Novel Insights for Patients with Multiple Basal Cell Carcinomas and Tumors at High-Risk for Recurrence: Risk Factors, Clinical Morphology, and Dermatoscopy

SIMPLE SUMMARY: We investigated 225 patients with 304 primary basal cell carcinomas (BCCs) and we conducted a retrospective, morphological, cohort study aimed at evaluating patients’ demographics and tumors’ clinical and dermatoscopic characteristics. Our main objectives were the detection of risk factors for multiple BCCs in individual patients and the description of clinical and dermatoscopic features of low and high risk for local recurrence tumors. The rising incidence of BCC and the occurrence of multiple tumors in individual patients poses BCC as a major issue for health systems. To the best of our knowledge, this is one of the first studies to attempt to unveil clinical and dermatoscopic features of low-/high-risk neoplasms beyond histopathology and take into equal account parameters, such as anatomic location and size of the lesion. We strongly support that profiling of multiple patients with BCCs and a thorough knowledge of high-risk tumors’ clinico-dermatoscopic morphology could provide physicians with important information towards prevention of this neoplasm. ABSTRACT: Introduction: Basal cell carcinoma (BCC) quite frequently presents as multiple tumors in individual patients. Neoplasm’s risk factors for local recurrence have a critical impact on therapeutic management. Objective: To detect risk factors for multiple BCCs (mBCC) in individual patients and to describe clinical and dermatoscopic features of low- and high-risk tumors. Materials & Methods: Our study included 225 patients with 304 surgically excised primary BCCs. All patients’ medical history and demographics were recorded. Clinical and dermatoscopic images of BCCs were evaluated for predefined criteria and statistical analyses were performed. Results: Grade II-III sunburns before adulthood (OR 2.146, p = 0.031) and a personal history of BCC (OR 3.403, p < 0.001) were the major predisposing factors for mBCC. Clinically obvious white color (OR 3.168, p < 0.001) and dermatoscopic detection of white shiny lines (OR 2.085, p = 0.025) represented strongly prognostic variables of high-risk BCC. Similarly, extensive clinico-dermatoscopic ulceration (up to 9.2-fold) and nodular morphology (3.6-fold) raise the possibility for high-risk BCC. On the contrary, dermatoscopic evidence of blue-black coloration had a negative prognostic value for high-risk neoplasms (light OR 0.269, p < 0.001/partial OR 0.198, p = 0.001). Conclusions: Profiling of mBCC patients and a thorough knowledge of high-risk tumors’ clinico-dermatoscopic morphology could provide physicians with important information towards prevention of this neoplasm.