Introduction: Male gender, age, fair skin, ultraviolet radiation and immunosuppression are known risk factors for BCC. However there is limited understanding of the impact of these risk factors with increasing frequency of BCC development. In this study, we sought to investigate the association of gender, age, BCC subtype, distribution and immunosuppressant use with increasing frequency of BCCs. Methods: We performed a retrospective cohort study of 3,392 BCCs biopsied in 1,419 patients between 2005 and 2015 at Stanford Hospital and Clinics. Results: During the 10-year observational period, 53.3% patients were diagnosed with single BCC; 38.8% patients developed 2 to 5 BCCs; 7.8% patients developed 6 or more BCCs (high frequency BCCs or hfBCCs). We found that as the number of BCC increased, the proportion of male patients also significantly increased. Adjusting for age, race, and follow-up duration, male sex was associated with a 1.18 fold-increase in risk of 2 or more BCCs (p ¼ 0.007) and a 2.40-fold increase in risk of 6 or more BCCs (p < 0.001) using logistic regression. Multivariate regression analysis adjusted for age, gender, race, and transplant status also showed that patients with history of azathioprine had 5.22 fold-increase in risk for developing 6 or more BCCs (95% CI 1.31 e 20.81, p ¼ 0.019) compared to single BCC. Mycophenolate, cyclosporine, sirolimus, and tacrolimus did not change the risk of BCC. Conclusion: The data implicates the continued high risk of male gender on the development of numerous BCCs. In addition, azathioprine is associated with increased risk of hfBCCs. Continued clinical surveillance is needed to identify and understand this subset of patients who develop BCC at high frequency.

There are various neurological manifestations of coronavirus disease 2019 (COVID-19). Recent data suggest a connection between hemifacial paralysis, or Bell’s palsy, and COVID-19. Although the etiology of Bell’s palsy is unknown, the leading proposed etiology is viral in nature. Since the onset of the pandemic, numerous studies have investigated the relationship between Bell’s palsy, COVID-19 infection, and COVID-19 vaccination. The researchers studied the current literature on the topic of COVID-19 as it relates to Bell’s palsy.

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