Basal Cell Carcinoma Multiplicity - a Retrospective Analysis of 899 Biopsy-proven Patients from a Single Institute

An interesting clinical feature of basal cell carcinoma (BCC) of the skin is a marked interpatient variation in tumor number, lesion accrual and anatomic distribution. We analyzed a proportion of patients with multiple BCCs in the cohort of pathology report-confirmed cases of BCC and investigated clinicopathological differences between individuals suffering from multiple tumor lesions and patients with a single tumor.

All consecutive patients with primary cutaneous BCCs, who were histologically diagnosed at our Department of Pathology during a 10-year period were enrolled into the study.

A cohort of 899 participants with a total of 1,239 histologically proven primary BCCs were assessed. Of them, 728 (81%) had single BCC and 171 (19%) had multiple BCCs. Multiple lesions occurred more frequently in men than women. Mean number of tumors per patient was 1.5 in males and 1.2 in females. Among participants with multiple BCC manifestation, there was a steady increase of the male-to-female ratio with rising tumor number per individual. In the multiple BCC subgroup, the tumors were found more commonly in the trunk and upper limbs, and less frequently in the face. Histologically, these BCCs much more commonly included superficial subtype. There was a positive correlation between the non-aggressive histologic phenotype of BCC and multiple tumor presentations on the one hand, and the aggressive histologic phenotype of BCC and a single tumor occurrence on the other.

Our analysis shows that clinicopathological features associated with multiple BCC manifestations include male gender, tumor location in the trunk and upper extremities, and superficial histological subtype. Focus on this risk profile may be beneficial for clinical screening and may help clinicians in the selection of individuals, who should be followed-up more closely.Key words: basal cell carcinoma - single and multiple manifestations - clinicopathological differences.