Basal cell carcinoma viewed as a chronic disease for some

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Because people who have had multiple bouts of basal cell carcinoma (BCC) are always at risk of recurrence, the disease can be considered chronic for such patients.

BCC is the most common cancer in the United States, and patients who have had one BCC are likely to have several more over time, explained Martin A. Weinstock, MD, PhD, and colleagues in Journal of Investigative Dermatology. Weinstock, a professor of dermatology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, and other members of the VA Topical Tretinoin Chemoprevention (VATTC) Trial Group 7 prospectively studied predictors of new BCCs on the faces and ears of 1,131 VATTC participants. All the participants were veterans (97% male; median age 72 years), and all were at very high risk of recurrent BCC. On average, each person had had more than three episodes of BCC or squamous cell carcinoma prior to study enrollment.

Overall, 44% of the patients developed new BCCs during the 6-year study period. The investigators learned that number of BCCs experienced in the prior 5 years was the most important predictor of new lesions: The 129 veterans who had had more than five BCCs in that time had a hazard rate ratio that was nearly four times higher than that of the 204 participants with no or one BCC in that time, and more than twice as high as that of the 200 participants who had had three prior BCCs.

Eczema proved to be another predictor of BCC recurrence, conferring a hazard rate ratio upon participants with a family history of eczema that was 1.54 times higher than that for participants with no family history, after statistical adjustments.

“The connection with eczema is something that's new, that needs to be further explored,” noted Weinstock in a statement issued by Brown University.

Other independent predictors of BCC recurrence included:

  • aging
  • sun sensitivity
  • occupational sun exposure before age 30 years, but not afterward (“While we don't exonerate UV [ultraviolet] exposure in one's 40s, 50s, and 60s, it was particularly UV exposure before the age of 30 that was most closely related to BCC in our study,” Weinstock pointed out.)
  • lower level of education
  • history of eczema
  • use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs)
  • more sunscreen use in the week before, but not in the 6 months before, study enrollment.

Sunburns, baseline sun exposure, other skin cancers, and actinic keratoses were not found to be independent predictors of BCC recurrence.

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