External Medicine
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Basal Cell Carcinoma
EPIDEMIOLOGY
Race/Ethnicity
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Risk of keratinocyte carcinomas, of which BCC is the most common (SCC being the other), is geometrically if not exponentially higher in fairer skin types. In fact, only 2.4% of ~785,000 medicare beneficiaries who had skin cancer were non-white. 97.6% of keratinocyte carcinomas in the medicare population are in non-hispanic white patients. (38019561)
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This difference in risk is even more stark when comparing white and black patients: white patients have nearly 70x the risk of black patients and nearly 2.5x the risk of non-white/black individuals. Whites have 90x the risk of BCC compared to blacks and 63x the risk of SCC. (38019561)
Genetics
SUFU Pathogenic Variants
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"Patients with germline SUFU PVs may present with multiple indolent basaloid neoplasms in addition to conventional basal cell carcinomas, typically appearing in the fourth to sixth decades of life." (39292485)
METASTASIS
Groover M, Gupta N, Granger E, et al. Patterns of metastasis from a multicenter cohort of metastatic basal cell carcinoma. J Am Acad Dermatol. 2024. PMID: 38331097.
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BCC metastasis is extremely rare, estimated at 0.0028% (this is ~1 in 33,000, which is probably still a gross overestimate).
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It happens in the setting of very large tumors (mean size of primary tumor was over 7cm).
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41.5% were limited to regional lymph nodes.
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30.2% were distant mets with LN involvement (usually diagnosed concurrently).
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28.3% were distant mets without lymph node involvement.
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Over 90% of distant mets were to lung, and over a third of distant mets were to bone (7 cases had both lung and bone mets).