BackgroundThe behaviour of each basal cell carcinoma is known to be different according
to the histological growth pattern. Among these aggressive lesions,
sclerodermiform basal cell carcinomas are the most common type. This is a
challenging-to-treat lesion due to its deep tissue invasion, rapid growth,
risk of metastasis and overall poor prognosis if not diagnosed in early
stages.ObjectiveTo investigate if sclerodermiform basal cell carcinomas are diagnosed later
compared to non-sclerodermiform basal cell carcinoma Method: All lesions
excised from 2000 to 2010 were included. A pathologist classified the
lesions in two cohorts: one with specimens of non-aggressive basal cell
carcinoma (superficial, nodular and pigmented), and other with
sclerodermiform basal cell carcinoma. For each lesion, we collected
patient's information from digital medical records regarding: gender, age
when first attending the clinic and the tumor location.Results1256 lesions were included, out of which 296 (23.6%) corresponded to
sclerodermiform basal cell carcinoma, whereas 960 (76.4%) were
non-aggressive subtypes of basal cell carcinoma. The age of diagnosis was:
72.78±12.31 years for sclerodermiform basal cell and
69.26±13.87 years for non-aggressive basal cell carcinoma
(P<.0001). Sclerodermiform basal cell carcinomas are diagnosed on average
3.52 years later than non-aggressive basal cell carcinomas. Sclerodermiform
basal cell carcinomas were diagnosed 3.40 years and 2.34 years later than
non-aggressive basal cell carcinomas in younger and older patients
respectively (P=.002 and P=.03, respectively).Study limitationsretrospective design.ConclusionThe diagnostic accuracy and primary clinic conjecture of sclerodermiform
basal cell carcinomas is quite low compared to other forms of basal cell
carcinoma such as nodular, superficial and pigmented. The dermoscopic
vascular patterns, which is the basis for the diagnosis of non-melanocytic
nonpigmented skin tumors, may not be particularly useful in identifying
sclerodermiform basal cell carcinomas in early stages. As a distinct entity,
sclerodermiform basal cell carcinomas show a lack of early diagnosis
compared to less-aggressive subtypes of BCC, and thus, more accurate
diagnostic tools apart from dermatoscopy are required to reach the goal of
early-stage diagnosis of sclerodermiform basal cell carcinomas.