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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 - 07/08/11

Doi : 10.1016/j.jaad.2009.03.015 
Sudarshan Ramachandran, MBChB, MD a, b, Ratna Rajaratnam, MBChB, BSc c, , Andrew G. Smith, MBBS c, John T. Lear, MBBS d, Richard C. Strange, PhD, FRC Path a
a Institute of Science and Technology in Medicine, Keele University Medical School, Hartshill Campus, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom 
b Department of Biochemistry, Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom 
c Department of Dermatology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom 
d Department of Dermatology, Salford Royal Hospital, Salford, United Kingdom 

Reprint requests: Ratna Rajaratnam, MBChB, MD, Department of Dermatology, Central Outpatients Department, Newcastle Rd, University Hospital North Staffordshire NHS (National Health Service) Trust, ST4 7PA, England.

Abstract

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.

Le texte complet de cet article est disponible en PDF.

Key words : basal cell carcinoma, squamous cell carcinoma, subsequent tumor

Abbreviations used : BCC, CI, SCC, UV, UVR


Plan


 Supported in part by a grant from the Cancer Research Campaign.
 Conflicts of interest: None declared.


© 2009  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 61 - N° 2

P. 247-251 - août 2009 Retour au numéro
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