This article is more than 5 years old. Information may no longer be current.
BCC on lip found slightly more common among women than men
Click Here to Manage Email Alerts
By a 1.2:1 ratio, women developed basal cell carcinoma on their upper lip — requiring Mohs micrographic surgery — slightly more often than did men, although the difference was smaller than previously reported, according to study results.
Researchers at the Warren Alpert School of Medicine, Brown University, performed a chart review of basal cell carcinoma (BCC) cases from 2005 to 2011 to evaluate 275 patients (mean age, 72.3 years for men; 69.2 years for women; 55% women) with lesions located on the upper lip. Defect size was larger, both initially (P<.01) and in final size (P=.03), for men. Larger initial and final area (both P<.01) were related to infiltrative tumors “but were not associated with a significant difference in the number of Mohs layers required for clearance,” according to the researchers.
Approximately 10% of tumors treated in the study had recurred after previous treatment. Larger initial tumor size was associated with recurrent lesions (P<.001) and older age (P=.03). Following Mohs procedures, surgeons used a local flap or graft in 44% of repairs. Thirteen percent of patients — with men and women likely opting equally (P=.08) — elected to have repair by plastic surgery, “reflecting heightened levels of cosmetic concern,” the researchers reported.
“Unlike prior findings … this study suggests that BCC of the upper lip occurs with nearly equal predominance in men and women,” the researchers concluded. “This is in contrast to previous reports of female predominance, ranging upwards of 3.5:1 in a Canadian population and 2:1 in a Brazilian population. … Elderly patients were also more likely to have a larger initial lesion size. These findings may suggest the need for increased screening efforts … to aid in early detection of primary lesions in the elderly population.
“These findings suggest that [Mohs micrographic surgery] is important in delineating subclinical tumor spread and providing complex repairs.”
Perspective
Back to Top
Joseph F. Sobanko, MD
The recent Dermatologic Surgery articles addressing basal cell carcinoma (BCC) of the upper lip and squamous cell carcinoma in situ (SCCIS) of the ear are retrospective studies from a single academic institution in the Northeastern United States. While the design and cohort are significant limitations of the studies, many of the findings support much of what we already know about nonmelanoma skin cancers:
* Recurrent nonmelanoma skin cancers are more challenging to extirpate and the resultant defects are more challenging to reconstruct.
* Primary and recurrent nonmelanoma skin cancers of the head and neck frequently demonstrate subclinical spread.
* Mohs surgery addresses the above challenges by providing precise microscopic margin control while also sparing tissue in these cosmetically sensitive areas.
Additionally, the data by Lee et al reveal unique epidemiological trends. The group reports a male preponderance of SCC is on the ear while the male:female ratio of upper lip BCCs is closer to 1 to 1. While these findings are interesting, the aforementioned study flaws limit their applicability and further research into these trends is warranted.
There is an epidemic of skin cancer in the United States with nonmelanoma and melanoma skin cancer increasing at staggering rates. Studies such as these allow for physicians and researchers to better understand patient and tumor risk factors so that tumors may be detected earlier and treatment outcomes may be improved. It is imperative that patients understand the risk factors for skin cancer development. Additionally, those patients susceptible to skin cancer must be counseled on early detection strategies and the importance of skin cancer screenings by skilled health professionals.
Finally, if detected, skin cancer should be treated in a manner that ensures complete extirpation as recurrent tumors introduce a greater risk of cosmetic disfigurement and/or distant metastasis.
Click Here to Manage Email Alerts