Aggressive basal cell carcinoma in young patients: fact or fiction?

It has been suggested that basal cell carcinomas (BCC) arising in younger patients may be of a more aggressive phenotype than those that present in the older population. The purpose of this study was to investigate this hypothesis by comparing the histological types of BCC in a large cohort of young and old patients.A total of 271 histological specimens and clinical records were evaluated. A consecutive series of 120 patients under 50 years old were compared with a consecutive series of 151 patients over 50 years of age. Tumours were classified according to the accepted definition of aggressive (morphoeic, infiltrative and micronodular) and less aggressive (nodular and superficial) histological growth patterns. Aggressive growth types were found in 35% of patients over 50 and 33% of patients under 50. There was a higher rate of incomplete excision in younger patients but this did not reach significance (16% compared to 9%, P = 0.1). This study found that BCC arising in young patients are not histologically different to those found in the older population. Clinically observed aggressive behaviour of BCC in young patients may result from inadequate surgical excision due to cosmesis and diagnostic doubt.