Advertisement

Basal cell carcinoma on the ear is more likely to be of an aggressive phenotype in both men and women

Published:August 29, 2011DOI:https://doi.org/10.1016/j.jaad.2011.05.020

      Background

      We observed that basal cell carcinoma (BCC) on the ear demonstrates a more aggressive phenotype compared with other body sites.

      Objective

      We sought to determine if it is statistically significant that BCC on the ear is more aggressive.

      Methods

      We queried our 2009 database for all BCCs biopsied from the ear. Multiple data points, including tumor subtype and risk level, were analyzed for 100 BCCs on the ear and 100 BCCs on the cheek.

      Results

      BCC on the ear was diagnosed 471 times. Of the first 100 occurrences of BCC on the ear, 57% were high risk compared with 38% on the cheek (odds ratio 2.16, 95% confidence interval 1.23-3.81, P = .01). Men were more likely to have BCC on the ear: 79% male on the ear and 53% male on the cheek (P < .001). However, BCC on the ear in women is also more likely to be aggressive (57%, 12 of 21).

      Limitations

      The data were retrieved from a single year at our institution, and there could potentially be regional bias given that the population of data is from a single institution. Many of the specimens we evaluate are reviewed in consultation and may thus represent a selection bias.

      Conclusion

      BCC on the ear presents as an aggressive phenotype in the majority of cases for both men and women, and it occurs much more frequently in men. Knowledge of this information can help guide physicians and ensure that these tumors are adequately biopsied and treated.

      Key words

      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Miller D.L.
        • Weinstock M.A.
        Nonmelanoma skin cancer in the United States: incidence.
        J Am Acad Dermatol. 1994; 30: 774-778
        • Rodriguez-Vigil T.
        • Vazquez-Lopez F.
        • Perez-Oliva N.
        Recurrence rates of primary basal cell carcinoma in facial risk areas treated with curettage and electrodesiccation.
        J Am Acad Dermatol. 2007; 56: 91-95
        • Preston D.S.
        • Stern R.S.
        Nonmelanoma cancers of the skin.
        N Engl J Med. 1992; 327: 1649-1662
        • John Chen G.
        • Yelverton C.B.
        • Polisetty S.S.
        • Housman T.S.
        • Williford P.M.
        • Teuschler H.V.
        • et al.
        Treatment patterns and cost of nonmelanoma skin cancer management.
        Dermatol Surg. 2006; 32: 1266-1271
        • Gulleth Y.
        • Goldberg N.
        • Silverman R.P.
        • Gastman B.R.
        What is the best surgical margin for a basal cell carcinoma: a meta-analysis of the literature.
        Plast Reconstr Surg. 2010; 126: 1222-1231
        • Ozgediz D.
        • Smith E.B.
        • Zheng J.
        • Otero J.
        • Tabatabai Z.L.
        • Corvera C.U.
        Basal cell carcinoma does metastasize.
        Dermatol Online J. 2008; 14: 5
        • McGuire J.F.
        • Ge N.N.
        • Dyson S.
        Nonmelanoma skin cancer of the head and neck I: histopathology and clinical behavior.
        Am J Otolaryngol. 2009; 30: 121-133
        • Batra R.S.
        • Kelley L.C.
        Predictors of extensive subclinical spread in nonmelanoma skin cancer treated with Mohs micrographic surgery.
        Arch Dermatol. 2002; 138: 1043-1051
        • Mosterd K.
        • Thissen M.R.
        • van Marion A.M.
        • Nelemans P.J.
        • Lohman B.G.
        • Steijlen P.M.
        • et al.
        Correlation between histologic findings on punch biopsy specimens and subsequent excision specimens in recurrent basal cell carcinoma.
        J Am Acad Dermatol. 2011; 64: 323-327
        • Wade T.
        • Ackerman A.
        The many faces of basal-cell carcinoma.
        J Dermatol Surg Oncol. 1978; 4: 23-28
        • Crowson A.
        Basal cell carcinoma: biology, morphology and clinical implications.
        Mod Pathol. 2006; 19: 127-147
        • Weedon D.
        Weedon’s skin pathology.
        3rd ed. Elsevier CL, Brisbane2010 (p. 682-691)
        • Rubin A.I.
        • Chen E.H.
        • Ratner D.
        Basal-cell carcinoma.
        N Engl J Med. 2005; 353: 2262-2269
        • Mosterd K.
        • Arits A.H.
        • Thissen M.R.
        • Kelleners-Smeets N.W.
        Histology-based treatment of basal cell carcinoma.
        Acta Derm Venereol. 2009; 89: 454-458
        • Mosterd K.
        • Krekels G.
        • Nieman F.
        • Ostertag J.U.
        • Essers B.A.
        • Dirksen C.D.
        • et al.
        Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomized controlled trial with 5-years’ follow-up.
        Lancet Oncol. 2008; 9: 1149-1156
        • Ratner D.
        • Lowe L.
        • Johnson T.
        • Fader D.
        Perineural spread of basal cell carcinomas treated with Mohs micrographic surgery.
        Cancer. 2000; 88: 1605-1613
        • Miladi A.
        • Bingham J.
        Triage in Mohs micrographic surgery.
        J Drugs Dermatol. 2011; 10: 257-259
        • Bath-Hextall F.
        • Bong J.
        • Perkins W.
        • Williams H.
        Interventions for basal cell carcinoma of the skin.
        Cochrane Database Syst Rev. 2007; 1: CD003423
        • Dandurand M.
        • Petit T.
        • Martel P.
        • Guillot B.
        Management of basal cell carcinoma in adults: clinical practice guidelines.
        Eur J Dermatol. 2006; 16: 394-401
        • Betti R.
        • Radaelli G.
        • Mussino F.
        • Menni S.
        • Crosti C.
        Anatomic location and histopathologic subtype of basal cell carcinomas in adults younger than 40 or 90 and older: any difference?.
        Dermatol Surg. 2009; 35: 201-206
        • Betti R.
        • Radaelli G.
        • Bombonato C.
        • Crosti C.
        • Cerri A.
        • Menni S.
        Anatomic location of basal cell carcinomas may favor certain histologic subtypes.
        J Cutan Med Surg. 2010; 14: 298-302
        • Redondo P.
        • Lloret P.
        • Sierra A.
        • Gil P.
        Aggressive tumors of the concha: treatment with postauricular island pedicle flap.
        J Cutan Med Surg. 2003; 7: 339-343
        • Bartos V.
        • Adamicova K.
        • Kullova M.
        • Pec M.
        Basal cell carcinoma of the skin–biological behavior of the tumor and a review of the most important clinical predictors of disease progression in pathological practice.
        Klin Onkol. 2011; 24: 8-17
        • Mueller C.
        • Nicolaus K.
        • Thorwarth M.
        • Schultze-Mosgau S.
        Multivariate analysis of the influence of patient-, tumor-, and management-related factors on the outcome of surgical therapy for facial basal-cell carcinoma.
        Oral Maxillofac Surg. 2010; 14: 163-168
        • Smeets N.
        • Kuijpers D.
        • Nelemans P.
        • Ostertag J.U.
        • Verhaegh M.E.
        • Krekels G.A.
        • et al.
        Mohs’ micrographic surgery for treatment of basal cell carcinoma of the face–results of a retrospective study and review of the literature.
        Br J Dermatol. 2004; 151: 141-147
        • Nakayama M.
        • Tabuchi K.
        • Nakamura Y.
        • Hara A.
        Basal cell carcinoma of the head and neck.
        J Skin Cancer. 2011; 2011: 496910
        • Buljan M.
        • Bulat V.
        • Situm M.
        • Mihic L.
        • Stanic-Duktaj S.
        Variations in clinical presentation of basal cell carcinoma.
        Acta Clin Croat. 2008; 47: 25-30
      1. Betti R, Radaelli G, Crosti C, Ghiozzi S, Moneghini L, Menni S. Margin involvement and clinical pattern of basal cell carcinoma with mixed histology. J Eur Acad Dermatol Venereol doi: 10.1111/j.1468-3083.2011.04104.x. Published online May 5, 2011.

        • Cohen P.
        • Schulze K.
        • Nelson B.
        Basal cell carcinoma with mixed histology: a possible pathogenesis for recurrent skin cancer.
        Dermatol Surg. 2006; 32: 542-551
        • Rippey J.
        Why classify basal cell carcinomas?.
        Histopathology. 1998; 32: 393-398
        • Gallagher R.P.
        • Hill G.B.
        • Bajdik C.D.
        • Fincham S.
        • Coldman A.J.
        • McLean D.I.
        • et al.
        Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer, I: basal cell carcinoma.
        Arch Dermatol. 1995; 131: 157-163
        • Yap F.B.
        Clinical characteristics of basal cell carcinoma in a tertiary hospital in Sarawak, Malaysia.
        Int J Dermatol. 2010; 49: 176-179
        • Lovatt T.J.
        • Lear J.T.
        • Bastrilles J.
        • Wong C.
        • Griffiths C.E.
        • Samarasinghe V.
        • et al.
        Associations between ultraviolet radiation, basal cell carcinoma site and histology, host characteristics, and rate of development of further tumors.
        J Am Acad Dermatol. 2005; 52: 468-473
        • Anthouli-Anagnostopoulou F.
        • Hatziolou E.
        Recurrent morphean basal cell carcinoma of the skin: a clinico-histopathological study of 97 cases.
        Adv Clin Path. 2002; 6: 17-24