JAMA Dermatology

<jats:sec id="ab-doi250045-4"><jats:title>Importance</jats:title><jats:p>Nicotinamide supplementation has been studied as a chemopreventive medication for reducing skin cancer risk, but large-scale data are limited.</jats:p></jats:sec><jats:sec id="ab-doi250045-5"><jats:title>Objective</jats:title><jats:p>To determine the clinical efficacy of nicotinamide supplementation for skin cancer prevention in the general population and among solid organ transplant recipients.</jats:p></jats:sec><jats:sec id="ab-doi250045-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>A retrospective cohort study was conducted using electronic health record data (October 1, 1999, to December 31, 2024) from the Veterans Affairs Corporate Data Warehouse (CDW) of 33 822 patients. Analyses were conducted from January 17, 2025, to May 9, 2025. Patients who were exposed to nicotinamide were propensity score matched based on the number and year of skin cancers after which treatment with nicotinamide was initiated, age, sex, self-reported race, exposure to acitretin, exposure to field therapy, history of chronic lymphocytic leukemia, and history of solid organ transplant. The index date was the first prescription of nicotinamide filled within the VA system. Stratified Cox models were used to investigate the association of nicotinamide with skin cancer development.</jats:p></jats:sec><jats:sec id="ab-doi250045-7"><jats:title>Exposures</jats:title><jats:p>Nicotinamide, 500 mg, twice daily for longer than 30 days as documented in the electronic health record.</jats:p></jats:sec><jats:sec id="ab-doi250045-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Time to the next skin cancer after baseline.</jats:p></jats:sec><jats:sec id="ab-doi250045-9"><jats:title>Results</jats:title><jats:p>There were 12 287 patients (mean [SD] age, 77.2 [8.9] years; 241 women [2.0%]; 31 [0.3%] American Indian or Alaska Native, 3 [&amp;amp;lt;0.1%] Asian, 13 [0.1%] Black or African American, 59 [0.5%] Native Hawaiian or other Pacific Islander, and 11 662 [94.9%] White individuals) exposed to oral nicotinamide, 500 mg, twice daily for longer than 30 days who were matched to 21 479 unexposed patients (mean [SD] age, 76.9 [8.7] years; 374 women [2.0%]; 49 [0.2%] American Indian or Alaska Native, 3 [&amp;amp;lt;0.1%] Asian, 16 [0.1%] Black or African American, 88 [0.4%] Native Hawaiian or other Pacific Islander, and 20 517 [95.3%] White individuals). Within the matched dataset, there were 10 994 instances of basal cell carcinoma after nicotinamide exposure and 12 551 cutaneous squamous cell carcinoma (cSCC). A total of 1334 (3.9%) in the matched cohort were solid organ transplant recipients. Overall, there was a significant 14% reduction in skin cancer risk. When nicotinamide was initiated after a first skin cancer, the risk reduction rose to 54%, although this benefit declined with initiation following subsequent skin cancers. This risk reduction was seen for skin cancers overall, basal cell carcinoma, and cSCC, with the greatest risk reduction seen for cSCC. Among solid organ transplant recipients, no overall significant risk reduction was observed, although early nicotinamide use was associated with reduced cSCC incidence.</jats:p></jats:sec><jats:sec id="ab-doi250045-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>The results of this cohort study suggest that there is a decreased risk of skin cancer among patients treated with nicotinamide, with the greatest effect seen when initiated after the first skin cancer.</jats:p></jats:sec>

Nicotinamide for keratinocyte carcinoma chemoprevention: a nationwide survey of Mohs surgeons.

Dermatol Surg

A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention.

N Engl J Med

Nicotinamide for skin-cancer chemoprevention in transplant recipients.

Nicotinamide for skin-cancer chemoprevention in transplantation.

Nicotinamide for secondary keratinocyte carcinoma prevention in solid organ transplant recipients.

Arch Dermatol Res

Frequency and timing of multiple skin cancer development in five cohorts.

J Am Acad Dermatol

Risk of major adverse cardiovascular events following nicotinamide exposure.

JAMA Dermatol

Validity of using billing codes from electronic health records to estimate skin cancer counts.

New primary nonmelanoma skin cancer in patients with a history of squamous cell carcinoma of the skin: implications and recommendations for follow-up.

Duration of acceptable delay between the time of diagnosis and treatment of melanoma, cutaneous squamous cell carcinoma and basal cell carcinoma.

J Eur Acad Dermatol Venereol

Development of phenotyping algorithms for the identification of organ transplant recipients: cohort study.

JMIR Med Inform

Effect of nicotinamide in skin cancer and actinic keratoses chemoprophylaxis, and adverse effects related to nicotinamide: a systematic review and meta-analysis.

J Cutan Med Surg

A bioluminescent-based probe for in vivo non-invasive monitoring of nicotinamide riboside uptake reveals a link between metastasis and NAD+ metabolism.

Biosens Bioelectron

Sirolimus and secondary skin-cancer prevention in kidney transplantation.

Differences in skin cancer rates by transplanted organ type and patient age after organ transplant in White patients.

Risks of multiple skin cancers in organ transplant recipients: a cohort study in 2 administrative data sets.

Timing of subsequent new tumors in patients who present with basal cell carcinoma or cutaneous squamous cell carcinoma.

Consensus-based recommendations on the prevention of squamous cell carcinoma in solid organ transplant recipients: a Delphi consensus statement.

A phase II randomized controlled trial of nicotinamide for skin cancer chemoprevention in renal transplant recipients.

Br J Dermatol

Chemoprevention of basal and squamous cell carcinoma with a single course of fluorouracil, 5%, cream: a randomized clinical trial.

Tolerability of high-dose topical tretinoin: the Veterans Affairs Topical Tretinoin Chemoprevention Trial.

Skin cancer in the military: a systematic review of melanoma and nonmelanoma skin cancer incidence, prevention, and screening among active duty and veteran personnel.

Skin cancer risk factors and preventative behaviors among United States military veterans deployed to Iraq and Afghanistan.

J Invest Dermatol

Nicotinamide supplementation has been studied as a chemopreventive medication for reducing skin cancer risk, but large-scale data are limited.
To determine the clinical efficacy of nicotinamide supplementation for skin cancer prevention in the general population and among solid organ transplant recipients.
A retrospective cohort study was conducted using electronic health record data (October 1, 1999, to December 31, 2024) from the Veterans Affairs Corporate Data Warehouse (CDW) of 33 822 patients. Analyses were conducted from January 17, 2025, to May 9, 2025. Patients who were exposed to nicotinamide were propensity score matched based on the number and year of skin cancers after which treatment with nicotinamide was initiated, age, sex, self-reported race, exposure to acitretin, exposure to field therapy, history of chronic lymphocytic leukemia, and history of solid organ transplant. The index date was the first prescription of nicotinamide filled within the VA system. Stratified Cox models were used to investigate the association of nicotinamide with skin cancer development.
Nicotinamide, 500 mg, twice daily for longer than 30 days as documented in the electronic health record.
Time to the next skin cancer after baseline.
There were 12 287 patients (mean [SD] age, 77.2 [8.9] years; 241 women [2.0%]; 31 [0.3%] American Indian or Alaska Native, 3 [<0.1%] Asian, 13 [0.1%] Black or African American, 59 [0.5%] Native Hawaiian or other Pacific Islander, and 11 662 [94.9%] White individuals) exposed to oral nicotinamide, 500 mg, twice daily for longer than 30 days who were matched to 21 479 unexposed patients (mean [SD] age, 76.9 [8.7] years; 374 women [2.0%]; 49 [0.2%] American Indian or Alaska Native, 3 [<0.1%] Asian, 16 [0.1%] Black or African American, 88 [0.4%] Native Hawaiian or other Pacific Islander, and 20 517 [95.3%] White individuals). Within the matched dataset, there were 10 994 instances of basal cell carcinoma after nicotinamide exposure and 12 551 cutaneous squamous cell carcinoma (cSCC). A total of 1334 (3.9%) in the matched cohort were solid organ transplant recipients. Overall, there was a significant 14% reduction in skin cancer risk. When nicotinamide was initiated after a first skin cancer, the risk reduction rose to 54%, although this benefit declined with initiation following subsequent skin cancers. This risk reduction was seen for skin cancers overall, basal cell carcinoma, and cSCC, with the greatest risk reduction seen for cSCC. Among solid organ transplant recipients, no overall significant risk reduction was observed, although early nicotinamide use was associated with reduced cSCC incidence.
The results of this cohort study suggest that there is a decreased risk of skin cancer among patients treated with nicotinamide, with the greatest effect seen when initiated after the first skin cancer.

Nicotinamide for Skin Cancer Chemoprevention.

Nicotinamide for Skin Cancer Chemoprevention

<jats:sec id="ab-doi250017-4"><jats:title>Importance</jats:title><jats:p>Skin cancer is a significant public health threat in the aging population, yet data on its burden and trends are limited.</jats:p></jats:sec><jats:sec id="ab-doi250017-5"><jats:title>Objective</jats:title><jats:p>To evaluate the global burden of skin cancer among adults 65 years or older from 1990 to 2021, and to project its change to 2050.</jats:p></jats:sec><jats:sec id="ab-doi250017-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>In this observational study, population-based registry data were extracted from the Global Burden of Diseases (GBD) Study 2021. The database covers 204 countries and territories, ensuring global applicability of the results. Data analysis was conducted from June 9, 2024, to February 18, 2025.</jats:p></jats:sec><jats:sec id="ab-doi250017-7"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Age-standardized rates of prevalence, incidence, deaths, and disability-adjusted life-years (DALYs) were calculated per 100 000 population. Estimated rates of disease burden were calculated for 2050.</jats:p></jats:sec><jats:sec id="ab-doi250017-8"><jats:title>Results</jats:title><jats:p>A worldwide total of 153 993 melanoma, 1 463 424 squamous cell carcinoma (SCC), and 2 802 354 basal cell carcinoma (BCC) instances were estimated for 2021. SCC exhibited the highest age-standardized rate of prevalence (236.91 per 100 000 population; 95% uncertainty interval [UI], 188.23-303.82), deaths (6.16 per 100 000 population; 95% UI, 5.13-6.87), and DALYs (95.50 per 100 000 population; 95% UI, 81.65-106.39), whereas BCC displayed the highest incidence rate (371.97 per 100 000 population; 95% UI, 310.75-439.58). The disease burden was notably greater in male individuals than in female individuals. During the observation period, the global burden of skin cancer among older people demonstrated a general upward trend. Decomposition analysis indicated that population growth was the primary contributor to this increase. Health-inequality analysis revealed a disproportionately higher burden shouldered by countries with higher sociodemographic index (SDI) levels. Frontier analysis identified the countries with considerable potential to mitigate skin cancer. It was anticipated that only incidence and prevalence rates attributable to keratinocyte cancer (KC), along with DALYs rate related to BCC, would increase by 2050.</jats:p></jats:sec><jats:sec id="ab-doi250017-9"><jats:title>Conclusions and Relevance</jats:title><jats:p>The older population (particularly male individuals and those living in high-SDI countries) is facing a substantial growing burden of skin cancer. Despite the relative incompleteness of KC data and lack of race and ethnicity data, these results highlight the urgency for more effective prevention and management strategies targeting high-risk groups.</jats:p></jats:sec>

The global burden of skin cancer: a longitudinal analysis from the Global Burden of Disease Study, 1990-2017.

JAAD Int

United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019.

Financial worry in people with cancer: relationship to employment and outcomes.

Psychooncology

Effect of age on melanoma risk, prognosis and treatment response.

Acta Derm Venereol

Aging trends in skin cancer: a long-term observational study in Japan.

Skin cancer epidemics in the elderly as an emerging issue in geriatric oncology.

Aging Dis

Melanoma incidence increases in the elderly of Catalonia but not in the younger population: effect of prevention or consequence of immigration?

Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.

Lancet

Global burden of non-communicable diseases attributable to kidney dysfunction with projection into 2040.

Chin Med J (Engl)

The global burden of scabies: a cross-sectional analysis from the Global Burden of Disease Study 2015.

Lancet Infect Dis

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017.

Inj Prev

Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030.

Int J Surg

Global, regional, and national burden of CKD due to glomerulonephritis from 1990 to 2019: a systematic analysis from the Global Burden of Disease Study 2019.

Clin J Am Soc Nephrol

Global, regional, and national burdens of HIV and other sexually transmitted infections in adolescents and young adults aged 10-24 years from 1990 to 2019: a trend analysis based on the Global Burden of Disease Study 2019.

Lancet Child Adolesc Health

Global, regional, and national burden of preterm birth, 1990-2021: a systematic analysis from the global burden of disease study 2021.

EClinicalMedicine

The global, regional, and national patterns of change in the burden of congenital birth defects, 1990-2021: an analysis of the global burden of disease study 2021 and forecast to 2040.

Global, regional, and national burden of cancers attributable to particulate matter pollution from 1990 to 2019 and projection to 2050: Worsening or improving?

J Hazard Mater

Revisiting Das Gupta: refinement and extension of standardization and decomposition.

Demography

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the Global Burden of Disease Study.

JAMA Oncol

Promoting health equity: WHO health inequality monitoring at global and national levels.

Glob Health Action

The health equity measurement framework: a comprehensive model to measure social inequities in health.

Int J Equity Health

The global, regional, and national patterns of change in the burden of nonmalignant upper gastrointestinal diseases from 1990 to 2019 and the forecast for the next decade.

Global burden and cross-country inequalities in autoimmune diseases from 1990 to 2019.

Autoimmun Rev

Rheumatic heart disease burden, trends, and inequalities in the Americas, 1990-2017: a population-based study.

Lancet Glob Health

Calculating concentration index with repetitive values of indicators of economic welfare.

J Health Econ

Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016.

Kidney Int

Trends and projections of kidney cancer incidence at the global and national levels, 1990-2030: a Bayesian age-period-cohort modeling study.

Biomark Res

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.

Spatiotemporal trends of the global burden of melanoma in 204 countries and territories from 1990 to 2019: Results from the 2019 global burden of disease study.

Neoplasia

Trends in keratinocyte skin cancer incidence, mortality and burden of disease in 33 countries between 1990 and 2017.

Clinical implications of aging skin: cutaneous disorders in the elderly.

Am J Clin Dermatol

Sun protective behaviors among US racial and ethnic minorities with sun-sensitive skin.

Skin cancer: epidemiology, disease burden, pathophysiology, diagnosis, and therapeutic approaches.

Dermatol Ther (Heidelb)

Age-specific incidence of melanoma in the United States.

Cancer registration in China and its role in cancer prevention and control.

Lancet Oncol

Non-melanoma skin cancers in the older patient.

Curr Oncol Rep

Skin cancers and their risk factors in older persons: a population-based study.

BMC Geriatr

Analysis of prevalence, socioeconomic and disease trends of non-melanoma skin cancer in New Zealand from 2008 to 2022.

J Epidemiol Glob Health

Sex-based differences in melanoma survival improvement from 2004 to 2018.

Cancers (Basel)

Let’s talk about sex: a biological variable in immune response against melanoma.

Pigment Cell Melanoma Res

Estimated healthcare costs of melanoma and keratinocyte skin cancers in Australia and Aotearoa New Zealand in 2021.

Int J Environ Res Public Health

Sunburn, sunbeds and melanoma skin cancer: a story behind the statistics.

Clin Exp Dermatol

Basal cell carcinoma, squamous cell carcinoma and melanoma of the skin: analysis of the Singapore Cancer Registry data 1968-97.

Systemic therapy of metastatic melanoma: on the road to cure.

Oncology (Williston Park)

Combining immunotherapy with oncogene-targeted therapy: a new road for melanoma treatment.

Front Immunol

European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2024.

Eur J Cancer

Mortality from nonmelanoma skin cancer in Australia from 1971 to 2021.

Development of a healthy ageing index in Latin American countries - a 10/66 dementia research group population-based study.

BMC Med Res Methodol

Age-related differences in tumour characteristics and prognostic factors for disease progression in cutaneous squamous cell carcinoma of the head and neck.

Systematic skin examination in an acute geriatric unit: skin cancer prevalence.

Skin cancer is a significant public health threat in the aging population, yet data on its burden and trends are limited.
To evaluate the global burden of skin cancer among adults 65 years or older from 1990 to 2021, and to project its change to 2050.
In this observational study, population-based registry data were extracted from the Global Burden of Diseases (GBD) Study 2021. The database covers 204 countries and territories, ensuring global applicability of the results. Data analysis was conducted from June 9, 2024, to February 18, 2025.
Age-standardized rates of prevalence, incidence, deaths, and disability-adjusted life-years (DALYs) were calculated per 100 000 population. Estimated rates of disease burden were calculated for 2050.
A worldwide total of 153 993 melanoma, 1 463 424 squamous cell carcinoma (SCC), and 2 802 354 basal cell carcinoma (BCC) instances were estimated for 2021. SCC exhibited the highest age-standardized rate of prevalence (236.91 per 100 000 population; 95% uncertainty interval [UI], 188.23-303.82), deaths (6.16 per 100 000 population; 95% UI, 5.13-6.87), and DALYs (95.50 per 100 000 population; 95% UI, 81.65-106.39), whereas BCC displayed the highest incidence rate (371.97 per 100 000 population; 95% UI, 310.75-439.58). The disease burden was notably greater in male individuals than in female individuals. During the observation period, the global burden of skin cancer among older people demonstrated a general upward trend. Decomposition analysis indicated that population growth was the primary contributor to this increase. Health-inequality analysis revealed a disproportionately higher burden shouldered by countries with higher sociodemographic index (SDI) levels. Frontier analysis identified the countries with considerable potential to mitigate skin cancer. It was anticipated that only incidence and prevalence rates attributable to keratinocyte cancer (KC), along with DALYs rate related to BCC, would increase by 2050.
The older population (particularly male individuals and those living in high-SDI countries) is facing a substantial growing burden of skin cancer. Despite the relative incompleteness of KC data and lack of race and ethnicity data, these results highlight the urgency for more effective prevention and management strategies targeting high-risk groups.

Burden of Skin Cancer in Older Adults From 1990 to 2021 and Modelled Projection to 2050.

Burden of Skin Cancer in Older Adults From 1990 to 2021 and Modelled Projection to 2050

Photodermatology, Photoimmunology &amp; Photomedicine

<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Several widely used drugs have photosensitizing properties, and much research has been conducted to find associations between their use and the risk of developing cutaneous malignant melanoma (cM), basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (cSCC), often with conflicting results.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To assess whether the use of commonly prescribed photosensitizing drugs increases skin cancer risk.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Analyses were performed using a large cohort of women, with prospectively collected information on phenotypic traits and sun exposure. Comprehensive information on pharmaceutical treatments and skin cancer occurrence was obtained through national registries. Drugs with photosensitizing properties were grouped according to the Anatomical Therapeutic Chemical system in nine groups, and associations between the use of such drugs were investigated using multivariable Cox regression analysis. The number of retrieved daily doses was analyzed to test the dose–response relationship.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Hormone replacement therapy significantly increased the risk of BCC (hazard ratio [HR] 1.24; 95% confidence interval [CI]: 1.11–1.39), cSCC (HR 1.23; 95% CI: 1.03–1.47) and cM (HR 1.31; 95% CI: 1.01–1.69), with estrogen driving this risk. There was a trend of increased risk of BCC and cM with higher doses of estrogen treatment. Subgroup analysis among those using diuretics showed that loop diuretics were associated with increased cSCC risk (HR 1.6; 95% CI: 1.3–2.0), including a positive association between risk and dose. Furthermore, increased risks of BCC (HR 1.25; 95% CI: 1.09–1.44) and cM (HR 1.41; 95% CI: 1.03–1.93) were associated with thiazide use. NSAIDs showed a possible curvilinear association to BCC and cSCC.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Estrogen treatment increased the risk of all investigated skin cancers. Among those using diuretics, loop diuretics increased the risk of cSCC, and thiazide use increased the risk of BCC. We suggest that physicians should advise female patients prescribed estrogen, thiazides, or loop diuretics to limit their sun exposure.</jats:p></jats:sec>

publication_history

received

accepted

published

Cancerfonden

HudFonden

Participation in a Prospective Cohort Study on Melanoma Did Not Affect the Incidence and Mortality of the Studied Disease

Acta Dermato‐Venereologica

Hormonal and Reproductive Factors and Incidence of Basal Cell Carcinoma and Squamous Cell Carcinoma in a Large, Prospective Cohort

Journal of the American Academy of Dermatology

Several widely used drugs have photosensitizing properties, and much research has been conducted to find associations between their use and the risk of developing cutaneous malignant melanoma (cM), basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (cSCC), often with conflicting results.
To assess whether the use of commonly prescribed photosensitizing drugs increases skin cancer risk.
Analyses were performed using a large cohort of women, with prospectively collected information on phenotypic traits and sun exposure. Comprehensive information on pharmaceutical treatments and skin cancer occurrence was obtained through national registries. Drugs with photosensitizing properties were grouped according to the Anatomical Therapeutic Chemical system in nine groups, and associations between the use of such drugs were investigated using multivariable Cox regression analysis. The number of retrieved daily doses was analyzed to test the dose-response relationship.
Hormone replacement therapy significantly increased the risk of BCC (hazard ratio [HR] 1.24; 95% confidence interval [CI]: 1.11-1.39), cSCC (HR 1.23; 95% CI: 1.03-1.47) and cM (HR 1.31; 95% CI: 1.01-1.69), with estrogen driving this risk. There was a trend of increased risk of BCC and cM with higher doses of estrogen treatment. Subgroup analysis among those using diuretics showed that loop diuretics were associated with increased cSCC risk (HR 1.6; 95% CI: 1.3-2.0), including a positive association between risk and dose. Furthermore, increased risks of BCC (HR 1.25; 95% CI: 1.09-1.44) and cM (HR 1.41; 95% CI: 1.03-1.93) were associated with thiazide use. NSAIDs showed a possible curvilinear association to BCC and cSCC.
Estrogen treatment increased the risk of all investigated skin cancers. Among those using diuretics, loop diuretics increased the risk of cSCC, and thiazide use increased the risk of BCC. We suggest that physicians should advise female patients prescribed estrogen, thiazides, or loop diuretics to limit their sun exposure.

Photosensitizing Drugs and Risk of Skin Cancer in Women-A Prospective Population-Based Study.

Photosensitizing Drugs and Risk of Skin Cancer in Women—A Prospective Population‐Based Study

Dermatology Practical &amp; Conceptual

<jats:p>Introduction: Being able to recognize high-risk facial basal cell carcinoma (BCC) may lead to fewer incomplete excisions and inappropriate treatments. Objectives: We sought to investigate clinical and dermoscopic criteria for predicting facial BCC subtypes, analyze the interobserver agreement between readers, and develop a diagnostic algorithm to predict high-risk histopathological subtype. Methods: In this single-center, retrospective investigation, 6 independent readers evaluated predefined clinical and dermoscopic criteria in images of histopathologically verified primary facial BCCs including: topography, border demarcation, vessels, ulceration, white porcelain areas, shiny white blotches and strands, and pigmented structures and vessels within ulceration. Results: Overall, 297 clinical and dermoscopic image pairs were analyzed. The strongest associations with high-risk subtype were: “bumpy” topography (OR 3.8, 95% CI, 3.1-4.7), ill-defined borders (OR 3.4, 95% CI 3.1-4.7), white porcelain area (OR 3.5, 95% CI 2.8-4.5), and vessels within ulceration (OR 3.1, 95% CI 2.4-4.1). Predominantly focused vessels were a positive diagnostic criterium for either nodular (OR 1.7, 95% CI 1.3-2.2) or high-risk (OR 2.0, 95% CI 1.6-2.5) subtypes and a strong negative diagnostic criterium for superficial BCC (OR 14.0, 95% CI 9.6-20.8). Interobserver agreement ranged from fair to substantial (κ=0.36 to 0.72). A diagnostic algorithm based on these findings demonstrated a sensitivity of 81.4% (95% CI, 78.9-83.7%) and a specificity of 53.3% (95% CI, 49.7-56.9%) for predicting high-risk BCC subtype. Conclusions: Integration of both clinical and dermoscopic features (including novel features such as topography and vessels within ulceration) are essential to improve subtype prediction of facial BCCs and management decisions.</jats:p>

Being able to recognize high-risk facial basal cell carcinoma (BCC) may lead to fewer incomplete excisions and inappropriate treatments.
We sought to investigate clinical and dermoscopic criteria for predicting facial BCC subtypes, analyze the interobserver agreement between readers, and develop a diagnostic algorithm to predict high-risk histopathological subtype.
In this single-center, retrospective investigation, 6 independent readers evaluated predefined clinical and dermoscopic criteria in images of histopathologically verified primary facial BCCs including: topography, border demarcation, vessels, ulceration, white porcelain areas, shiny white blotches and strands, and pigmented structures and vessels within ulceration.
Overall, 297 clinical and dermoscopic image pairs were analyzed. The strongest associations with high-risk subtype were: "bumpy" topography (OR 3.8, 95% CI, 3.1-4.7), ill-defined borders (OR 3.4, 95% CI 3.1-4.7), white porcelain area (OR 3.5, 95% CI 2.8-4.5), and vessels within ulceration (OR 3.1, 95% CI 2.4-4.1). Predominantly focused vessels were a positive diagnostic criterium for either nodular (OR 1.7, 95% CI 1.3-2.2) or high-risk (OR 2.0, 95% CI 1.6-2.5) subtypes and a strong negative diagnostic criterium for superficial BCC (OR 14.0, 95% CI 9.6-20.8). Interobserver agreement ranged from fair to substantial (κ = 0.36 to 0.72). A diagnostic algorithm based on these findings demonstrated a sensitivity of 81.4% (95% CI, 78.9-83.7%) and a specificity of 53.3% (95% CI, 49.7-56.9%) for predicting high-risk BCC subtype.
Integration of both clinical and dermoscopic features (including novel features such as topography and vessels within ulceration) are essential to improve subtype prediction of facial BCCs and management decisions.

Importance of Both Clinical and Dermoscopic Findings in Predicting High-Risk Histopathological Subtype in Facial Basal Cell Carcinomas.

Importance of Both Clinical and Dermoscopic Findings in Predicting High-Risk Histopathological Subtype in Facial Basal Cell Carcinomas

Papers