Patterns of Basal Cell Carcinoma Presentation in the NIH All of Us Database

To examine risk factors for the development of eyelid, face, and body basal cell carcinoma (BCC) within the National Institutes of Health All of Us database.

Around 7342 patients with BCC and 29,728 age-matched controls were included. Patients with genetic syndromes predisposing to BCC, and patients with a history of solid organ transplants were excluded. Outcomes examined included tumor location, ethnicity, age, smoking, alcohol intake, income, and access to care. Univariate and multivariate regression analyses were performed to examine the association between BCC on different areas of the body and race as well as the effect of modifiable risk factors.

Almost 48.7% (3623) of patients had BCC on the body (nonface), 47.2% had BCC on the face (3505), and 4.1% (304) had BCC of the eyelid. White race (OR, 11.79; CI, 5.99-27.73; p < 0.001) and male sex (OR, 1.23; CI, 1.14-1.33; p < 0.001) were nonmodifiable risk factors for BCC and overall, patients with facial BCC were significantly older ( p < 0.001) than those with body BCC. Nonwhite patients with BCC were younger, and significantly more likely to have nonfacial BCC ( p < 0.001). On multivariate analysis, alcohol intake also showed a dose-dependent increased risk for BCC (OR, 1.54; CI, 1.14-2.13; p < 0.001) of the face.

Nonwhite patients were significantly younger and more likely to be diagnosed with nonfacial BCC. Thus, we hypothesize that BCC pathogenesis may not be as closely related to cumulative sun exposure as for white patients. Alcohol intake is an important modifiable risk factor.