Basal cell carcinomas without histological confirmation and their treatment: an audit in four European regions

Abstract

SummaryBackground Limited data are available on how often basal cell carcinomas (BCCs) are clinically diagnosed without histological confirmation and how they are treated. Objectives Within the framework of the EPIDERM project, an audit was conducted in four European countries to study the occurrence of clinically diagnosed BCCs without histological confirmation and to investigate how these are treated. Methods In the Netherlands, Scotland, Finland and Malta studies were performed within different timeframes. Patients with one or more BCC(s) were selected and the number of clinically diagnosed BCCs without histological confirmation and their treatment was investigated by (manually) reviewing the (electronic) patient records and checking the (hospital) pathology databases to find evidence of histological confirmation. Results In the Netherlands, 1089 patients with a first histologically confirmed BCC developed 1974 BCCs of which 1833 (92AE9%) were histologically confirmed and 141 (7AE1%) were not. A 4-month retrospective study conducted in Scotland selected 294 patients with 344 BCCs; 306 (89AE0%) were histologically confirmed and 38 (11AE0%) were not. A 3-month prospective study performed at the same centre in Scotland identified 44 patients who developed 58 BCCs; 44 (75AE9%) of these were histologically confirmed and 14 (24AE1%) were not. In Finland, there were 701 patients who developed 977 BCCs, of which 807 (82AE6%) were histologically and 170 (17AE4%) nonhistologically confirmed. In Malta, there were 420 patients with 477 BCCs. Only three (0AE7%) of them were clinically diagnosed without histological confirmation. In the Netherlands and Finland, clinically diagnosed BCCs without histological confirmation were most often treated with cryotherapy, whereas in Scotland 5% imiquimod cream was the preferred treatment modality. Conclusions Although the frequency of clinically diagnosed BCCs without histological confirmation differed between the four European regions (range 0AE7-24AE1%), this confirms that the burden of BCC in Europe is underestimated when based on data from pathology and ⁄or cancer registries.

Risk of subsequent cutaneous malignancy in patients with prior melanoma: a systematic review and meta‐analysis

“…This problem is almost non‐existent for melanoma and SCC, because these cutaneous malignancies have a higher metastatic potential than BCC and are usually surgically treated and histologically confirmed. A recent European study observed that only 0.7–24.1% of the subsequent BCCs in patients with a prior BCC were clinically diagnosed, indicating that the degree of underestimation of our data is relatively limited, but country‐specific . The risk estimate proportion was the most frequently reported estimate in the literature describing risks of subsequent cutaneous malignancies, but has the disadvantage that it does not control for the background incidence in the general population and it is not time‐specific nor does it account for the competing risk ‘death’.…”

“…13 The pooled risk estimates presented for a BCC after a melanoma are probably underestimated, because some BCCs may be diagnosed clinically without histological confirmation. 42 This problem is almost non-existent for melanoma and SCC, because these cutaneous malignancies have a higher metastatic potential than BCC and are usually surgically treated and histologically confirmed. A recent European study observed that only 0.7-24.1% of the subsequent BCCs in patients with a prior BCC were clinically diagnosed, indicating that the degree of underestimation of our data is relatively limited, but country-specific.…”

Mohs micrographic surgery for basal cell carcinoma: evaluation of the indication criteria and predictive factors for extensive subclinical spread

“…4 Surgery is still considered the first-line treatment in different European countries, and 57-87% of all BCCs are still treated by standard excision (SE). [5][6][7][8] In the current observational literature, 5-year recurrence rates for Mohs micrographic surgery (MMS) are reported to be 1Á0-6Á5% for primary BCC and 4Á0-10Á0% for recurrent tumours. 9-15 A large, 10-year followup randomized controlled trial of high-risk facial BCCs showed a difference of 7Á8% for primary and 9Á6% for recurrent BCCs in favour of MMS over SE, although only the latter reached statistical significance.…”

Epidemiology of basal cell carcinoma in the United Kingdom: incidence, lifestyle factors, and comorbidities

“…Nevertheless, it is often omitted from official cancer statistics, as little is known about the true extent of the disease. Cancer registries, if at all, only include histologically confirmed tumours and do not take into account the substantial proportion of BCCs diagnosed clinically without histology (Flohil et al , 2012). …”