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

Dermatopathology Trends in African Americans: A Retrospective Analysis of Biopsies

ABSTRACT

In a retrospective analysis of biopsies from January 1, 2019 to December 31, 2020, at University Hospitals Cleveland Medical Center, we aimed to determine the frequency of dermatologic conditions biopsied in African Americans (AA). Given that AAs constitute 13.4% of the US population, understanding the skin disease profile within this significant demographic is crucial. From a total of 1701 biopsies collected from 1442 AA patients, benign neoplasms emerged as the most common diagnosis, accounting for 26.7%, predominantly in females. Notably, cutaneous T-cell lymphoma was the most frequently biopsied malignancy, whereas pigmentary disorders were the least common at 1.4%. The study highlighted the higher occurrence of squamous cell carcinoma compared with basal cell carcinoma in AA, contrasting trends in other racial demographics. Moreover, recognizing the unique presentations of skin disorders in different racial backgrounds is essential, especially because disparities have been reported in skin of color training among dermatology residency programs. Understanding these racial differences in skin diseases can assist clinicians in refining their diagnostic approach. Future research could further explore the potential gaps between clinical expectations and histologic findings, improving diagnostic accuracy.

Facial basal cell carcinoma: A retrospective study of 67 cases

BACKGROUND

Basal cell carcinoma (BCC) is a slow-growing malignant tumor characterized by local invasiveness but an exceptionally rare metastatic potential. It ideally affects sun-exposed skin of older patients with more propensity for the facial region.

AIM

To evaluate the different clinicopathological characteristics of the facial BCC and the efficacy and safety of diode laser for the treatment of these lesions.

METHODS

We retrospectively reviewed facial BCC lesions of < 1.5 cm in diameter and subjected them to diode laser ablation during the period from September 2016 to August 2021 at Al-Ramadi Teaching Hospital, Ramadi City, Iraq. Data matching the age, gender, duration, site, and clinical and histological types were registered for every subject. The functional and aesthetic outcomes and complications following diode laser ablation for each patient were also recorded.

RESULTS

Of 67 patients with facial BCC, there was 65.67% from the age group ≥ 60 years and 58.21% males. The mean duration of the lesions was 5.15 ± 1.836 mo. The most involved location was the nose (29.85%). About half of the cases belong to the noduloulcerative type. Solid histological type comprises 40.3% of the cases, while the least was keratotic (13.4%). Moreover, 65.2% of the solid cases were from the age group ≤ 60 years and 38.6% of the adenoid type from the age group > 60 years (P value = 0.007). Excellent aesthetic and functional outcomes were reported in all cases after 6 mo of follow-up. Few complications were reported after diode laser ablation.

CONCLUSION

Facial BCC was mostly seen in the elderly and men. The mean duration was 5.15 mo. The nose was the commonest involved site. Noduloulcerative lesions were seen in approximately half of the lesions. The age of the patients determined the histological type of the lesion (solid type was mostly seen in the age group ≤ 60 years, while, adenoid in the age group > 60 years). Diode laser ablation showed excellent functional and aesthetic outcomes following a 6-mo follow-up.

Skin Cancer in People of Color: A Systematic Review

BACKGROUND

People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS).

OBJECTIVES

In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature.

METHODS

An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search.

RESULTS

We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review.

CONCLUSION

Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.

Skin cancer in women of color: Epidemiology, pathogenesis and clinical manifestations

Malignant melanoma and nonmelanoma skin cancers (NMSC), which include basal cell carcinoma and squamous cell carcinoma, account for 40% of all neoplasms in white patients, making these cancers the most common malignancy in the United States. Given the large number of NMSC cases in white patients, there is a correspondingly large body of literature addressing various aspects of epidemiology, pathogenesis, and treatment. The incidence of both malignant melanoma and NMSC is well established and remains significantly lower in patients with skin of color (SoC) when compared with white patients. Although there is a lower incidence of skin cancer in SoC, there is often a poorer prognosis among this group. There is even more limited data focusing on women of color, making an accurate determination of incidence and mortality difficult. This gender disparity causes decreased skin cancer awareness and index of suspicion among patients and providers, hindering appropriate evaluation and care. Therefore, there is a need for an increased understanding of skin cancer in women of color. In the traditional sense, SoC refers to people of African, Asian, Native American, Middle Eastern, and Hispanic backgrounds. Patients in these ethnic groups have richly pigmented skin that is usually categorized as Fitzpatrick types III through VI and thus have notable differences in skin disease and presentation compared with fair-skinned individuals. We present this review of skin cancer in women of color to give a reasonably comprehensive representation of the literature to advance our understanding and knowledge in this unique population.

Optimizing the spray parameters of a cryospray process

Smaller spray zone of single-hole nozzle (SHN) constrains cryospray as a treatment method suitable for lesions having diameter larger than 15 mm on the skin surface. The present study is an attempt to resolve this issue, through the improvement in conventional technique of spraying liquid nitrogen on cancerous lesion. A multi-hole nozzle (MHN) with 5 holes is fabricated to demarcate the variation in outcome when cryogen is sprayed through customised MHN instead of conventional SHN. Special emphasis is placed on reducing the number of sitting required for completion of treatment and increasing the feasibility of cryospray process for larger lesions. Commercial SHN having a hole diameter of 0.8 mm is selected to compare results with the customised MHN having 5 holes of 0.8 mm diameter (4 holes are arranged in a circle of radius 2 mm around the central hole). Single freeze-thaw cycle is carried out to spray liquid nitrogen on tissue mimicking gel. Temperature profile accessed through infrared images advocates that lethal area formed through application of MHN is twice larger than the lethal area formed through the application of SHN on the surface of gel for same spraying distance (z). Thermocouples placed at various locations strengthen the fact that higher cooling rate (CR) corresponding to MHN ensures 15 mm spread of necrotic zone from the centre of spray (CS) and up to a depth of 2 mm from the gel surface while in case of SHN, it is limited to the vicinity of CS. On the basis of observations made through thermal images and digital images, it can be said that the ratio of lateral spread to penetration depth of ice ball remains almost same for SHN and MHN. However, the lateral spread of ice ball formed through the application of MHN is twice larger than SHN while the axial depth of ice ball does not record such increment. This reflects that MHN provides more destruction to superficial skin than SHN. Among the three spraying distances selected (i.e. z = 13 mm, 18 mm and 23 mm), the most optimised spraying distance (z) for MHN is also explored in this study. It has been found that cryoablation is not inversely proportional to the spraying distance. Spraying distance of z = 18 mm provided the most optimised result in terms of cryoablation.

Metastatic Basal Cell Carcinoma of the Skin: A Comprehensive Literature Review, Including Advances in Molecular Therapeutics

Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. In Europe, the incidence of BCC ranges from 44.6 to 128 cases per 100,000 inhabitants annually, whereas in the United States, the yearly incidence rate ranges between 500 and 1500. The global incidence has been calculated to be as high as 10 million cases of BCC per year. There are 2 main clinical patterns of BCC-the familial BCC in basal cell nevus syndrome and sporadic BCC. The etiology of cutaneous BCC is usually the result of the interaction between solar ultraviolet radiation and genetic factors. Somatic or germline mutations in the effector components of the hedgehog signaling pathway (ie, PTCH1, PTCH2, SMO or SUFU genes) are responsible for ∼90% of the cases of both sporadic and familial BCC, all causing a constitutive activation of the hedgehog pathway. Cutaneous BCC very rarely metastasizes, and diagnosis in metastatic sites can be very difficult. Metastatic BCC has weakly effective therapeutic options with a poor prognosis until few years ago. In 2012, small-molecule therapies, involving inactivation of the hedgehog signaling pathway, and capable of reducing tumor growth and progression have been introduced into clinical practice for advanced (locally advanced or metastatic) BCC. We performed a comprehensive literature review on metastatic BCC and found at least 915 cases reported to date. In addition, we extensively discussed the differential diagnosis of metastatic BCC, and outlined the advances in clinical therapeutics involving these small molecules.

Metastatic Cutaneous Basal Cell Carcinoma: Report of 2 Cases Preceding the Hedgehog Pathway Antagonists Era

Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. However, metastatic BCC is a very rare event with weakly effective therapeutic options and a poor prognosis, until a few years ago. In 2012, small-molecule therapies, capable of inactivating the hedgehog signaling pathway and thus reducing tumor growth and progression, were introduced into clinical practice for the treatment of patients with advanced BCC. We present retrospectively 2 personal cases of metastatic BCC of the skin, from the premolecular therapy era, from primary tumors that arose years before in the head and neck area. The former case occurred in a 45-year-old woman with a history of recurrent BCC of the retroauricular skin who eventually died due to diffuse metastatic spread. The latter case concerned a 70-year-old man also with a history of recurrent BCC of the nasal-perinasal skin who developed multiple subcutaneous and lymph node metastases in the neck. In both cases, the diagnoses were based on biopsies of the metastatic sites. The first patient died 5 months after the diagnosis of metastatic disease, while the second was alive and disease-free 2 years after neck lymph node dissection and external radiation therapy, and then lost to follow-up. We extensively discuss several tumor entities with basal or basaloid features that may enter the differential diagnosis with BCC in metastatic sites. In addition, we briefly summarize the advances in clinical therapeutics using small molecules, which are now an integral part of the treatment of such advanced BCC cases.

Review of Nonmelanoma Skin Cancer in African Americans, Hispanics, and Asians

BACKGROUND

Skin cancer has traditionally been studied in Caucasian skin. Although it does occur with increased relative frequency in Caucasians, patients with skin of color suffer from elevated morbidity and mortality when diagnosed with skin cancer.

OBJECTIVE

To detail the unique demographic and clinical features of nonmelanoma skin cancer (NMSC) in patients with skin of color, including Hispanic, African American, and Asian patients.

MATERIALS AND METHODS

A complete PubMed search was conducted spanning dates from 1947 to June 2017 yielding a total of 185 manuscripts, from which 45 were included in this review.

RESULTS

Relative to Caucasians, NMSC, comprised squamous cell carcinoma and basal cell carcinoma, has unique demographic and clinical features in African Americans, Hispanics, and Asians.

CONCLUSION

Familiarization with these unique presentations of skin cancer in skin of color is imperative to accurate identification and treatment of cutaneous malignancies in these populations and ultimately to improved disease-related outcomes.

Rare Presentations of Basal Cell Carcinoma

Background:

Even though basal cell carcinomas (BCC) are the most common skin cancers in the world, they rarely appear in the African–American, Hispanic, and Asian populations. BCCs most commonly present on the head and neck of elderly, light-skinned individuals who have received an excessive amount of sun exposure. However, it has been hypothesized that the development of BCCs in unusual populations is a result of an alteration in tumor surveillance or an impairment in cellular immunity.

Objective:

We present two cases of BCC, one in an Asian woman and one in an African–American woman. Neither of these patients had any history of genodermatoses or were immunocompromised.

Conclusion:

BCCs can occur in Asian and African–American patients. Clinicians should include the diagnosis of BCC in their differential for these patients despite their rare presentations.

Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public

Skin cancer is less prevalent in people of color than in the white population. However, when skin cancer occurs in non-whites, it often presents at a more advanced stage, and thus the prognosis is worse compared with white patients. The increased morbidity and mortality associated with skin cancer in patients of color compared with white patients may be because of the lack of awareness, diagnoses at a more advanced stage, and socioeconomic factors such as access to care barriers. Physician promotion of skin cancer prevention strategies for all patients, regardless of ethnic background and socioeconomic status, can lead to timely diagnosis and treatment. Public education campaigns should be expanded to target communities of color to promote self-skin examination and stress importance of photoprotection, avoidance of tanning bed use, and early skin cancer detection and treatment. These measures should result in reduction or earlier detection of cutaneous malignancies in all communities. Furthermore, promotion of photoprotection practices may reduce other adverse effects of ultraviolet exposure including photoaging and ultraviolet-related disorders of pigmentation.

Basal cell carcinoma in asians: a retrospective analysis of ten patients

Background. Few studies have been done that characterize basal cell carcinoma (BCC) in Asians because this tumor is relatively uncommon in this population group. Objective. To characterize BCC in Asians. Methods. We retrospectively examined fifteen patient variables and eight tumor variables of ten Asian patients with BCC and compared these results to those of thirty matched Caucasian controls with BCC. Results. Asians developed their first BCC at an older age than the age of first BCC in Caucasian controls (68.9 years versus 58.3 years; P < 0.05). During their lifetime, Asians had fewer BCCs than the number of BCCs in Caucasian controls (1.11 versus 5.41; P < 0.02), despite a similar estimated lifetime daily sun exposure (hours/day) for both groups. Compared to BCCs in Caucasian controls, a higher percentage of BCCs in Asians were clinically pigmented (50.0% versus 3.3%; P < 0.01). Conclusion. Asians develop BCCs later in life and develop fewer BCCs over their lifetime than Caucasians, despite similar estimated lifetime daily sun exposure. This finding is probably due to skin pigmentation in Asians being more protective of ultraviolet light than skin pigmentation in Caucasians.

Clinicopathologic and immunohistochemical features of pigmented Basal cell carcinomas of the eyelids

PURPOSE

To describe the clinical and microscopic features of pigmented basal cell carcinomas (pBCC) of the eyelid.

DESIGN

Retrospective observational case series collected at one institution.

METHODS

An analysis of clinical records, photographs, and histopathologic characteristics of 257 BCCs with a review of the literature. The frequencies of clinically pigmented, and of microscopically pigmented but clinically nonpigmented, BCCs were determined. Cytochemical stains (Fontana-Masson, Prussian blue) and immunohistochemical probes (S-100, microphthalmia-associated transcription factor [MiTF], HMB-45, MART-1, CK20, synaptophysin, chromogranin, CD1a, Ki-67) were then employed and the findings correlated with the degree of clinical pigmentation.

RESULTS

Histopathologically, 13 of 257 cases (5.06%) were found to have pigment; of these 13, 6 (all white patients) had clinically apparent pigmentation (2.33%), either focal or diffuse. Eight of 13 lesions developed on the lower eyelids. All stained positively for melanin but negatively for iron. MiTF highlighted numerous melanocytic nuclei in the tumor lobules, while MART-1 and HMB-45 revealed the dendritic shapes of the entrapped melanocytes. There was a subtotal blockage of melanin transfer to the surrounding basaloid cells. Intralobular S-100-positive cells included CD1a-positive Langerhans cells, while CK20 did not identify any Merkel cells.

CONCLUSIONS

Only 1 of 6 lesions was uniformly clinically pigmented, whereas the other 5 were only focally brown-black. The clinical pigmentation was imparted by varying densities and distributions of melanocytes with arborizing dendrites, which were present in all BCCs. Melanophages within the stroma and basaloid cell melanization also contributed to pigmentation. No behavioral or biologic differences in pBCC were documented compared with clinically nonpigmented lesions.

Perianal Basal cell carcinoma-an unusual site of occurrence

Basal cell carcinoma is the most common nonmelanoma skin cancer. Its occurrence in the perianal region is very rare. Awareness of its benign behavior in this region, in contrast to the earlier reports, is vital in its management. Local excision seems to provide adequate control. We are herewith reporting an extremely rare case of a 69-year-old male with basal cell carcinoma treated adequately with local excision.

Primary cutaneous malignancies in sub-Saharan Africa

Cutaneous malignancies are the most common malignancies in Whites; traditionally considered rare among Blacks, their occurrence in sub-Saharan Africa is yet to be fully characterized.Data on specimens submitted between 1992 and April 2008 on all histologically proven primary cutaneous malignancies were collected from the Pathology Department, including patient age, sex, anatomic site of malignancy, and histologic diagnosis. There were 1900 patients with primary cutaneous malignancies, aged between 8 months and 110 years, with a mean age of 49 years. There were 14 different types of malignancies found, with squamous cell carcinoma representing 45% of the total. A number of the rarer types have not been reported previously, from this region.Cutaneous malignancies in Africa present a number of management challenges including the following: difficulties in early diagnosis in the dark skin, late presentation, access to treatment, and the ability to pay for the appropriate treatment. The current human immunodeficiency virus/acquired immune deficiency syndrome scourge on the continent may lead a significant increase in cutaneous malignancies, posing even bigger challenges.

Pigmented basal cell carcinoma of the eyelid in Hispanics

BACKGROUND

Pigmented basal cell carcinoma (PBCC) of the eyelid has not been well cited in the literature, and is often overlooked in the differential diagnosis of pigmented eyelid lesions. We aim to describe PBCC of the eyelid in Hispanic patients.

METHODS

Retrospective review of patients with eyelid skin cancer who presented to the Department of Dermatology at the Keck School of Medicine of the University of Southern California and the Doheny Eye Institute from January 2002 to November 2005.

RESULTS

Sixty-nine of the 79 patients with eyelid skin cancer had basal cell carcinoma. Eight of these patients were Hispanic. Four of the eight Hispanic patients had PBCC.

CONCLUSIONS

Although eyelid PBCC is regarded as a rare condition, it may occur more commonly in the Hispanic population and should be remembered in the differential diagnosis of pigmented eyelid lesions.

[Diagnosis of skin cancer by dermatologists in the French West Indies: a prospective study]

BACKGROUND

The incidence of skin cancer is not well established in the French West Indies, aside from old data concerning cutaneous melanoma.

METHOD

A prospective study was performed over a 3-month period in late 2007 in the French West Indies. The number of new cases of histologically confirmed skin cancer was determined using a questionnaire.

RESULTS

The rate of participation of dermatologists was 82 %. During the study period, 166 skin cancers were diagnosed in 134 patients (66 women and 68 men: mean age=63.3 years, SD=2.5), including 137 basal cell carcinomas, 12 melanomas, seven squamous cell carcinomas, six Bowen's disease, one B lymphoma and one Paget's disease. The raw incidence of skin cancers detected by dermatologists was calculated as 64.6 cases/100 000 inhabitants/year for basal cell carcinoma, 5.7 cases/100 000 inhabitants/year for melanoma, 3.3 cases/100 000 inhabitants/year for squamous cell carcinoma, and 2.8 cases/100 000 inhabitants/year for Bowen's disease. Seven melanomas (almost exclusively of plantar topography) and seven basal cell carcinomas were diagnosed in patients of phototype V or VI.

DISCUSSION

Although lower than in metropolitan France, the number of skin cancers diagnosed by dermatologists in the French West Indies is fairly high. In addition, this study indicates the significant incidence of basal cell carcinomas and melanomas in subjects with phototype V or VI, underreported in the literature. These findings highlight the need to begin longer-term studies and to include skin carcinomas in the cancer registry of the French West Indies in order to better identify their characteristics among the Caribbean population.

Melanization in basal cell carcinomas: microscopic characterization of clinically pigmented and non-pigmented tumours

Clinical and microscopic pigmentation may affect the treatment outcomes in basal cell carcinoma. However, there have not been any in-depth histopathological comparisons between clinically pigmented and non-pigmented basal cell carcinomas with regards to microscopic melanization. The aims of our study were to determine the proportion of pigmented basal cell carcinomas presenting to the National Skin Centre in Singapore, to characterize the histological pattern of melanization and to perform a semi-quantitative analysis of the degree of microscopic melanization of the tumours. Patients with clinical features and histologically confirmed basal cell carcinomas were recruited. Demographic data and clinical characteristics were recorded and basal cell carcinoma sections were examined for histological subtype and pattern of melanization. Twenty-five Chinese patients with 30 basal cell carcinomas were recruited. Three of the five clinically non-pigmented and all of the clinically pigmented basal cell carcinomas had microscopic evidence of melanization. Microscopic melanization in clinically non-pigmented basal cell carcinomas was present only focally or in the centre of the tumour mass. Both groups of basal cell carcinomas may be colonized by melanocytes. Two morphological types of melanocytes, a dendritic and round cell type, were identified. Future research is required to evaluate if the degree of microscopic melanization influences the treatment outcome of basal cell carcinomas.

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.

Clinical and histopathologic findings of superficial basal cell carcinoma: A comparison with other basal cell carcinoma subtypes

BACKGROUND

Basal cell carcinoma (BCC) is the most common cancer in white populations. However, BCC is uncommon in Taiwan, and its subtype, superficial BCC (SBCC), is even less common. The characteristics of these 2 cancers in Taiwanese have never been analyzed before. Our purpose was to study the clinical and histopathologic features of SBCC in comparison with other BCC subtypes (OBCC).

METHODS

Thirty Taiwanese patients with SBCC from 1974 to 2003 were retrospectively examined at Taipei Veterans General Hospital. We analyzed the age, gender distribution, site of the lesions, clinical appearance, incidence of metastasis, and the proportion of secondary amyloid deposits. We then compared these features with those of 354 Taiwanese patients with OBCC.

RESULTS

Compared with the black pearly appearance of OBCC, erythematous plaques or patches with multiple tiny blackish papules were the most common clinical appearance of SBCC. Tumor size was significantly larger than OBCC (p < 0.05). The trunk was the most common area where SBCC arose. Conversely, OBCC occurred mainly on the head and neck (p < 0.001). Females were significantly younger than males in both SBCC and OBCC groups (p < 0.05). The frequency of secondary amyloid deposits was lower in SBCC than OBCC (p < 0.05).

CONCLUSION

The unique findings of SBCC would help to classify the subtypes of BCC. The mechanism of development of each subtype is worth further investigation in the future.

Basal cell carcinoma in Turkey

Basal cell carcinoma (BCC) is the most common form of cancer in Caucasians. This study was undertaken to define clinical features of BCC treated by surgical excision in Turkish patients. One-hundred and ninety-eight patients with 216 BCC, all treated by surgical excision, were studied prospectively. Age and sex distribution, personal and family history, skin type, site and size of the lesions, clinical type of the lesions, status of surgical margins and incidence of recurrence were analyzed. The male to female ratio was 9:10, and the average age of the patients was 64.5 years. Of the tumors, 91.5% occurred on the head and neck. There was also personal and/or family history of cancer in 24.8% of our cases. Of all BCC treated, 83.8% had a noduloulcerative clinical appearance. The vast majority of our patients were Fitzpatrick type 3 (53.0%) and type 2 (41.5%). There were seven recurrences after follow-up periods varying between 3 months and 2 years. In conclusion, clinical characteristics of BCC in Turkish patients have both similarities and differences compared with other countries.

Basal cell carcinoma in Turkey

Basal cell carcinoma (BCC) is the most common form of cancer in Caucasians. This study was undertaken to define the clinical features of BCC treated by surgical excision in Turkish patients. A group of 198 patients with 216 BCCs, all treated by surgical excision, were studied prospectively. The age and sex distribution, personal and family histories of the patients, skin type, sites and sizes of the lesions, clinical types of the lesions, status of the surgical margins, and incidences of recurrence were analyzed. The male to female ratio was 0.9, and the average age of the patients was 64.5 years. Of the tumors, 91.5% occurred on the head and neck. There were also personal and/or family histories of cancer in 24.8% of our cases. Of all BCCs treated, 83.8% had a noduloulcerative clinical appearance. The vast majority of our patients were Fitzpatrick type 3 (53.0%) and type 2 (41.5%). There were seven recurrences after follow-up periods varying between three months and two years. In conclusion, the clinical characteristics of BCC in Turkish patients have both similarities and differences compared to those of other countries.

Pigmentation in basal cell carcinoma involves enhanced endothelin-1 expression

Basal cell carcinoma (BCC) is the most prevalent malignant skin tumor. In Asian patients, marked pigmentation in BCC lesions is often observed. Recently, endothelins (ETs) have been implicated to participate in the pigmentation process of BCC. Therefore, we set out to investigate the involvement of ET in the pigmentation process of BCC and the potential regulators in the pigmentation pathway. We explored the effects of an established BCC cell line on melanocytes. The growth factor profiles of BCC culture supernatant and effects of supernatant on melanocytes were documented. Potential regulators involved in the pigmentation pathway were also studied. The immunohistochemical staining of pigmented and non-pigmented BCC specimens was performed to confirm our in vitro findings. Our results showed that BCC supernatant contained significant amount of ET-1, basic fibroblast growth factor, and nerve growth factor. Furthermore, BCC supernatant stimulated melanin formation of cultured melanocytes. Addition of ET-receptor antagonist abrogated the melanogenic effect of BCC supernatant on melanocytes. Introduction of UVB irradiation decreased the ET-1 secretion by BCC cells. Immunohistochemical staining of the pigmented facial BCC specimens showed prominent expression of ET-1 on pigmented BCC, while the non-pigmented facial BCC specimens showed little ET-1 reactivity. Tumor necrosis factor-alpha (TNF-alpha) staining showed little expression on BCC specimens, regardless of pigmentation status. In summary, our results indicate that enhanced ET-1 expression in pigmented BCC plays an important role in the hyperpigmentation of this tumor. Moreover, this enhanced ET-1 cascade showed little correlation with UV irradiation and TNF-alpha expression in our study.

Basal Cell Carcinomas of the Eyelids

Basal cell carcinomas (BCC) are the more frequent malignant tumors seen in France as in other western countries. They represent 20% of eyelid tumors and 90% of eyelid malignancies. Due to their local growth, problems may arise when treating BCC, and curative exeresis must be the preferred choice each time it is possible. BCC of the eyelids have a high risk of recurrence. Recurrences are more aggressive, infiltrative and destructive and have a considerably poorer rate of cure than primary tumors. Eyelid reconstructions can entail use of complex methods which should only be carried out by a trained ophthalmologist who is also able to treat any associated age-related ocular pathologies. BCC is the most common cause leading to eyelid reconstructive surgery; a surgery which has a triple objective: tumor removal, functionality and an esthetic outcome.

Pigmented speckling as a sign of basal cell carcinoma

BACKGROUND

Basal cell carcinoma may present as a discrete skin-colored papule, which may mimic other common skin tumors.

OBJECTIVES

We present pigmented speckling as a clinical sign for basal cell carcinoma.

METHODS

Twenty cases of basal cell carcinoma with pigmented speckling were collected and their clinical and histologic features were reviewed.

RESULTS

There were 12 men and 5 women. The patients' average age was 70.5 years (range 33-90 years). Fifteen of the 17 tumors were on the head and neck, and 2 tumors were on the shoulders and back. Clinical examination revealed a "speckled appearance" of brown-black pigmentation within and/or at the border of the tumors. Histopathology showed basal cell carcinoma with melanin pigment (positive for Fontana-Masson stain and negative for Perl's stain) within nests of tumor cells.

CONCLUSION

The speckled pigmentation of a basal cell carcinoma is a distinguishing feature, which may be useful in the differential diagnosis of this tumor from other discrete skin tumors.

Morpheaform basal cell carcinoma in African Americans

BACKGROUND

Although it has been established that basal cell carcinoma is an uncommon diagnosis in black patients, the morpheaform subtype is very rare among these individuals.

OBJECTIVE

The objective is to present two cases of morpheaform basal cell carcinoma in African-American patients.

METHODS

This is a case series and a literature review using the Ovid Medline Database. Key words used in the search include "basal cell carcinoma," "African American," "black," "African," "negros," "morpheaform," "sclerosing," "fibrosing," and "scar-like basal cell carcinoma." The Ovid Medline Database was searched from 1966 to present and was restricted to the English language.

RESULTS

A review of the Emory Dermatology clinic charts from 1989 to 2004 revealed two black patients with morpheaform basal cell carcinomas.

CONCLUSIONS

Although extremely rare, morpheaform pattern basal cell carcinoma must be considered in the differential diagnosis for black patients presenting with nonhealing lesions.

Basal Cell Carcinoma on the Eyelids: Own Experience

BACKGROUND

Basal cell carcinoma (BCC) is the most common skin malignancy. Eyelids constitute a special location of BCC because of the proximity of the eyeball.

OBJECTIVE

This study was undertaken to evaluate the incidence of BCC located on the eyelids, to examine the clinical and histologic types of BCCs in this location, and to present some reconstructive techniques used in the treatment of BCC in palpebral region.

METHODS

There were 330 patients with BCC retrospectively included in the study. The comparison was performed between clinical and histologic features of BCCs located on eyelids and in other locations.

RESULTS AND CONCLUSIONS

Approximately 16% of all tumors were located on the eyelids. The majority of tumors were situated on the lower eyelid. Noduloulcerative clinical type was observed in 96.3% of tumors. This type was significantly more frequently found on eyelids than on trunk and extremities (p<0.00001). The histologic nodular type was the most common found on eyelids. It was significantly more common on eyelids than on trunk and extremities (p=0.002). The superficial type was significantly less frequently found on the eyelids (p<0.00001). The infiltrative type was significantly more seldom observed on the eyelids compared with other locations of head and neck region (p=0.048). Some technical aspects of reconstructive surgery of the eyelids are presented.

Skin cancer awareness in suburban employees: a Hispanic perspective

Skin cancer is the most common form of cancer in the United States and accounts for an estimated 1 million new cases per year. In the white population, the rate of new melanomas diagnosed yearly has more than doubled from 5/100,000 in 1973 to 12/100,000 in 1990. The current lifetime risks for white persons are estimated to be 28% to 33% for basal cell carcinoma and 7% to 11% for squamous cell carcinoma. Skin cancer is more common in sun-sensitive, fair-skinned individuals but can occur in any ethnic group, especially with exposure in tropical or sunny climates. Little is known about awareness of skin cancer, risk perception, and performance of skin self-examination (SSE) by people with skin that rarely burns. Our purpose was to evaluate skin cancer awareness, perceptions of skin cancer risk, and performance of SSE in a Hispanic versus non-Hispanic white population with similar access to health care and promotion. One hundred forty people employed by a suburban city voluntarily attended a free skin cancer screening and completed a self-administered survey. Hispanic individuals reported decreased skin sensitivity and tendency to burn. Non-Hispanic individuals believed they were at greater than average risk for skin cancer, and most Hispanics believed they were at average or below average risk. None of the 27 Hispanics reported ever being taught SSE. More non-Hispanics (32%) had performed SSE within the last year than Hispanics (15%). Regular SSE was associated with a history of skin cancer. Multimedia messages usually link skin cancer warning signs and early detection strategies with having sun-sensitive skin. People without sun sensitivity did not perceive themselves as being at risk, did not learn the warning signs of skin cancer, and did not perform SSE. Awareness of melanoma and non-melanoma skin cancer and perception of risk among Hispanics were less than among non-Hispanics, which may contribute to presentation for care at an advanced stage.

Neck location of basal cell carcinomas: a new-significant variant?

Basal cell carcinoma of the neck has been suggested to have a distinct clinical, histological and prognostic significance. The aim of our study is to verify this assumption. Among 1,185 basal cell carcinomas, we have observed 42 tumors localized on the neck. The mean age did not differ from that of patients with basal cell carcinomas on other sites, and there was no difference in incidence between sexes. The frequence of recurrence was 4.76%, similar to the recurrence rate of basal cell carcinomas on other sites. The lesions were typed histologically according to accepted criteria. The patterns observed were: nodular (62.8%), superficial (21.1%), mixed (4.7%), micronodular (5.9%), and infiltrative (5.7%). These frequencies did not differ significantly from those observed in the basal cell carcinomas on other sites. Thus, in comparison with the overall basal cell carcinoma population, the tumors of the neck do not represent a particular clinical and histologic subtype and do not have a particular recurrence potential. We think that basal cell carcinomas localized on the neck do not represent a particular subtype of these tumors; their treatment can be the same as that of basal cell carcinomas on other regions.

Clinical and histopathological characteristics of basal cell carcinoma in Korean patients

Seventy-eight Korean patients with basal cell carcinoma (BCC) between 1984 and 1998 were retrospectively examined at Ewha Womans University Tongdaemun Hospital, Seoul, Korea. We analyzed the annual incidence, age and sex distribution, site of the lesions, clinical appearance, including the proportion of clinically pigmented tumors, modalities of treatment, incidence of recurrence and metastasis of the tumors, the histopathological patterns, and whether solar elastosis, microscopic pigmentation, or adamantinoid feature were associated. The male-to-female ratio was 0.902, and the average age of the patients at first examination was 58.2 years. Eighty percent of the tumors occurred on the head and neck, most commonly on the nose (26.9%), followed by the cheek, eyelid, and upper lip. Ulcerated nodules were the most common clinical presentation. Clinically, 55% of the tumors were pigmented. Six tumors recurred; none metastasized. Surgical excision was the most common modality of treatment. The most frequent histopathological pattern was the solid type (60.3%), followed by the superficial (11.5%) and fibrosing (9.0%) types. The occurrence of the superficial type was significantly associated with truncal lesions (p < 0.001). Solar elastosis was present in 62.1% of the tumors on the head and neck, compared with 8.3% in those of the trunk and limbs (p < 0.001), indicating the significance of sun exposure in the pathogenesis of BCC on exposed areas. Microscopic pigmentation was seen in 69.2% of the tumors. The focal adamantinoid feature was found in 14.1%, which is much higher than the previously reported incidence.

Why classify basal cell carcinomas?

Basal cell carcinoma of the skin is the commonest form of cancer in the white population. A simple pathological classification is presented and recommended for general use to aid clinicians in their management of cases. Basal cell carcinoma can be classified as nodular, infiltrative, superficial apparently multifocal and mixed in terms of the histological growth pattern. These patterns can be related to the likelihood of complete excision and, if excision is incomplete, to the frequency of recurrence.

Pigmented basal cell carcinoma in Hispanics

BACKGROUND

Pigmented basal cell carcinoma (PBCC) may occasionally be misdiagnosed as melanoma. In the Hispanic population, PBCC is common.

OBJECTIVE

We attempted to determine the prevalence of PBCC in a Hispanic population.

METHODS

A randomized, blinded, retrospective study was designed to assess histologic slides for the presence of microscopic pigment. Basal cell carcinoma (BCCs) from 30 patients with a Hispanic surname were compared histologically with BCCs from 30 patients with a northern European surname. In the prospective phase of the study, 15 Hispanic and 44 non-Hispanic patients with clinically suspected BCC or PBCC completed a questionnaire about their ethnic background and skin type to determine whether PBCC is more common in Hispanics.

RESULTS

Pigment was identified twice as frequently in BCCs from patients with a Hispanic surname than in BCCs from patients with a northern European surname. In the prospective clinical study, 66% of clinically diagnosed PBCCs were found in Hispanic patients, whereas only 11% of nonpigmented BCCs came from Hispanic patients (p < 0.01).

CONCLUSION

In patients with a BCC, PBCCs are more common in Hispanics than non-Hispanics. This may reflect an increased incidence of PBCCs in the Hispanic population.

Basal cell carcinoma on the scalp of an Indian patient

BACKGROUND

Basal cell carcinoma (BCC) is the most common malignancy in whites, but it rarely occurs in dark persons.

OBJECTIVE

To report a BCC on the hairy scalp of an Asian Indian female with no obvious risk factors except previous scalp trauma.

METHODS

We review the English literature concerning BCC in Indians, and compare this with data for North American blacks and whites; and reports of BCC arising in areas of prior trauma.

RESULTS/CONCLUSION

Skin cancer accounts for 1-2% of malignancies in blacks and Indians, compared with one-third of neoplasms in whites. BCC comprises 75% of skin cancers in whites, but squamous cell carcinoma represents 60-65% of skin cancers in blacks and Indians. Although most BCCs occur in sun-exposed areas in whites, blacks, and Indians, a significant percentage also develop in photoprotected areas. Trauma may be a significant risk factor for BCC, either with actinic damage or alone, as in our case.

Skin cancer in African Americans

Skin cancer is the most common type of malignancy in the United States. Incidence within the African American population remains relatively low, but data is limited for this racial group, making accurate determination of incidence and mortality difficult. Factors implicated as causative in the pathogenesis of cutaneous malignancy in African Americans include, but are by no means limited to, sunlight, albinism, burn scars, X-rays, preexisting pigmented lesions, chronic inflammation, and chronic discoid lupus erythematosus. Anatomic distribution of lesions may be similar to that seen in whites for basal cell carcinoma but not for other skin cancers. For squamous cell carcinoma, melanoma, and cutaneous T-cell lymphoma, African Americans do not as well in terms of mortality as do whites. This difference probably is due either to the fact that African Americans have more advanced stages of disease at diagnosis than do whites or, in some cases, because the course of the disease is more aggressive in African Americans for reasons yet unknown. There is a need for heightened awareness of skin cancer in African Americans by patients and physicians. Emphasis should be on education and early diagnosis with the primary goal in mind being the reduction of incidence of and mortality due to skin cancer in African Americans. In addition, because of environmental factors, African Americans will be exposed to more solar ultraviolet radiation in the future. Strategies should be developed for public education to keep this exposure to low levels in this racial group.

Clinical findings in two African-American families with the nevoid basal cell carcinoma syndrome (NBCC)

The nevoid basal cell carcinoma syndrome (NBCC) is an autosomal dominant multisystem disorder with variable expressivity. We present the clinical findings on 11 African-American NBCC cases from 2 families and a review of the literature of NBCC in African-Americans. The 2 new families, as well as those previously reported, suggest minimal expression of the basal cell carcinomas and full expression of the other components of the syndrome. The 3 most common findings in the 11 cases were jaw cysts, palmar and/or plantar pits, and calcification of the falx cerebri. Only 44% (4/11) of these cases had one or more confirmed basal cell carcinomas. This frequency is substantially less than that observed in whites (90% with basal cell carcinomas). The relative lack of these skin tumors in African-Americans partly reflects ultraviolet radiation protection resulting from increased skin pigmentation. Future research should help identify the specific mutation(s) in blacks as well as other modifying genes and environmental exposures that may contribute to the varied manifestations of the syndrome.

Pattern of malignant skin tumors in Asir region, Saudi Arabia

The current study describes the pattrn of malignant skin tumors in 137 cases seen in Asir Central Hospital histopathology laboratory over a five year period (1987 to 1991). Ninety percent (90.5%) were Saudis and the mean age was 61.0 years with a male:female ratio of 1.6:1. Squamous cell carcinoma was the most common type of skin cancer presenting (41.6%), followed by basal cell carcinoma (36.5%), and then malignant melanoma (11.7%). Ninety-eight percent of basal cell carcinoma occurred on the head, compared to only 47.4% of squamous cell carcinoma; and 24.6% of squamous cell carcinoma cases occurred in the lower limbs. Eighty-seven percent (87.6%) of malignant melanoma cases occurred in the extremities. The distribution of the other types of malignant skin tumors are also discussed. Our findings were compared with the very few studies from the Kingdom and other parts of the world.