Novel Insights for Patients with Multiple Basal Cell Carcinomas and Tumors at High-Risk for Recurrence: Risk Factors, Clinical Morphology, and Dermatoscopy

Abstract

Introduction: Basal cell carcinoma (BCC) quite frequently presents as multiple tumors in individual patients. Neoplasm's risk factors for local recurrence have a critical impact on therapeutic management.

Objective: To detect risk factors for multiple BCCs (mBCC) in individual patients and to describe clinical and dermatoscopic features of low- and high-risk tumors.

Materials & methods: Our study included 225 patients with 304 surgically excised primary BCCs. All patients' medical history and demographics were recorded. Clinical and dermatoscopic images of BCCs were evaluated for predefined criteria and statistical analyses were performed.

Results: Grade II-III sunburns before adulthood (OR 2.146, p = 0.031) and a personal history of BCC (OR 3.403, p < 0.001) were the major predisposing factors for mBCC. Clinically obvious white color (OR 3.168, p < 0.001) and dermatoscopic detection of white shiny lines (OR 2.085, p = 0.025) represented strongly prognostic variables of high-risk BCC. Similarly, extensive clinico-dermatoscopic ulceration (up to 9.2-fold) and nodular morphology (3.6-fold) raise the possibility for high-risk BCC. On the contrary, dermatoscopic evidence of blue-black coloration had a negative prognostic value for high-risk neoplasms (light OR 0.269, p < 0.001/partial OR 0.198, p = 0.001).

Conclusions: Profiling of mBCC patients and a thorough knowledge of high-risk tumors' clinico-dermatoscopic morphology could provide physicians with important information towards prevention of this neoplasm.

Keywords: basal cell carcinoma; dermatoscopy; diagnosis; histopathology; non-melanoma skin cancer; prevention; skin cancer.

Figure 1

(a) A brown-black plaque on the chest of a 51-year-old female patient. The lesion has a maximum diameter of 0.6 cm. Histology set the diagnosis of a superficial BCC; (b) dermatoscopy confirmed our observations for low-risk neoplasms. Pigmentation was the striking feature in this tumor with leaf-like structures at the periphery (white asterisks), concentric structures (white circle), and a hint of telangiectasias (white arrow).

Figure 2

(a) A pinkish nodule on the left temple of a 66-year-old male patient with dark skin phototype and a maximum diameter of 1.3 cm, histopathologically diagnosed as a mixed BCC (nodular and metatypical). Due to anatomic location and size, the lesion was treated as a high-risk tumor for local recurrence; (b) dermatoscopic evaluation was in line with histology. A combination of arborizing (pink asterisk) and hairpin (black circle) vessels was evident. White, shiny linear structures (white arrows) were also obvious on the lesion’s surface. Finally, white, perifollicular circles along with central yellow clods were dermatoscopically apparent (black arrows).