Original articleFactors predictive of recurrence, metastasis, and death from primary basal cell carcinoma 2 cm or larger in diameter
Section snippets
Methods
Patients with a histologic diagnosis of BCC, BCC with focal squamous differentiation, or basosquamous carcinoma (together referred to as BCC) at Brigham and Women's Hospital and Massachusetts General Hospital were identified between January 1, 2000, and December 31, 2009. Included cases were surgically treated BCCs as determined by excision operative reports (MMS and non-MMS). Duplicate records were excluded. Recurrent tumors and tumors with no primary information were also excluded. If a tumor
Results
From 11,905 patients with BCC who were screened, 248 large BCC tumors (≥2 cm) were identified in 234 patients. The cohort of small BCC tumors (<2 cm) included 248 cases from 162 patients. The risk of LR and M/D in small BCCs was 0.8% and 0%, respectively, which was less than our 5% threshold, so small BCCs were excluded from further analyses.
The patient and tumor characteristics for disease-related outcomes are provided in Table I. There were 22 LRs and 16 M/Ds. Men had a 13% LR risk and 8% M/D
Discussion
Our results identify large BCCs (those with clinical diameter ≥2 cm) as having a 6.5% risk of M/D, which is more than 10-times higher than prior estimates of the risk of metastasis in BCC as a whole. Large BCCs also had a 9% risk of LR, which was significantly greater than the 0.8% risk in small BCCs. In addition, tumor diameter ≥4 cm, depth beyond fat, and head/neck location were predictors of M/D in large BCCs on multivariable analysis.
Most of the information on metastatic BCC (mBCC) is
Conclusion
The results reported here represent an important step toward the identification of a subset of BCC with a clinically significant risk of recurrence, metastasis, and death. BCC tumors with a diameter of at least 2 cm were found to have a 9% risk of LR and a 6.5% risk of M/D, which is significantly higher than that of the small BCC cohort and sufficient to warrant further investigation of optimal management. Prognostic factors, including tumor diameter ≥4 cm, head/neck location, and depth beyond
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2023, Dermatologic ClinicsCitation Excerpt :Head and neck locations were nearly 12 times more likely to have metastasis or lead to death.32,35,37 In patients with BCC 2 cm or greater, the risk of metastasis and death in those with underlying nevoid basal cell carcinoma syndrome (NBCCS) is 50%, and in nonsyndromic patients with prior RT, the risk is 22%.37 Dermoscopy is a common clinical tool to aid in the identification of BCC.
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Funding sources: Genentech, Inc provided support for the conduct of this study. Mr Karia is supported by a Cancer Epidemiology, Prevention, and Control Training Grant from the National Cancer Institute of the National Institutes of Health (T32-CA-009314).
Conflicts of interest: None disclosed.
IRB approval status: The Partners Human Research Committee approved this study.
Reprints not available from the authors.