and SCC occurred on the head and neck. Allowing for some detection bias a rise in the true incidence of BCC and SCC was observed, with an increase in SCC only since 1982. There was a marked decline in the incidence of SCC on the lips of males. These rates and trends fit into a pattern observed in other parts of Europe.     

[Translated article] Risk of a Second Skin Cancer in a Cohort of Patients With Nonmelanoma Skin Cancer – Basal Cell Carcinoma or Squamous Cell Carcinoma – Treated With Mohs Micrographic Surgery: A National Prospective Cohort Study

ObjectivePatients with nonmelanoma skin cancer (NMSC)—ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)—have an increased risk of developing a second skin cancer. The aim of this study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS).Material and methodsProspective study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the study period, and risk factors identified using mixed-effects logistic regression.ResultsWe analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101–113) for any cancer, 90 per 1000 person-years (95% CI, 85–96) for BCC, 14 (95% CI, 12–16) per 1000 person-years for SCC, and 2 (95% CI, 1–3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9–7.1), immunosuppression (RR, 2.1; 95% CI, 1.4–3.1), and male sex (RR, 1.6; 95% CI, 1.4–1.9).ConclusionPatients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex.     

Increased proportion of aggressive-growth basal cell carcinoma in the Veterans Affairs population of Palo Alto, California

Background: We have noted a high frequency of aggressive-growth basal cell carcinomas (BCCS) in our patient population. Subtypes observed with increased frequency include morpheaform, infiltrative, and micronodular.Objective: Our purpose was to examine the frequency of histologic subtypes of all BCCs seen in the dermatology clinics in the Veterans Affairs Palo Alto Health Care System in an 18-month period.Methods: We reviewed 432 consecutive primary BCC biopsy specimens taken from 252 patients.Results: Aggressive-growth BCC was observed in 20.7% of biopsy specimens, including 13.4% morpheaform, 5.7% infiltrative, and 1.6% micronodular subtypes. The mean age of the patient population was 70 years, with a standard deviation of 9.1 years.Conclusion: Our observed percentage of aggressive-growth BCC is substantially higher than in most other large studies. A high frequency of aggressive-growth BCC coupled with the increasing incidence of nonmelanoma skin cancer may have significant implications for future health care resource allocation.     

High incidence of skin cancer in the Channel Islands

Background. Previous studies looking at rates of malignant melanoma (MM) and nonmelanoma skin cancer (NMSC) in the UK have documented one of the highest rates in the southwest of England; however, the incidence of these tumours in Guernsey and Jersey, two of the Channel Islands, has not previously been reported. Aims. To determine the incidence of cutaneous MM and NMSC in the Channel Islands. Methods. Data for the period 2005–2009 were obtained from clinical and histopathological records for all MMs excised in the Channel Islands, and from the South‐west Cancer Registry for MMs excised in the southwest of England and for NMSCs in both areas. The age‐standardized incidence rate (ASRs) per 100 000 of the population in the Channel Islands were compared with those with the southwest of England, the UK and the rest of Europe where available. The MM characteristics of the Channel Islands were then compared with the southwest of England using standardized incidence ratios (SIRs). Results. The ASR/100 000 for cutaneous MM for 2005–2009 was 30 for the Channel Islands (31.3 for Jersey, 28.2 for Guernsey), 20.3 for the southwest of England, and 15.6 for the UK. Comparison with the rest of Europe indicated that the incidence of MM in the Channel Islands is one of the highest in Europe. The highest incidence of MM was in the over 65 years age group on both Guernsey and Jersey, and when divided into 5‐year age bands, the 70–74 years age group had the highest rate. This suggests that this particular age group may have previously received greater exposure to some environmental factor that promotes MM development. The ASR/100 000 for NMSC was also higher for the Channel Islands (263.3) than for the southwest of England (174.6) for 2005–2009, and for the UK in 2009 (104.9). Conclusions. This study indicates that the Channel Islands have a high incidence of skin cancer (both MM and NMSC). In addition, the data show that the ASRs in older people in this population group differ from those in mainland UK, showing higher rates in the over 65 years age group.     

Basal cell carcinoma,squamous cell carcinoma and melanoma of the skin: analysis of the Singapore Cancer Registry data 1968-97

BACKGROUND: There has been an alarming recent increase in skin cancer incidence among fair-skinned populations. Information from Asian populations is less readily available. OBJECTIVES: This study examines time trends and ethnic differences of skin cancers among Asians in Singapore. METHODS: Data from 1968 to 1997 was obtained from the Singapore Cancer Registry, a population-based registry. Age-standardized incidence rates (ASRs) and age-adjusted average annual percentage change, using the Poisson regression model, were calculated. RESULTS: A total of 2650 basal cell carcinomas (BCCs), 1407 squamous cell carcinomas (SCCs) and 281 melanomas were reported. There was an overall increase of skin cancer from 6.0 per 100000 person years (1968-72) to 8.9 per 100000 person years (1993-97). BCC incidence increased 3% annually, melanoma remained constant, and SCC decreased 0.9% annually. BCC ASRs were highest among Chinese, then Malays and Indians. A similar pattern was noted for SCC and melanomas. CONCLUSIONS: The incidence rates of skin cancer increased in Singapore during the period 1968-97. Fairer-skinned Chinese had a higher incidence of skin cancer.     

Basal cell carcinoma in young adults

The epidemiology and outcome of basal cell carcinoma (BCC) in adults aged 15-34 years were examined. Northern Region Cancer Registry data from 1979 to 1989 revealed a crude annual incidence of 37/100,000 total population and the incidence was constant in all age-groups during this period; 150 patients (1.2%) were aged 15-34 years. There was a small excess of females in the young age-group. The outcome of BCC in young adults was determined using records of all patients registered over 5 years ago and additional information from family doctors where required. Patients with BCC in naevus sebaceous or with syndromes of which BCCs are a feature were excluded. Median duration of BCC pre-diagnosis was 3 years. Of 39 patients with completed 5-year follow-up data, 21% had either incomplete excision requiring further early treatment (n = 4), a later local recurrence (n = 2), metastatic BCC (n = 1) or a subsequent further primary tumour (n = 1); an additional three patients had two primary tumours at initial presentation. Median hospital follow-up was 12 months but the apparent disease-free interval in patients with recurrent or new BCC was frequently over 2 years. BCC in young adults may not be suspected because it is uncommon. However, the high frequency of local recurrence and of multiple primary tumours indicates that careful follow-up is prudent in young patients with this tumour.     

Awareness of, knowledge of and attitudes to nonmelanoma skin cancer (NMSC) and actinic keratosis (AK) among physicians

BACKGROUND: Nonmelanoma skin cancer (NMSC) is the most common type of cancer that affects the Caucasian population. Approximately 80% of NMSCs are basal cell carcinoma (BCC) and 20% are squamous cell carcinoma (SCC). Actinic keratosis (AK) is a precancerous lesion that may develop into SCC. METHODS: A market research survey was conducted in which dermatologists and primary care physicians (PCPs) were randomly selected from seven countries (USA, Australia, UK, Italy, France, Germany and Spain). Their knowledge of nonmelanoma skin cancer and their current clinical practice were assessed. RESULTS: In total, 2100 physicians took part in the survey. They had practised medicine for between 1 and 30 years and saw at least 30 patients in a typical week. The majority of dermatologists (97%) were familiar with BCC and AK, and treated each condition with a minimum of referrals. PCPs were more familiar with BCC (90%) than with AK (74%). Of the PCPs that were aware of BCC, only 31% treated the condition, and of those aware of AK, 40% treated the condition. Surgery was the most common choice of treatment for BCC. The most popular treatment choice for AK lesions was cryotherapy. Eighty to 100% of physicians reported that they discussed skin cancer prevention with their patients. A much lower number of physicians (ranging from 5 to 37%) provided educational material to patients. Overall, PCPs in the two countries that have a high incidence of NMSC (USA and Australia) were more familiar with BCC and AK and more likely to treat each condition than PCPs in Europe. All physicians rated BCC as a more serious condition than AK. Facial lesions were considered more serious than lesions on the head or trunk for both conditions. CONCLUSIONS: As the burden of disease and the number of patients seeking treatment for NMSC increase, dermatologists are well placed to lead educational initiatives for PCPs and provide educational material for patients. This would increase awareness of AK and BCC and could improve early diagnosis.     

Incidence, prevalence and future trends of primary basal cell carcinoma in the Netherlands

Basal cell carcinoma (BCC) incidence rates are increasing worldwide. This study's objective was to estimate the occurrence of BCC in the Netherlands in terms of incidence and prevalence. Data on first primary carcinomas were retrieved from the Eindhoven Cancer Registry and extrapolated to the Dutch population. Extrapolated data showed a total of 444,131, histologically confirmed cases in the Netherlands between 1973 and 2008. During this period, age-adjusted incidence rates (European Standard Population) increased approximately three-fold from 40 to 148 per 100,000 in males and from 34 to 141 in females. Lifetime risk of BCC was 1 in 5-6 for Dutch citizens. Disease prevalence in the Netherlands was 1.4% and almost four times higher than this (5.4%) in the oldest age group (age 65 years or more). Predictions of future trends showed no signs of a plateau in the number of cases. These estimates should urge Dutch policymakers to provide solutions for the growing group of patients with BCC.     

Skin cancer trends in northern Jordan

Background The Jordan Cancer Registry was established in 1996, since which time all cases of cancer have been reported and registered. We have used this registry to perform the first analysis of skin cancer in northern Jordan and to compare our findings with those of published reports from other regions. Methods All histopathologically proven cases of skin cancer, reported during the years 1997 through 2001, were reviewed. Information regarding tumor type, age, gender, and anatomical location was collected. Results A total of 272 cases of malignant skin tumors were diagnosed between the years 1997 and 2001. Basal cell carcinoma (BCC) was the commonest type, representing 52.9% of all skin cancers. Females were more frequently affected than males, with age‐adjusted incidence rates of 23.3 and 19.7 per 100,000 of population, respectively. Squamous cell carcinoma (SCC) comprised 26.4% of the total, its age‐adjusted incidence rate per 100,000 of population being 14.2 for males and 6.18 for females. the incidence rate increased in males and decreased in females during the study period. The incidence of both BCC and SCC increased with age. The head and neck region was the commonest site affected by both types of cancer. Malignant melanoma (MM) comprised 11.39% of all skin cancer cases, with a female to male ratio of 1.2 : 1. The median age at onset for female patients was 49 years while that for males was 70 years, and the commonest site affected was the lower limbs, followed by the trunk. Conclusions In Jordan, sun‐related skin cancers have relatively low incidences and a rather stable pattern, compared with other areas with similar climate and skin phenotypes.     

Positivity for HLA DR1 is associated with basal cell carcinoma in renal transplant patients in southern Brazil

Background Renal transplant patients have a higher incidence of non‐melanoma skin cancer (NMSC). Previous studies hypothesized that human leukocyte antigen (HLA), especially types DR1, DR4, and DR7, may influence the incidence of these tumors. This study investigates the association between NMSC and the presence of HLA DR1, DR4, and DR7 in renal transplant patients in southern Brazil. Methods In a historical cohort study, 1032 patients who underwent renal transplantation during the period from January 1993 to December 2006 were examined to identify occurrences of NMSC and HLA status prior to transplant. Results Of the 1032 patients examined, 59 (5.71%) developed NMSC (squamous cell carcinoma [SCC]: 2.42%; basal cell carcinoma [BCC]: 1.74%; both: 1.55%). The presence of HLA DR1 was associated with a higher probability of developing any NMSC and particularly with developing BCC (P < 0.05). There was no statistically significant association between the presence of HLA DR4 or DR7 and the occurrence of NMSC in this sample. Conclusions HLA DR1 appears to be associated with the development of BCC, as well as with the higher number of NMSC lesions in renal transplant patients. This study supports the trend to associate the DR1 allele with BCC and not with SCC.     

NONMELANOMA SKIN CANCER IN NORTHERN FINLAND

Background and Objectives. The incidence of nonmelanoma skin cancers is highest in those geographic areas where light-skinned people are exposed to large amounts of sunlight. The purpose of this study was to detect differences in nonmelanoma skin cancers diagnosed in Northern Finland compared to those from elsewhere. Another purpose was to estimate whether changes have occurred in clinical diagnosis, site distribution, and recurrence rate during the past 15 years. Methods. The material included patients treated at Oulu University Hospital in Northern Finiand (64.6°N) during the years 1976—1977 and 1991—1992. Information was collected from files on 334 patients with 428 different, histologically verified skin cancers. Results. In 1976—1977, the average age of men with basal cell carcinoma (BCC) was 61 years, whereas the women's average age was 66 years. In 1991—1992, the corresponding ages were 69 and 72 years. The site distribution did not show any obvious changes in the 15 years, but the differences between sexes had become more prominent. Men had more BCC on the ears and the trunk, whereas women had more BCC on the nose and the forehead. Most of the squamous cell carcinomas (sec) were on the head and neck similar to BCC, but on the ears of men there occurred relatively more secthan BCC. Conclusions. The clinical diagnosis of BCC was fairly easy to make, whereas that of sec seemed to be very difficult clinically and was only correct in 10% of the cases. The markedly decreased recurrence rate of BCC between 1976 and 1992 probably occurred because of changes in treatment practices.