Cellular immune deficiency in black patients with basal cell carcinoma

Basal Cell Carcinoma, Squamous Cell Carcinoma, and Cutaneous Melanoma in Skin of Color Patients

Skin cancers are relatively rare in patients with skin of color; however, they are an important public health concern because of disparities in patient outcomes. Gaps in skin cancer knowledge exist because of lack of large-scale studies involving people of color, and limitations in data collection methods and skin classification paradigms. Additional research is needed to address questions regarding risk and reasons for disparate skin cancer outcomes in these patients. We summarize the clinical and epidemiologic features for basal cell carcinoma, squamous cell carcinoma, and melanoma and touch on some of their unique features in patients with skin of color.

[A case study of bilateral cystic basal cell carcinoma in an albino]

Basal cell carcinoma is the most common skin cancer. It occurs in young adults older than 50 years and it is often caused by chronic exposure to solar rays, which explains why it often affects the face. In patient who are not treated immediately, the tumour develops slowly, with locoregional extension, but it rarely metastasizes. We here report a very rare case of bilateral cystic basal cell carcinoma in an albino young adult aged 36 years. The patient had terebrant left brachial ulcero-budding infiltrating mass with bone erosion (pathological fracture of the humerus) evolving over the last 7 years as well as ulcero-budding secondarily infected mass in the cervicodorsal junction evolving over the last 6 months. During his 1 month stay in our hospital, he underwent transfusion of 6 units of isogroup isoRh 450cc and boric acid dressings were applied as a complement to antibiotic therapy and iron therapy. Given the poor general health of the patient (cachexia, chronic anemia, development of the cancerous lesions), amputation of the left upper member and cervicodorsal mass excision were controindicated. Multidisciplinary team opted for second line treatment, including chemotherapy and/or radiotherapy. Given the lack technical equipment, the patient was transferred out to Lusaka.

[Basal cell carcinoma in a Congolese (DRC) albinos: about one observation]

Les auteurs rapportent un cas d'un carcinome basocellulaire non décris dans la littérature de notre pays chez un adulte jeune congolais âgé de 25 ans, de sexe masculin présentant une récidive probable de la tumeur. Cette observation permet de décrire le carcinome basocellulaire chez un sujet noir albinos, et de souligner les particularités thérapeutiques.

Skin cancer in skin of color

Skin cancer is less common in persons with skin of color than in light-skinned Caucasians but is often associated with greater morbidity and mortality. Thus, it is crucial that physicians become familiar with skin cancer in persons of color so as to maximize the likelihood of early detection of these tumors. In dark-skinned ethnic groups, squamous cell carcinoma is most common; squamous cell carcinoma and melanoma usually occur on nonsun-exposed sites; and ultraviolet radiation is not an important etiologic factor for skin cancer with the exception of basal cell carcinoma. Races of intermediate pigmentation, such as Hispanics and Asians, share epidemiologic and clinical features of dark-skinned ethnic groups and Caucasians. Skin cancers pose a significant risk in skin of color and clinicians should focus on preventive measures in these groups such as regular skin exams, self-examination, public education, and screening programs.

LEARNING OBJECTIVE

At the completion of this learning activity, participants should be familiar with the epidemiology and unique clinical features of skin cancer in skin of color and be aware of strategies to prevent skin cancer in skin of color.

Basal cell carcinoma in the groin of a black patient with femoral vessel invasion and a second primary malignancy

We have presented an unusual case of basal cell carcinoma that presented in a 76-year-old black woman. This is an atypical case in that it occurred in a black patient, and the incidence of basal cell carcinoma is low in black people. The lesion was located in the groin, which is an uncommon location for basal cell carcinoma. The femoral vessels in this patient also were invaded by the tumor, which is also a very rare occurrence. The patient in this report had a coexisting squamous cell carcinoma of the lung, which may be a common finding in black patients with basal cell carcinoma. It is extremely important for the physician to include skin cancer in the differential diagnosis of any suspicious skin lesion. This will avoid delays in treatment and decrease the overall morbidity. The physician who encounters a black patient with a basal cell carcinoma also should screen the patient for a coexisting noncutaneous malignancy.

Basal cell carcinoma in North American blacks. Clinical and histopathologic study of 26 patients

Basal cell carcinoma is rare in blacks. A clinical and histopathologic review of 43 basal cell carcinomas in 26 black patients is reported. Basal cell carcinoma was found to be more common in women than in men. Our data indicated a lower prevalence on the nose and trunk compared with other reports. Multiple tumors were more common in our series. Our study included the youngest black patient with a pure basal cell carcinoma, the first reported superficial basal cell carcinoma, the second reported perianal basal cell carcinoma, and one albino patient with 12 tumors. Histologically there was a positive correlation between the maximum depth of tumor invasion and the maximum diameter of the lesion. Of three basal cell carcinomas arising in scars, metastasis developed in one. Our report includes a review of basal cell carcinomas in North American blacks.

Biology of basal cell carcinoma (Part II)

Host-tumor relationships involve several factors that can enhance or suppress neoplastic growth. This second part of a review of basal cell carcinoma biology examines the role that hormones, cytokines, local and systemic immunity, congenital and genetic syndromes, and environmental factors play in the development of this neoplasm. Theories of etiology and pathogenesis are discussed, and transplantation and cell culture techniques used to study this cancer are explored. Valuable second-line therapies for treatment of multiple tumors are reviewed, and important areas of present and future research are emphasized.

Carcinoembryonic antigen in basal cell neoplasms in black patients: an immunohistochemical study

The development of skin cancer in black persons is rare, and basal cell epitheliomas are the most uncommon. Eight tumors were evaluated by routine histochemistry examination and immunoperoxidase staining for carcinoembryonic antigen (CEA). Our results demonstrate that half these tumors showed a positive reaction to this antigen, supporting the adnexal origin/differentiation of these lesions. Sixteen (16/18) similar tumors from white patients failed to show equivalent features. In addition, some of these CEA-positive tumors seem to demonstrate less aggressive behavior.

Basal cell carcinomas and lymphoma: biologic behavior and associated factors in sixty-three patients

The relationship between basal cell carcinoma and lymphoma was investigated in 63 patients with both diagnoses who were seen at Memorial Sloan-Kettering Cancer Center between 1949 and 1984. The majority of patients were diagnosed with lymphoma before the onset of their first basal cell carcinoma. Multiple basal cell carcinomas developed in most patients. The overall recurrence rate of basal cell carcinoma was high (17%), and metastatic disease developed in one patient. These data support a more aggressive behavior of basal cell carcinomas in patients with lymphoma than in otherwise healthy individuals.

Pedunculated pigmented basal-cell carcinoma on the buttock of a black man

A pedunculated pigmented basal-cell carcinoma on the buttock of a black male is presented. Unusual features of this case include an atypical pendunculated appearance, suggesting nevus or neurofibroma, atypical location on a covered area of the body, and occurrence in a low-incidence racial group.

Impairment of thymus-derived lymphoid cell function in patients with basal cell carcinoma

The host-tumor relationships in 34 patients with basal cell carcinoma was investigated by characterizing thymus-derived (T) and bone marrow-derived (B) lymphoid subpopulations in the blood by cell surface markers and lymphoid function in vitro by proliferative responses to mitogenic and antigenic stimulation. Results were correlated with tumor stage. In patients with tumor present, the data demonstrate significantly (P less than .02) decreased responsiveness of T cells to the lectin mitogens phytohemagglutinin and concanavalin A, and further demonstrate significantly decreased responsiveness of T cells to antigens (P less than .001 for Candida antigen, P less than .05 for Staphylococcal filtrate and Streptococcal varidase). In patients who were grossly disease free after resection of tumors, there was no significant difference in these responses from normal. These results document, for the first time, impaired T-cell function in patients with basal cell carcinoma and suggest that the functional impairment is tumor induced.

The biology of basal cell carcinoma: a review

Features of basal cell carcinoma are reviewed within the broad categories of growth characteristics, histogenesis, ultrastructural features, biochemical properties, site of origin, metastatic potential, and immunobiology. Biologic features that pertain to host-tumor interactions are emphasized. Perhaps a better understanding of these host-tumor relationships will offer more effective methods of treating and preventing these neoplasms in the future.