Frequency of basal cell carcinoma in a population younger than 50 years of age: clinical study and literature review

Abstracts

O carcinoma basocelular é a neoplasia maligna cutânea mais comum em humanos, que pode ser prevenida e diagnosticada precocemente. O propósito deste estudo é apresentar os achados clínicos e microscópicos do carcinoma basocelular na população menor de 50 anos. Realizaram-se exames microscópicos em múltiplos cortes de lesão de pele e fez-se revisão da literatura pertinente.

Adulto jovem; Carcinoma basocelular; Dermatite fototóxica

COMMUNICATION

Frequency of basal cell carcinoma in a population younger than 50 years of age: clinical study and literature review^*

Ana Carolina Conde Almeida^I; Thamy Yamashita^II; Bruno Conte^III; Amílcar Castro Mattos^IV; Rilde Plutarco Veríssimo^V; Maria Cristina Furian Ferreira^VI

^I

^IIPhysician graduated from Faculdade de Medicina, Centro de Ciências da Vida, Pontifícia Universidade Católica de Campinas – Campinas (SP), Brazil

^IIIPhysician graduated from Faculdade de Medicina, Centro de Ciências da Vida, Pontifícia Universidade Católica de Campinas – Campinas (SP), Brazil

^IVPathologist, Service of Clinical Pathology, Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas – Campinas (SP), Brazil

^VPathologist, Service of Clinical Pathology, Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas – Campinas (SP), Brazil

^VIPathologist, Service of Clinical Pathology, Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas. Professor of Clinical Pathology, Faculdade de Medicina – Centro de Ciências da Vida – Puc Campinas – Campinas (SP), Brazil

Mailing Address

ABSTRACT

Basal cell carcinoma is the most common type of malignant cutaneous neoplasm in humans, and it can be prevented and diagnosed early. The purpose of this study is to present clinical and microscopic findings of basal cell carcinoma in a population younger than 50 years of age. Microscopic examinations of multiple sections of skin lesion have been done, as well as a review of relevant literature.

Keywords: young adult; carcinoma, basal cell; dermatitis, phototoxic

Basal cell carcinoma is a cutaneous neoplasm that is originated from immature pluripotent epithelial basal cells that have lost their capability for normal differentiation and keratinization ^1-4 and for cutaneous annexes. Head and neck are sites of predilection for basal cell tumors.

It is described as the most frequent malignant tumor in humans, and its occurrence is more common in elderly subjects ^1,2,3. However, we have observed in analyses of large published series that there has been considerable variation in rates of incidence of this tumor ^5-9.

We have studied a series of patients with basal cell carcinoma (BCC) at the University Hospital whose age range was below 50 years and we compared them with some data from the medical literature.

We studied 57 patients aged younger than 50 years, comprising the period 2000 to 2005, whose biopsies were referred to the Service of Pathology of the hospital, coming from the centers of plastic surgery and dermatology of the hospital or from the Municipal Hospital.

In our Center, between 2000 and 2005, out of 62,565 biopsies, there were 1,001 (1.59%) patients with BCC. There were 57 patients aged between 15 and 49 years who presented lesions with general papulous aspect, with pearled and irregular margins. About 20 (35.08%) lesions were ulcerated. None of them had cutaneous presentation of xeroderma pigmentosum or other indications that they could be associated with syndromic disorders. Out of these 57 patients, 11 (19. 29%) had chronic sun exposure for occupational reasons. One patient had multifocal lesions and 56 had single isolated lesions.

The most frequent topography found was face and neck in 27 cases (47.36%) (the nose and temporal region were the most frequent sites, with 5 patients in each). Six patients were smokers. Sixteen were male and 15 were female. One patient was albino (the only patient with multifocal lesions).

There was predominance of classical solid form (Figure 1) with 24 (42.10%) cases, 4 (16.66%) cases containing the micronodular pattern and 5 (20.83%) cases had sclerodermiform presentation (combined subtypes) (Figure 2). The solid form showed lesions with immature microscopic aspect, dark basaloid cells, with increase in number of mitosis and cell palisade. The sclerodermiform form contained dense and fibrosing stroma with loss of peripheral neoplastic palisade, whereas adenoid has cell clusters of cribiform aspect, in general maintaining the peripheral cellular palisade. The superficial form has peripheral palisade on the upper dermis. The combined form has squamous differentiation, present cells with abundant eosinophilic cytoplasm similar to the cells of classical epidermoid carcinoma.

There is a consensus concerning progressive increase in incidence of BCC (in the elderly and also in non-syndromic young patients), with marked local aggressiveness, which may be followed by deformities or even metastases. Many authors agree that the latitude, unprotected skin exposed to the sun, depletion of ozone layer, ethnic heritage and type of skin (phototypes I, II, for example) are probably the factors that contribute the most to this great variation ^5-9.

Growth in the incidence of this cancer in the young population may mean exponential growth in its occurrence in the future of the elderly population, because those who had BCC or squamous cell carcinoma (SCC) are more likely to have tumor recurrence during their life spam, in case they do no change drastically their habits, especially those related with environmental factors ⁸.

To understand the incidence rates, histological characteristics and natural history, some BCC phenomena have been observed in the young population ^4,5,6,8. Traumatic exposure to sun, smoking, artificial tanning, associated with some genetic factors (such as for example xeroderma pigmentosum, basal cell nevus syndrome - Gorlin-Goltz) may facilitate the onset of these tumors in this population ^6-9. Considering that tumor histogenesis phenomena are poorly known ^4,10, preventive behavior seems to be the most effective solution.

REFERENCES

• 1.  Stanley J, Miller MD. Biology of basal cell carcinoma (part I). J Am Acad Dermatol. 1991;24:1-13.
• 2.  Stanley J, Miller MD. Biology of basal cell carcinoma (part II). J Am Acad Dermatol. 1991;24:161-75.
• 3.  Sampaio SAP, Rivitti EA. Dermatologia. 2 ed. São Paulo: Artes Médicas; 2001. p.839-46.
• 4.  Weedon D. Skin pathology. 2 ed. Edinburgh: Churchill Livingstone; 2002. p.765-72.
• 5.  Christenson LJ, Borrowman TA, Vachon CM, Tollefson MM, Otley CC, Weaver AL et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA. 2005;294:681-90.
• 6.  LeSueur BW, Silvis NG, Hansen RC. Basal cell carcinoma in children: report of 3 cases. Arch Dermatol. 2000;36:370-2.
• 7.  Boyd AS, Shyr Y, King LE Jr. Basal cell carcinoma in young women: an evaluation of the association of tanning bed use and smoking. J Am Acad Dermatol. 2002;46:706-9.
• 8.  Kevan G, Lewis MS, Martin A, Weinstock MD. Nonmelanoma skin cancer mortality (1988-2000). Arch Dermatol. 2004;40:837-42.
• 9.  Ramachandran S, Fryer AA, Strange RC. Genetic factors determining cutaneous basal cell carcinoma phenotype. Med Pediatr Oncol. 2001;36:559-63.
• 10.  Fletcher CDM. Diagnostic histopathology of tumors. 2 ed. New York: Churchill Livingstone; 2000. p.1375-80.

*

Trabalho realizado no Serviço de Anatomia Patológica, Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica (PUC) de Campinas – Campinas (SP), Brasil.

Publication Dates

• Publication in this collection
  25 Feb 2010
• Date of issue
  Dec 2009

History

• Accepted
  06 Oct 2009
• Received
  18 June 2006