Differences in Age, Site Distribution, and Sex Between Nodular and Superficial Basal Cell Carcinomas Indicate Different Types of Tumors

Abstract

Basal cell carcinomas (BCC) are among the most common cancers in white subjects. Etiologic factors include ultraviolet and ionizing radiation, chemical carcinogens, and possibly infection with human papillomaviruses. Because of clinical and histologic differences, differential pathogenetic mechanisms have been suggested for different BCC subtypes. We studied the patient and tumor characteristics of all BCC diagnosed and/or treated at the departments of Dermatology and Plastic Surgery of our hospital between 1985 and 1996, and a review of the literature was carried out. Some important differences between patients with nodular BCC and patients with superficial BCC were observed. The frequency of superficial BCC was higher in females and was seen in younger patients as compared with nodular BCC. The latter occurred mainly in the head/neck region: in males they were seen more frequently on the ears, and in females they were predominantly seen on the eyelids, the lips, and in the neck. Superficial BCC occurred mainly on the trunk, and occurred significantly more often on the trunk in males than in females, where the legs were the most common site. These findings strongly suggest that the superficial subtype is a separate group within the clinical entity of BCC. Furthermore, our findings seem to support the etiologic role of sun exposure in these tumors; however, this role may be different for each subtype. Chronic sun exposure may be an etiologic factor in nodular BCC as compared with intermittent sun exposure in superficial BCC. Other factors, such as differences in site specific host factors and referral bias, may also play a role in the differences found between the subtypes.

Carcinoma basocelular - Análise de 300 casos observados em Uberlândia - MG

“…1,3-6,11,14-17,19,21,22 The age group mostly affected by BCC was 70-79 years, similar to the findings of Bastiaens et al 3 The increasing incidence of BCC in young individuals has been emphasized; 8,11 however, the mean age is still high, probably because of the cumulative action of ultraviolet light throughout life and of reduction of the ozone layer. 4,7,8 In this study, BCC affected mostly women.…”

“…High frequency of the superficial type in the trunk (20.7%), as mentioned in other studies, 3,27,28 was found when pathological types were related to the sites affected.…”

“…Some authors also consider prolonged and continuous sun exposure, related or not to occupational activities, responsible for the high incidence of BCC. 3,8,10,11,23 Contrary to this theory, English et al 15 did not observe any correlation between BCC and daily sun exposure for working-related activities, differently from what happens with squamous cell carcinoma. According to these authors, rural workers subject to sustained sun exposure protected themselves wearing clothes and hats whereas those under intermittent sun exposure, for instance, on weekends, spent more time under the sun and did not wear adequate clothing, running the risk of presenting sunburns.…”

“…1 BCC usually affects the face. [2][3][4][5][6][7][8] of male patients, mainly fair-skinned and aged over 40 years, with history of chronic sun exposure. In addition to its increased incidence, 2,9-11 BCC has changed over the last years affecting sun-protected sites 12 and greater likelihood to affect women.…”

Solar and ultraviolet radiation

“…Of the studies that collected information on the presence of actinic keratoses (Green et al, 1996;Corona et al, 2001;Walther et al, 2004;Pelucchi et al, 2007), all showed this also to be a strong risk factor (Tables 2.1 and 2.3 on-line). It was proposed that the association of basal cell carcinoma with sun exposure may vary by histological subtype and anatomical site (Bastiaens et al, 1998). Although a case-control study showed this variation for recalled sun exposure (Pelucchi et al, 2007), a cohort study did not (Neale et al, 2007).…”