Pigmented basal cell carcinoma develops De nova without pre-existing solar keratosis in skin type III and IV
Abstract
Objective Basal cell carcinoma (BCC) is a common tumor all over the world that affects middle age and elderly people that often involve the face and scalp in people with skin type I although other skin types are inflected. Sun-damaged skin is more liable to have this disease. The objective of the study is to evaluate the different demographic and clinical pictures in a series of 140 patients with basal cell carcinoma in relation to solar keratosis and wrinkling. Methods This is a case series descriptive study where all patients with BCC were recorded during the period from 2014-2022. All demographic features were described and a full clinical examination was carried out. Skin photo type was established for all patients according to Fitzpatrick’s classification. The sites, the number of lesions, the type of lesions, the associated solar keratosis, and squamous cell carcinoma were evaluated. A histopathological examination was performed as a confirmatory test. Results This study included 140 patients, whose ages ranged from 35-75 years with a mean of 60 years, with 95 (67.9 %) males and 45 (32.1%) females. All patients who had outdoor activities with Fitzpatrick’s classification of skin type were type III and IV. The location of lesions was 117 (83.6%) on the face and scalp while in 23 (16.4%) patients, the lesions were located on the covered parts body mainly the trunk and limbs. The tumor was pigmented in 123 (87.9%) cases while in 17 (12.1%) patients lesions were non-pigmented. The associated solar keratosis was observed in 20 (14.3%) cases but no case with squamous cell carcinoma was detected. The number of lesions was multiple in 42(30%) cases while single lesions were in 98 (70%) cases. Coarse wrinkling of the face mainly the forehead and around the eyes was detected in 20 (14.3%) cases. The type of lesions were ulcerative superficial non-healing ulcers while few cases presented with nodular lesions but rarely with rolled-up rodent ulcers. Also, a few cases are presented with thread-like margins. Conclusion Pigmented basal cell carcinoma is a common disease seen in older male patients with skin type III and IV living in highly sunny atmospheres presenting with a single pigmented superficial non-healing ulcer in non-wrinkling skin with low association with solar keratosis but no cases with squamous cell carcinoma. Accordingly, BCC develops and appears de novo without pre-existing solar keratosis.References
Rogers, H.W.; Weinstock, M.A.; Feldman, S.R.; Coldiron, B.M. Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the US Population, 2012. JAMA Dermatol. 2015;151:1081.
Akinci, M., Aslan, S., Morkoc, F., Cetin, A. Metastatic basal cell carcinoma. Acta Chir Belg. 2008;108(2):269–72.
Al-Waiz, M.K.E. Skin cancer in Iraq: an epidemiological study. Iraqi Med J. 1998;47:1–4.
Sharquie,KE , Noaimi, AA. Basal cell carcinoma: Topical therapy versus surgical treatment. J Saudi Soc Dermatol Surg. 2012;16: 41–51.
Mudigonda T, Pearce DJ, Yentzer BA, et al. The economic impact of non-melanoma skin cancer: a review. J Natl Compr Canc Netw. 2010;8:888-96.
Staples MP, Elwood M, Burton RC, et al. Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Med J Aust. 2006;184:6-10.
Demers AA, Nugent Z, Mihalcioiu C, et al. Trends of nonmelanoma skin cancer from 1960 through 2000 in a Canadian population. J Am Acad Dermatol. 2005;53: 320-8.
Rudolph C, Schnoor M, Eisemann N, et al. Incidence trends of nonmelanoma skin cancer in Germany from 1998 to 2010. J Dtsch Dermatol Ges. 2015;13:788-97.
Australian Institute of Health and Welfare. Cancer in Australia 2014: actual incidence data from 1982 to 2011 and mortality data from 1982 to 2012 with projections to 2014. Asia Pac J Clin Oncol. 2015;11:208-20.
Holme SA, Malinovszky K, Roberts DL. Changing trends in non-melanoma skin cancer in South Wales, 1988-98. Br J Dermatol. 2000;143:1224-9.
de Vries E, Louwman M, Bastiaens M, et al. Rapid and continuous increases in incidence rates of basal cell carcinoma in the southeast Netherlands since 1973. J Invest Dermatol. 2004;123:634-8.
Koh D, Wang H, Lee J, et al. Basal cell carcinoma, squamous cell carcinoma and melanoma of the skin: analysis of the Singapore Cancer Registry data 1968-97. Br J Dermatol. 2003;148:1161-6.
Sng J, Koh D, Siong WC, et al. Skin cancer trends among Asians living in Singapore from 1968 to 2006. J Am Acad Dermatol. 2009;61:426-32.
Godbole VK, Toprani HT, Shah HH. Skin cancer in Saurashtra. Ind J Pathol Bacteriol. 1968;11:183-9.
Deo S V, Hazarika S, Shukla NK, Kumar S, Kar M, Samaiya A. Surgical management of skin cancers: Experience from a regional cancer center in North India. Indian J Cancer. 2005;42:145-50.
Saudi Cancer Registry, cancer incidence report, Saudi Arabia, 2010.
Betti R, Inselvini E, Carducci M, et al. Age and site prevalence of histologic subtypes of basal cell carcinomas. Int J Dermatol. 1995; 34:174-176.
Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of the worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166:1069-80.
Bath-Hextall F, Bong J, Perkins W, et al. Interventions for basal cell carcinoma of the skin: a systematic review. BMJ. 2004; 329:705.
Asgari MM, Moffet HH, Ray GT, et al. Trends in basal cell carcinoma incidence and identification of high-risk subgroups, 1998-2012. JAMA Dermatol. 2015;151:976-81.
Roewert-Huber J, Lange-Asschenfeldt B, Stockfleth E, et al. Epidemiology and etiology of basal cell carcinoma. Br J Dermatol. 2007;157(suppl 2):47-51.
Kim, M., Park, H.J., Baek, S. Mutations of the P53 and PTCH gene in basal cell carcinoma: UV mutation signature and strand bias. Dermatol Sci. 2002;29(1): 1–6.
Oikarinen, A., Raitio, A. Melanoma and other skin cancers in circumpolar areas. Int J Circumpolar Health. 200;59;52–6.
Crowson, A.N. Basal cell carcinoma: biology, morphology, and clinical implications. Mod Pathol. 2006;19 (Suppl. 2):S127.
Carucci, J.A., Leffell, D.J., 2008. Epidermal and appendageal tumors, seventh ed. In: Wolff, Klaus, Goldsmith, Lowell A., Katz, Stephen I., Gilchrest, Barbara A., Paller, Amy S., Leffell, David J. (Eds.), . In: Fitzpatrick’s Dermatology in General Medicine, vol. 21 McGraw Hill Book Company, New York, pp. 1007–1015.
Miller, S.J. Biology of basal cell carcinoma. I. J Am Acad Dermatol. 1991;24:1–13.
Miller, S.J. Biology of basal cell carcinoma. II. J Am Acad Dermatol. 1991;24;161–75.
Cameron MC, Lee E, Hibler BP, Barker CA, Mori S, Cordova M, Nehal KS, Rossi AM. Basal cell carcinoma: Epidemiology; pathophysiology; clinical and histological subtypes; and disease associations. J Am Acad Dermatol. 2019;80(2):303-17. doi: 10.1016/j.jaad.2018.03.060. Epub 2018 May
Green A, Battistutta D, Hart V, et al. Skin cancer in a subtropical Australian population: incidence and lack of association with occupation. The Nambour Study Group. Am J Epidemiol. 1996; 144:1034-40.
Zanetti R, Rosso S, Martinez C, et al. Comparison of risk patterns in carcinoma and melanoma of the skin in men: a multi-center case-case-control study. Br J Cancer. 2006;94:743-51.
Freedman DM, Sigurdson A, Doody MM, et al. Risk of basal cell carcinoma in relation to alcohol intake and smoking. Cancer Epidemiol Biomarkers Prev. 2003;12:1540-1543.
Sahl WJ, Glore S, Garrison P, et al. Basal cell carcinoma and lifestyle characteristics. Int J Dermatol. 1995;34:398-402.
Schierbeck, J.; Vestergaard, T.; Bygum, A. Skin Cancer Associated Genodermatoses: A Literature Review. Acta Derm Venereol. 2019;99:360–9.
Dika E, Scarfì F, Ferracin M, Broseghini E, Marcelli E, Bortolani B, Campione E, Riefolo M, Ricci C, Lambertini M. Basal Cell Carcinoma: A Comprehensive Review. Int J Mol Sci. 2020;21(15):5572.
doi: 10.3390/ijms21155572. PMID: 32759706; PMCID: PMC7432343.
Scherer, D.; Bermejo, J.L.; Rudnai, P.; Gurzau, E.; Koppova, K.; Hemminki, K.; Kumar, R. MC1R variants associated susceptibility to basal cell carcinoma of the skin: Interaction with host factors and XRCC3 polymorphism. Int J Cancer. 2007;122:1787–93.
Ferrucci, L.M.; Cartmel, B.; Molinaro, A.M.; Gordon, P.B.; Leffell, D.J.; Bale, A.E.; Mayne, S.T. Host Phenotype Characteristics and MC1R in Relation to Early-Onset Basal Cell Carcinoma. J Investig Dermatol. 2012;132:1272–9.
Gudbjartsson, D.F.; Sulem, P.; Stacey, S.N.; Goldstein, A.M.; Rafnar, T.; Sigurgeirsson, B.; Benediktsdottir, K.R.; Thorisdottir, K.; Ragnarsson, R.; Sveinsdottir, S.G.; et al. ASIP and TYR pigmentation variants associate with cutaneous melanoma and basal cell carcinoma. Nat Genet. 2008;40: 886–91.
Ramachandran, S.; Lear, J.T.; Ramsay, H.; Smith, A.G.; Bowers, B.; Hutchinson, P.E.; Jones, P.W.; Fryer, A.A.; Strange, R.C. Presentation with multiple cutaneous basal cell carcinomas: Association of glutathione S-transferase and cytochrome P450 genotypes with clinical phenotype. Cancer Epidemiol. Biomark. Prev. 1999;8:61–7.
Jayaraman, S.S.; Rayhan, D.J.; Hazany, S.; Kolodney, M.S. Mutational Landscape of Basal Cell Carcinomas by Whole-Exome Sequencing. J. Investig. Dermatol. 2014; 134:213–20.
Pellegrini, C.; Maturo, M.; Di Nardo, L.; Ciciarelli, V.; Gutiérrez García-Rodrigo, C.; Fargnoli, M. Understanding the Molecular Genetics of Basal Cell Carcinoma. Int. J. Mol. Sci. 2017;18:2485.
Sharquie, K.E., Noaimi, A.A.; Mohsin, S.Y. Frequency of autoimmune diseases and estimation of P53 among vitiligo patients. Thesis for Fellowship of Iraqi Board for Medical Specializations in Dermatology and Venereology Baghdad 2011.
Sharquie, KE, Al-Rawi, J.R., Al-Rawi A.S. Association between Facial Skin Tumors and Wrinkling. Iraqi Journal of Community Medicine. 2009;22:147-51.
Sharquie, K.E., Al-Rawi, A.R., & Aljumaily, M.M. Association between smoking and facial wrinkling in relation with age and sex.
Messina, J.; Epstein, E.H., Jr.; Kossard, S. Basal cell carcinoma. In World Health Organization Classification of Skin Tumours; Elder, D.E., Massi, D., Scolyer, R.A., Willemze, R., Eds.; IARC Press: Lyon, France, 2018; pp. 26–34.
Scrivener Y, Grosshans E, Cribier B. Variations of basal cell carcinomas according to gender, age, location, and histopathological subtype. Br J Dermatol. 2002;147:41-7.
Prieto-Granada C, Rodriguez-Waitkus P. Basal cell carcinoma: epidemiology, clinical and histologic features, and basic science overview. Curr Probl Cancer. 2015; 39:198-205.
Grabski, W.J. and Salasche, S.J. Positive Surgical Excision Margins of A Basal Cell Carcinoma. Dermatol Surg. 1998;24:921-4.
http://dx.doi.org/10.1111/j.1524-4725.1998.tb04276.x.
Nouri, K., Spencer, J. and Taylor, J. Does Wound Healing Contribute to the Eradication of Basal Cell Carcinoma Following Curettage and Electrodesiccation? Dermatol Surg. 1999;25:183.
http://dx.doi.org/10.1046/j.1524-4725.1999.08128.x.
Kaur, S., Thami, G.P. and Kanwar, A.J. Basal Cell Carcinoma-Treatment with Cryosurgery. Indian J Dermatol Venereol Leprol. 2003;69:188-90.
Mendenhall, W.M., Amdur, R.J., Hinerman, R.W., Cognetta, A.B. and Mendenhall, N.P. Radiotherapy for Cutaneous Squamous and Basal Cell Carcinomas of the Head and Neck. The Laryngoscope. 2009; 119:1994-9. http://dx.doi.org/10.1002/lary.20608.
Tierney, E.P. and Hanke, C.W. Cost Effectiveness of Mohs Micrographic Surgery: Review of the Literature. J Drugs Dermatol. 2009;8:914-22.
Foley, P. Clinical Efficacy of Methyl Aminolevulinate Photodynamic Therapy in Basal Cell Carcinoma and Solar Keratosis. Australas J Dermatol. 2005;46:S8-S10.
Padgett, J.K., and Hendrix, J.D. Cutaneous Malignancies and Their Management. Otolaryngol Clinics North America. 2001; 34:523-53. http://dx.doi.org/10.1016/S0030-6665(05)70004-9.
Kim, K.H., Yavel, R.M., and Gross, V.L. Intralesional Interferon Alpha-2b in the Treatment of Basal Cell Carcinoma and Squamous Cell Carcinoma: Revisited. Dermatol Surg. 2004;30:116-20.
Sharquie, K.E., Al-Nuaimy, A.A. and Al-Shmary, F.A. New Intralesional Therapy for Basal Cell Carcinoma by 2% Zinc Sulphate Solution. Saudi Med J. 2005;26:359-61.
Love, W.E., Bernhard, J.D. and Bordeaux, J.S. Topical Imiquimod or Fluorouracil Therapy for Basal and Squamous Cell Carcinoma: A Systematic Review. Arch Dermatol. 2009;145: 1431-8.
http://dx.doi.org/10.1001/archdermatol.2009.291.
Bianchi, L., Orlandi, A., Campione, E., Angeloni, C., Costanzo, A., and Spagnoli, L.G. Topical Treatment of Basal Cell Carcinoma with Tazarotene: A Clinicopathological Study on a Large Series of Cases. Br J Dermatol. 2004;151:148-56. http://dx.doi.org/10.1111/j.1365-2133.2004.06044.
Sharquie, K., Noaimi, A. and Al-Zoubaidi, M. Treatment of Basal Cell Carcinoma by Topical 25% Podophyllin Solution. J Cosmet Dermatol Sci Appl. 20015;5:189-97.
doi 10.4236/jcdsa.2015.53023.
Sharquie K.E., 1995. Treatment of Basal cell carcinoma by topical heat therapy using a heat electrotherapy probe without touching the lesion. Unpublished.
Browder JF, Beers B. Photo aging Cosmetic effects of sun damage. Postgraduate Medicine. 1993:93(8):74-92.
Daniel HW, Smoker's wrinkles: A study in the epidemiology of "Crow's Feet". Ann Intern Med. 1971;75:873-80.
Sharquie KE, Kadim KA, Actinic Keratosis in Iraqi patients, a clinical and Histopathological study. Thesis for the fellowship of the Iraqi Board. Iraqi Board for medical specialization in Dermatology and Venereology, 2002: 38-40.
Mackie RM (1998) Epidermal skin Tumours. Textbook of Dermatology (6thedn) London Black Well Publishing Company, UK 36:1654-5.
Sharquie, K., Noaimi, A. and Murtada, S. Frequency of Benign and Malignant Tumors in Localized Vitiligo in Comparison to Generalized and Universal Vitiligo. J Cosmet Dermatol Sci Appl. 2016;6:133-9. doi 10.4236/jcdsa.2016.64017.
Sharquie KE, Noaimi AA, Bandar AR, Mohsin SY (2014) Vitiligo: Skin Malignancies and Tumor Suppressive Marker P53. Pigmentary Disorders 1: 104. doi:10.1472/jpd.1000104.
Duncan KO, Geisse JK, Jeffell DJ. Epidermal and appendageal tumors. In: Freedberg IM, Eison AZ, Wolff K, Austenk F, Goldsmith LA, Katz SI, editors. Fitzpatrick’s Dermatology in General Medicine. 6th ed. Vol. 21. New York: McGraw Hill Book Company; 2008. pp. 1007–15.
Sharquie KE, Al-Mashhadani SA, Noaimi AA, Hasan AA. Topical zinc sulphate (25%) solution: a new therapy for actinic keratosis. J Cutan Aesthet Surg. 2012;5(1):53-6. DOI: 10.4103/0974-2077.94331.
Boyd AS, Rapini RP. Cutaneous collision tumors. An analysis of 69 cases and review of the literature. Am J Dermatopathol. 1994; 16:253-7.
Smith LJ, Husain EA. Colonization of basal cell carcinoma and actinic keratosis by malignant melanoma in situ in a patient with xeroderma pigmentosum variant. Clin Pract. 2012;2(2):e47. doi 10.4081/cp.2012.e47.
Braun-Falco M. Combined malignant melanoma and basal cell carcinoma tumor of the intermingled type. J Cutan Pathol. 2007; 34:731-5.
Pecorella I, Memeo L, Ciardi A, Rotterdam H. An unusual case of colonic mixed adenoendocrine carcinoma: collision versus composite tumor. A case report and review of the literature. Ann Diagn Pathol. 2007; 11:285-90.
