Original article
Patients with both basal and squamous cell carcinomas are at a lower risk of further basal cell carcinomas than patients with only a basal cell carcinoma

https://doi.org/10.1016/j.jaad.2009.03.015Get rights and content

Background

The rate of development of further basal cell carcinoma (BCC) after first presentation is highly variable. The mechanisms that determine this phenotypic difference are unclear.

Objective

We assessed the risks of developing a subsequent BCC in patients who developed a BCC and a squamous cell carcinoma (SCC) and compared them with patients who developed a BCC only.

Methods

In all, 1040 patients who developed BCC only were compared with 140 patients who developed BCC and SCC to see whether the latter group included a high proportion of risk phenotypes (eg, male sex and fair skin). We then compared the number of BCCs developing per year in the two groups (174 BCC only and 71 BCC/SCC) during a 5-year period after initial BCC presentation.

Results

The BCC/SCC group demonstrated a significantly lower BCC/year rate than BCC only group. The rate of development of further BCC during 5-year follow-up was lower in the BCC/SCC group because a smaller number of patients developed subsequent BCC and not because the same proportion of patients developed lesions but in smaller numbers. After 5 years of follow-up, 51.1% of BCC and 74.6% of BCC/SCC cases were free from a subsequent BCC. Logistic regression analysis corrected for age at initial presentation confirmed that patients with BCC/SCC were less likely to develop a further BCC during the 5 years after initial presentation (P = .001, odds ratio = 0.31, 95% confidence interval 0.15-0.63).

Limitations

Because of the large patient group and long study follow-up from the date of the index BCC or SCC, not all data were obtained. Where this is the case, the number of patients for whom the information is available is provided.

Conclusions

Patients who develop a BCC are similar to patients who develop both a BCC and SCC, confirming the overlap of causative factors. Patients who develop both a BCC and SCC are less likely to develop BCCs compared with patients who develop BCC only.

Section snippets

Patients

A total of 1180 unrelated English Caucasians were recruited from the dermatology outpatient clinics at our university hospital between 1991 and 1998 with local ethics committee approval and informed consent from all participants. The BCC only group comprised 1040 patients. These were patients with one or more histologically proven BCCs on presentation. The BCC/SCC group comprised 140 patients with both histologically confirmed BCC and SCC. Patients in both groups were recruited at the time of

Characteristics of patients with BCC only versus BCC/SCC

Table I shows the characteristics of the study group. We used logistic regression analysis to show that the proportion of male and female patients was not significantly different in the two groups. The proportion of patients with skin type I was greater in the BCC/SCC (18.8%) than BCC (10.7%) group although the difference was not statistically significant. Data on skin type were not available on all patients. A t test showed that the BCC/SCC group presented later with their initial BCC (t test,

Discussion

Patients with BCC or SCC are at increased risk of other cancers.7, 8 Frisch et al,8 in one of the largest population-based cohort studies, looked at the risks of subsequent malignancies after the diagnosis of either BCC or SCC in 37,674 and 5100 patients, respectively, within the Danish cancer registry. In addition to confirming that both patients with BCC and SCC were at increased risk of developing nonmelanoma skin cancer and melanoma they also demonstrated a higher risk of other cancers (eg,

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Supported in part by a grant from the Cancer Research Campaign.

Conflicts of interest: None declared.

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